Health Care Rounds

Insurance denials are exploding, and they’re costing lives. In this episode of Health Care Rounds, host John Marchica sits down with Neal Shah, CEO of CareYaya and Counterforce Health, to unpack the broken insurance system and the AI-driven surge in claim rejections. Neal shares how his personal caregiving experiences shaped his mission, why most patients never appeal, and how new tools can help level the playing field for families, physicians, and hospitals.  ================================================ 

Why do people trust Google and TikTok more than their doctors?Dr. Geeta Nayyar, MD, MBA, the author of Dead Wrong: Diagnosing and Treating Healthcare's Misinformation Illness, joins the show to break down how misinformation spreads, why patient trust continues to decline, and what health leaders must do to lead the cure.  ================================================  

Pharmacy benefit managers (PBMs) play a pivotal role in drug pricing, yet their practices often remain shrouded in a black box of rebates, spread pricing, and misaligned incentives. In this installment of our Pharma Series, Alan Pannier, Senior Vice President of Product Strategy at SmithRx, breaks down how legacy PBMs use opaque contracts and vertical integration to drive up costs, why employers are beginning to push back, and how transparent, cost-based models are reshaping the future of pharmacy benefits.

Specialty pharmacy is big business. And while PBMs and big pharma dominate the spotlight, health systems are quietly carving out their own advantage. In this episode of Health Care Rounds, host, John Marchica, sits down with Tim Affeldt, PharmD, Vice President, Specialty/Infusion Operations, Fairview Pharmacy Services, to unpack why health systems don’t just belong in specialty pharmacy - they may be unqiuely positioned to lead it. From tighter care integration and faster clinical decisions to improved outcomes and patient experience, Dr. Affeldt lays out a clear case: when pharmacists are embedded in the care team, everyone benefits, except the status quo.

What happens when state health policymakers lose access to the very data they rely on?In this episode of Health Care Rounds, John Marchica talks with David C. Radley, Ph.D., M.P.H., Director of Data and Analytics at The Center for Evidence-Based Policy and Senior Scientist at the Commonwealth Fund. They explore how states use administrative data to make informed Medicaid decisions, and why recent threats to public data infrastructure could undermine that progress.Dr. Radley breaks down how his team turns raw data into actionable insights, how states are planning for the financial impact of high-cost therapies, and why cutting long-standing federal data sets could cripple efforts to address health disparities.   CONNECT WITH US:

Value-based care isn’t a new idea—but making it work in today’s fragmented system is anything but simple. In this episode of Health Care Rounds, John Marchica talks with Dr. Tom Yackel, Chief Clinical Excellence Officer at CenterWell Senior Primary Care, about what it really takes to deliver high-quality, cost-effective care to Medicare patients.Dr. Yackel shares insights from his decades-long career in primary care, informatics, and practice leadership, explaining how CenterWell is scaling value-based care models in communities that need it most. From the business realities of Medicare Advantage to why primary care must be run like a business, not a charity, this is a frank and timely conversation about the future of senior care.

Value-based care is more than just a buzzword - it’s a fundamental shift in how we measure success in health care. In this episode of Health Care Rounds, John Marchica sits down with Dr. Trafford Crump, Associate Professor at McGill University, to discuss how patient-reported outcomes (PROs) can help us better understand the value of care from the patient’s perspective. Trafford explains where PROs fit into clinical trials, delivery systems, and the broader goals of value-based care and why measuring what actually matters to patients is harder (and more important) than it looks.  

In another installment of our Pharma Series,  we're joined by Dr. Tyson Frodin, Assistant Vice President of Pharmacy at MultiCare, to explore the evolving role of pharmacy in health care. Tyson shares insights from his diverse career path - from his early experience in telehealth on a Navajo reservation, to leading pharmacy initiatives at a top health system in the Pacific Northwest. They dive into the challenges of critical access hospitals, the importance of innovation in pharmacy, and how MultiCare is leveraging technology to improve patient care.

In this episode of Health Care Rounds, Host John Marchica sits down with Jason Bryll, Principal at Parable Associates, to unpack why health care organizations struggle with managing financial and patient data. They discuss the challenges of revenue cycle management, the headache of disconnected systems, and how better data practices can lead to better care. Jason also breaks down where AI and automation can help - and where they fall short.

TOPICS(0:19) Introduction(0:45) Meet John Driscoll(2:40) The Future of Pharma(8:28) How Pharmacies Can Put Patients First(12:25) Key Trends in Primary Care(15:16) The Challenges of Improving Quality Patient Care(19:25) Incoming Health Care Policy(25:48) The Impact of RFK and Trump's Nominees on Health Care(30:12) Where AI Can Have the Biggest Impact on Health Care(33:04) Increasing Efficiency with AI(35:04) John Driscoll's New Book: Pay the People(37:29) The Importance of Paying Workers a Living Wage

TOPICS(0:19) Introduction(0:45) Meet John Driscoll(2:40) The Future of Pharma(8:28) How Pharmacies Can Put Patients First(12:25) Key Trends in Primary Care(15:16) The Challenges of Improving Quality Patient Care(19:25) Incoming Health Care Policy(25:48) The Impact of RFK and Trump's Nominees on Health Care(30:12) Where AI Can Have the Biggest Impact on Health Care(33:04) Increasing Efficiency with AI(35:04) John Driscoll's New Book: Pay the People(37:29) The Importance of Paying Workers a Living Wage 

TOPICS(0:50) Introduction(1:33) Karthik Ganesh: Background and Transition to OnMed(6:02) Lessons Learned in Health Care(11:39) Navigating the Complexity of Health Care(14:00) Obstacles in Rural Health Care(23:50) Why Health Care Issues Differ from Other Industries(27:16) Exploring OnMed Care Stations(34:35) OnMed's B2B Growth Strategy(38:23) Expanding Access and Collaborating with IDNs(42:18) Conclusion 

TOPICS:(0:15) Intro(1:17) What Got Vinay Patel Into the Industry(4:00) Understanding Drug Pricing Models(11:01) What Is a Limited Distribution Network?(13:46) What Is Distribution Direct?(15:21) Looking at the Supply Side of Pharmaceuticals(19:34) Structuring Pharmacy Benefits(26:00) The Difference Between Fixed Dollar Rebates and Percentages(31:14) What Role Do Generic Companies Have in Product Use?(37:24) Moment-to-Moment Drug Pricing and Buying(39:07) How MakoRx Is Tackling Drug Pricing Issues(42:44) The Argument for Giving Drug Cost Transparency(47:19) What Is MakoRx's Value Proposition?(50:12) What's Behind the Drive for Pharmacy Innovation?(54:54) How Pharmacies Will Change in 2025 

TOPICS(0:20) Introduction(1:05) What Led Jasmine Bhatti to Healthcare(4:00) Going from Nurse to Business Owner(7:58) Looking at the Success of Care Transitions(12:38) The Difference in Home Care Coverage(15:40) The Complexities of Home Care(18:54) The Cost Equation for PRNs(23:43) How to Prevent Readmissions(25:12) Do Health Systems Understand Home Care?(28:40) How Can Home Care Generate a Profit?(31:09) Real-World Benefits of Navi Nurses(36:00) The Future of Home Health Care 

TOPICS(0:16) Intro(1:07) How Natalie Davis Got Started in Health Care(3:25) The Origins of United States of Care(8:00) Where Can We Find Common Ground in Health Care?(14:34) Where Do Policymakers Stand on Medicare for All?(19:00) Are People Paying Attention to Health Care in This Election?(21:08) Is United States of Care an Advocacy Organization?(21:54) United States of Care's Biggest Policy Wins(23:17) How AI Relates to Health Care Advocacy(25:25) How Do Patients Feel About AI?(30:57) The Current State of Value-Based Care(39:38) The Complicated Nature of Universal Health Care