EP442: A Short Rumination on Saving Money, Except Not Saving Money. Oncology Side Effect Management as a Case Study, With Andreas Mang

The number one cause of hospital readmissions during chemotherapy is dehydration — which is treatable with a simple, inexpensive anti-nausea medication. Stacey Richter plays an outtake from her earlier conversation with Andreas Mang of Blackstone's Equity Healthcare and then works through four ruminations sparked by it: why PBMs restricting nausea meds to save a few dollars can quietly generate thousands in downstream medical costs, and why fee-for-service so often fails to pay for the very side-effect management that keeps patients out of the ER in the first place.

WHAT YOU'LL LEARN

✅ Why the total cost of care — PBM spend and medical spend combined — is the only number that actually reveals whether a "savings" is real or just cost shifted somewhere else

✅ Why a value-based purchasing mindset, rather than a pure cost-containment mindset, is often what's actually cheaper once downstream costs are counted

✅ Why some oncology centers do integrative oncology and proactive side-effect management for real, while others don't — and why payers and employers should be asking which is which

✅ Why fee-for-service so often fails to pay for proactive side-effect management, rewarding providers for reacting to a crisis rather than preventing one

✅ Why studies have shown that managing chemo side effects properly can both save money and meaningfully extend patient survival time

WHY THIS MATTERS

A PBM that restricts a $5-to-$1,430-a-month nausea medication can save itself a little money while driving thousands of dollars in downstream ER and readmission costs — and unless someone is aggregating PBM and medical data into one total-cost-of-care view, that trade gets recorded as a win instead of the loss it actually is. This dynamic isn't unique to oncology; it's a pattern that shows up anywhere cost containment is measured in a silo instead of against total spend. For employers and plan sponsors, the fix starts with insisting on aggregated data and asking pointed questions about how providers and payers are actually managing (or not managing) the proactive, less flashy work that keeps patients out of the hospital.

MENTIONED IN THIS EPISODE

EP157 with Ethan Basch, MD: Apple Podcasts | Spotify | Other Apps

EP435 with Dan Mendelson: Apple Podcasts | Spotify | Other Apps

Encore! EP372 with Cora Opsahl: Apple Podcasts | Spotify | Other Apps

EP331 with Al Lewis: Apple Podcasts | Spotify | Other Apps

EP370 with Erik Davis and Autumn Yongchu: Apple Podcasts | Spotify | Other Apps

=== LINKS ===

🔗 Show Notes with all mentioned links: Episode Page

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00:00 Introduction.

01:12 Andreas Mang on oncology medication side effect management.

03:12 Mark Lewis, MD's Tweet.

03:39 Celena Latham's response.

04:22 How integrative oncology can save money and what it looks like.

04:47 EP157 with Ethan Basch, MD.

06:20 Why PBMs saving money doesn't necessarily mean savings for employers and payers.

07:36 EP435 with Dan Mendelson.

08:20 Encore! EP372 with Cora Opsahl.

08:40 EP331 with Al Lewis.

09:50 Stacey's second rumination.

10:19 Why having a value mindset when purchasing is a thing.

10:42 Stacey's third rumination.

12:03 EP370 with Erik Davis and Autumn Yongchu.

13:07 Why FFS does not pay or pay adequately for side effect management.

14:31 Stacey's final rumination.

17:08 Summarizing Stacey's four ruminations on this topic.