Relentless Health Value

Attorney Doug Aldean joins Stacey Richter to discuss how brokers and employee benefit consultants (EBCs) engage in rent-seeking payment models that harm self-insured health plans. The conversation covers three main categories of problematic compensation: direct overcharges, rent-seeking solution recommendations, and undisclosed vendor payments. A six-step roadmap is offered for plan sponsors to evaluate and protect themselves from these practices.

This episode explores the deep tension in value-based care between providing fair payment for clinical complexity and creating perverse incentives for upcoding, cherry-picking, and lemon-dropping. Hosts and guests Dr. Siva and Dr. Monica Lypson argue that physicians cannot fairly take on risk without transparent cost data, and that risk-scoring patients must be handled by neutral third parties rather than biased stakeholders. The conversation ultimately lands on whole-person health and detached arbiters of patient complexity as potential paths forward.