Let’s talk PBM’s.

What even is a P-B-M? Pharmacy benefit managers have been around since the 1960’s, although back then, they were basically claims processors. Things changed in the 80’s and 90’s following the first iteration of ERISA when employers saw PBMs as potential cost containment strategies. The industry continued to explode until 2007 when CVS acquired Caremark, and now the market is really consolidated into just three major players.

Why does this matter? Well, PBMs control just about everything drug-related in the US these days, and that includes the cost. Given that we have not seen the promised drop in drug prices, Americans and employers are still bearing the burden of this bloated and broken system.

To unpack how this works and what folks are doing about it, we invited back Shawn Gremminger, the President and CEO of the National Alliance of Healthcare Purchaser Coalitions. His organization works with regional coalitions of employers to help them advance health policy, leverage their collective power, and drive market change.

Ambulatory Surgical Centers (ASCs) have been around in concept for the past fifty years, but their recent explosion has caught the attention of healthcare systems and, frankly, patients. Why?

Today’s guest, Adnan Qureshi, is a Managing Director with the Mergers and Acquisitions practice at Kaufman Hall. He provides strategic advisory services for healthcare providers and investors around the merger or acquisition of ASCs. The benefit he’s seen in partnership with his clients perhaps explains the answer to this question.

The “DNA”, as Adnan puts it, of the ASC is rooted in independent physicians who, as an extension of their practice, saw the benefit of doing lower acuity surgeries in an outpatient setting. As pain management and technology improved over time, the use case also evolved to the point where there are now few specialty areas where uncomplicated surgeries cannot be performed in an ASC. Without the overhead and operating costs of a hospital, ASCs allow for far more transparent pricing, lower costs, greater efficiency, and often better outcomes, all driving towards higher patient satisfaction. And that’s a win we should all be paying attention to.

Adnan Qureshi has over fifteen years of healthcare transaction experience. Prior to joining Kaufman Hall, he was a Director of Development at SCA Health, a subsidiary of Optum/UnitedHealth Group. In that role, Mr. Qureshi led market entry strategy across several geographies, and sourced, structured, and executed ambulatory surgery center acquisitions.

We’ve been talking a lot about healthspan and longevity in our recent episodes, but how do we get there? What changes would it take in the way we practice medicine to move towards a system that helps maintain wellness instead of a system that diagnoses and manages disease?

This is the fundamental challenge that our guest today and her company, Radence, are tackling. Dr. Julie Chen is the Chief Medical Officer at Radence. An integrative internal medicine physician, she and her colleagues at Radence are working to develop a data-backed model of healthcare that identifies the precursors to problems, allowing for proactive intervention and, in many cases, prevention.

As Dr. Chen says, it will take awhile to amass the data needed to show that spending these resources when a person is well ultimately results in greater health, lower spend, and better longevity, but we have to start somewhere.

Dr. Chen is not just a practicing physician, but an accomplished researcher as well. Her research, at the FDA, NIH, National Cancer Institute, USC, and Mount Sinai, has shaped scientific advancement in precision medicine. As a fellowship-trained integrative internal medicine physician, she developed numerous corporate wellness programs in Silicon Valley focusing on whole-systems approach to healthcare and previously served as Chief Medical Officer at companies such as Human Longevity and Vitagene.