Dr. Nick van Terheyden aka Dr. Nick
Host of News You Can Use
LinkedIn: Nick van Terheyden, MD
X: @drnic1
As I wrap up this six-part series in this week’s special edition of “News You Can Use” on Healthcare NOW Radio I sat down with Adam Russo, CEO and Co-Founder of the Phia Group. In our last episode in the series, we reviewed the past episode topics and provided some updates and actionable things for everyone to take away.
Listen to the Conversation
How the System Profits From Your Ignorance
I’m struck by a recurring theme that’s emerged from our conversations: the healthcare system isn’t broken by accident, Healthcare is designed to keep us confused and compliant. We’ve covered everything from mobilizing workforces with cash rewards for finding billing errors, to the PBM trap, to fiduciary duties and surprise billing. But what’s become crystal clear is that the system thrives on our ignorance. As I discussed this with Adam, he suggested people are lazy, and I pushed back, suggesting this was more fear-related. What we both agreed was that we’ve been conditioned to accept whatever we’re told by doctors, brokers, and insurance companies without question. The reality is that 98% of procedures and surgeries are planned, yet most of us spend more time researching a new television than we do finding the right doctor or questioning a prescription.
What’s particularly troubling is how the entire supply chain is vertically integrated in ways that work against us. Hospital systems own physician practices, radiology groups, and anesthesia groups. All technically in “different industries” according to antitrust law, but functionally creating a closed loop that drives prices up. The PBMs we discussed started with good intentions but have become Kafkaesque cost-control mechanisms that ultimately enrich the same parent companies that own the pharmaceutical manufacturers. Adam’s example of the Nantucket hospital being purchased by a larger system, leading to unnecessary $45,000 medevac flights, illustrates this perfectly. We’re seeing a “TikTok world” where 30-second soundbites and AI-driven search results (that may be biased by who’s paying for placement) are replacing genuine education and due diligence.
But here’s the good news:
There is a path forward, and it starts with us
Adam’s own company proved that when you offer healthcare for free, engage employees transparently, and share both what’s working and what isn’t, you see better retention, better health outcomes, and more productive employees. The key is education and transparency and understanding that doctors aren’t aware of your copays or what’s covered, and that you have the right to ask questions about generics, out-of-network providers, and billing accuracy.
We need to stop being passive victims and start demanding to see how our healthcare dollars are being spent. As Adam powerfully shared, the woman crying on the phone wasn’t afraid of her cancer treatment, she was terrified of not being able to pay her medical bills.
We’re better than this. It’s time to get involved, ask questions, and demand the transparency we deserve.
Until next week, keep solving healthcare’s mysteries before they become your emergencies.
This article was originally published on the Dr. Nick – The Incrementalist blog and is republished here with permission.
About the Show
News You Can Use gives you a quick insight into the latest news, twists, turns and debacles going on in healthcare with Dr. Nick and Dr. Craig and where every diagnosis comes with a side of side-splitting humor. Your hosts are Dr Nick a long-time host, innovator and healthcare wizard who can prescribe a digital dose of innovation to cure even the most ailing operational inefficiencies. And Dr. Craig Joseph is the healthcare guru who can diagnose both patient and software glitches with equal precision, making sure hospitals run smoother than a well-oiled robot doc.
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