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Relentless Health Value

Relentless Health Value

By: Stacey Richter
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 American Healthcare Entrepreneurs and Execs you might want to know. Talking. Relentless Health Value is a weekly interview podcast hosted by Stacey Richter, a healthcare entrepreneur celebrating fifteen years in the business side of healthcare. This show is for leaders in pharma, devices, payers, providers, patient advocacy and healthcare business. It's for health industry innovators, entrepreneurs or wantrepreneurs or intrapreneurs. Relentless Healthcare Value is the show for you if you want to connect with others trying to manage the triple play: to provide healthcare value while being personally and professionally fulfilled.©BD Bridges LLC, All Rights Reserved. Hygiene & Healthy Living Physical Illness & Disease Politics & Government
Episodes
  • Take Two: EP445: What Does It Take for an Indie Primary Care Practice to Survive Right Now? With Tom X. Lee, MD

    Take Two: EP445: What Does It Take for an Indie Primary Care Practice to Survive Right Now? With Tom X. Lee, MD
    Jul 17 2025
    Let’s take a second listen to this interview with Dr. Tom Lee that originally aired last summer but listen to it this time within the context first of how primary care can or should reduce ER visits and also downstream specialty spend et cetera, which is one of the through lines that I, along with you lot, have been exploring a lot this past year. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. And much of this conversation is about how primary care can survive in these unfavorable times where CMS (Centers for Medicare & Medicaid Services) and commercial carriers complain about the rates that they have to pay consolidated entities with market power, consolidated health systems, but then they actively underpay indie practices. That is very illogical, I’d say, at a fundamental level. It’s not tricky math. Do not force out of business your potential best partners and then wonder why you have so few of them left. Dan O’Neill was talking about this on LinkedIn the other day. So, that is one context to kind of listen to: How does primary care survive? But then also listen to this show in the context of my latest tear, which is this mission versus margin tear. Some of the same themes come up as in the show with, for example, Ben Schwartz, MD, MBA, from last week (EP481). How do you ensure that if you want to achieve scale, and you can only achieve scale when you take professional capital from private equity or VCs (venture capital) or even a consolidated health system with a venture fund or an innovation studio, how do you take their money but not wind up with some board member sitting at the conference room table talking about a mission like, you know, Jeff Bezos’s where he said, “My mission is other people’s margin”? How do you tow that line? Rushika Fernandopulle, MD, talked about this a little bit, too—that you need money to scale but, once you get money, it’s easy for mission to get kicked off the bus. Today I am talking with Tom X. Lee, MD, who has a long history in primary care. He founded One Medical and then also, most recently, Galileo. Dr. Lee also was a founder at Epocrates (tossing that in for context). I wanted to talk with Dr. Lee because so many RHV (Relentless Health Value) listeners are trying to figure out how to sustain primary care as a stand-alone entity when most primary care docs these days are employees of health systems. And that makes sense because these days, the most obvious and most common way to make enough money in primary care is to drive and maximize the dollars from downstream volume of high-priced service lines, which, if you think about it, undermines the entire point of primary care but is also a really good motivation for a consolidated health system to purchase all of the primary care docs in the area. I’m starting to call this the paradox of primary care because when you begin seeing the promise of primary care have to erode if you’re gonna stay in the business of primary care, then yeah, it’s sort of a paradox. Said another way, if you do primary care really well and use evidence-based preventative care to curb the need for excess specialty care (ie, you reduce specialty revenue through primary care), now you’re asking specialty (high-profit health system service lines, that is) to not only make less money but use the remaining money to pay for primary care, which is the entity that is reducing its revenue. So, again, I am hereby coining the term the paradox of primary care to express the conundrum for why a consolidated entity that knows where its bread is buttered is going to do much, if anything, to empower primary care with the technology and the staff and the time, which, if it goes well, is going to cannibalize its own major source of revenue. Meanwhile, if you choose not to participate in this paradox within the context of a consolidated entity, it’s kinda hard to stand up a pure play primary care practice. And I’ve heard this so many times, most recently from Paul Buehrens, MD, who said, he wrote on LinkedIn, “My own primary care clinic lasted independent from 1946-2017, and when costs were rising faster than reimbursement with no alternatives available, we sought out purchase by our hospital, giving up on trying to stay independent. … Consolidation is not driven by bad actors nor by quality nor volume savings, but by the bizarre economics of healthcare as a highly regulated but hardly rational market.” I simply don’t get why knowing as much as we know about the importance of primary care, CMS and others continue to follow RUC (Relative Value Scale Update Committee) guidance on PCP (primary care provider) rates. How much power must be wielded by the AMA (American Medical Association) or the AHA (American Hospital Association) or who knows? I don’t know the half of it, admittedly. Listen to episode ...
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    46 mins
  • Bonus Add-on to Take Two: EP445: Dr. Tom Lee Talks About Why Retail Clinics Are Not Doing So Well, in His Opinion

    Bonus Add-on to Take Two: EP445: Dr. Tom Lee Talks About Why Retail Clinics Are Not Doing So Well, in His Opinion
    Jul 17 2025
    I clipped out this five-minute sort of sidebar conversation with Tom X. Lee, MD, when I was speaking with him last summer that I thought you might be interested in listening to by itself, because it is a bit of a, like I said, a sort of a tangent. For a full transcript of this episode, click here. If you enjoy this podcast, be sure to subscribe to the free weekly newsletter to be a member of the Relentless Tribe. And again, given all of the conversations that we’ve been having lately about trust and mission and margin, I think the points that Dr. Tom Lee makes in the conversation are all the more relevant. Also mentioned in this episode are Galileo and Tom Nash. You can learn more at Galileo and follow Dr. Lee on LinkedIn. Tom X. Lee, MD, is the CEO and visionary behind Galileo—a data-driven, multispecialty care model designed to improve quality and reduce total cost of care. Operating across 50 states and partnered with large employers and health plans, Galileo is one of the fastest-growing innovators in care delivery. Prior to Galileo, Tom helped build One Medical into the leading, independent primary care system in the country. And previously, he helped launch Epocrates, the #1 mobile app used by clinicians at the point of care. Tom is a board-certified internist who completed training at Harvard’s Brigham and Women’s Hospital. He received his bachelor’s degree from Yale University, an MD from the University of Washington School of Medicine, and an MBA from Stanford University’s Graduate School of Business. 01:01 Why have retail clinics failed in being longitudinal primary care destinations? 01:32 Why access is an important factor, but not the only one. 02:10 Access vs. longitudinal care. 02:47 The challenges of operating a service operation within primary care. 03:47 What is a longitudinal primary care destination and why does it matter? 04:15 How is primary care not delivering on its promise? 04:27 How is the “promise of primary care” different than an urgent care or MinuteClinic? You can learn more at Galileo and follow Dr. Lee on LinkedIn. Tom X. Lee of @galileomedical discusses #retailclinics on our #healthcarepodcast. #healthcare #podcast #financialhealth #patientoutcomes #primarycare #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation Recent past interviews: Click a guest’s name for their latest RHV episode! Dr Benjamin Schwartz, Dr John Lee (Take Two: EP438), Kimberly Carleson, Ann Lewandowski (Summer Shorts), Andreas Mang and Jon Camire (EP479), Justin Leader (Take Two: EP433), Andreas Mang and Jon Camire (EP478), Stacey Richter (EP477), Charles Green (Bonus Episode), Ann Lewandowski, Peter Hayes
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    7 mins
  • EP481: Seriously, IRL, What Does “No Margin, No Mission” Even Mean? With Benjamin Schwartz, MD, MBA

    EP481: Seriously, IRL, What Does “No Margin, No Mission” Even Mean? With Benjamin Schwartz, MD, MBA
    Jul 10 2025

    Balancing Mission and Margin in Healthcare: A Candid Conversation with Dr. Ben Schwartz

    In this episode, host Stacey Richter engages in a deep dive with Dr. Ben Schwartz to explore the phrase 'No Margin, No Mission' and its practical implications in the healthcare industry.

    They discuss the complex relationship between profitability and mission-driven care, the challenges of value-based care, and the role of dyad leadership. The episode emphasizes the importance of transparency, regulatory measures, and trust in fostering a balance between mission and margin. Along the way, Dr. Schwartz shares insights from his new role at Commons Clinic and addresses broader systemic issues like regulatory capture and the subjective nature of defining value in healthcare.

    === LINKS ===
    🔗 Show Notes with all mentioned links:
    https://relentlesshealthvalue.com/episodes

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    🎤 Listen on Apple Podcasts https://podcasts.apple.com/us/podcast/feed/id892082003?ls=1

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    📺 Subscribe to our YouTube channel https://www.youtube.com/@RelentlessHealthValue

    === CONNECT WITH THE RHV TEAM ===
    ✭ LinkedIn https://www.linkedin.com/company/relentless-health-value/
    ✭ Threads https://www.threads.net/@relentlesshealthvalue/
    ✭ Bluesky https://bsky.app/profile/relentleshealth.bsky.social
    ✭ X https://twitter.com/relentleshealth/

    08:50 Sister Irene Kraus and the origin of no margin, no mission.

    10:01 Margin and mission versus profit and profiteering.

    12:45 Stacey’s manifesto (EP400).

    13:01 What is the broad mission within healthcare?

    14:12 What is mission drift within healthcare?

    15:54 EP474 with Yashaswini Singh, PhD.

    17:26 Why do we struggle with balancing margin and mission?

    20:47 EP455 with Beau Raymond, MD.

    20:52 How does value vary?

    23:18 EP326 with Rishi Wadhera, MD, MPP.

    23:53 What needs to happen to balance margin with mission?

    28:29 Why does everything come down to trust?

    28:33 EP391 with Scott Conard, MD.

    30:30 EP419 with Andreas Mang.

    32:21 What are the “vectors of change” to create balance between mission and margin?

    32:43 EP475 with Peter Hayes.
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    34 mins

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