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.

Dr. Daphne Bascom earned a DPhil/PhD in physiological sciences at the University of Oxford, a medical degree at the University of Pittsburgh, and completed fellowship training in microvascular and reconstructive surgery of the head and neck at Oregon Health Sciences University. She has more than two decades of executive leadership across health systems, health technology, and community health. Most recently, she served as Vice President of Population Health at Saint Luke’s Health System in Kansas City.

So, how and why did she leave all of that to pursue lifestyle medicine, a “vegetable-forward” way of life, and a completely different kind of care?

As we’ve heard from many of our guests, for Dr. Bascom, it was personal. Between witnessing her mother’s long and arduous struggle with COPD and helping her father navigate the healthcare system, she recognized that despite her many years of training, her work as a surgeon, and her leadership, she still wasn’t doing the work that got her into medicine in the first place.

She wanted to help people be healthy. Period. 

That deep calling led her to become the Chief Operating Officer of The Vegan Gym, a global digital health platform dedicated to plant-based performance, healthspan, and longevity. She now hosts the Thrive on Plants podcast and is the Founder of The Longevity Lab. As a lifelong believer in equity and inclusion, Dr. Bascom works hard to ensure that this information is accessible to all people, and much of the education she puts together on these topics is available for free on her YouTube channel, @TheVeganGym.

In the last decade of a person’s life, we spend 7x what we spend on taking care of them in all the years that came before.

SEVEN TIMES!

That’s not only unbelievable, it’s unsustainable, particularly as our aging population grows and life span increases. So, if it’s not just about increasing life span, or the number of years someone lives, what is it about? For Dr. Tzipi Strauss, Founder and Director of the Sheba Longevity Center, it’s about increasing health span, that is the number of years a person lives healthily, without the need for significant intervention. 

The work Dr. Strauss and her team are doing focuses on longevity. It’s a step beyond lifestyle medicine in that they look across all body systems, and at the individual as a whole, to identify their biggest risk factors and what interventions they actually need, not just what the latest fad says. The emphasis on behavior change is significant, and that may be the holy grail, getting people to adopt these healthy changes permanently, but Dr. Strauss finds that when patients see their biological age and the impact of the decisions and choices they’ve been making, their motivation to change is different. It’s data driven.

Professor Strauss is a physician-scientist, pediatrician, and neonatologist, and a leading voice in the emerging field of longevity medicine. She is the Founder and Director of the Sheba Longevity Center—one of the first academic longevity centers embedded within a public healthcare system. Her work combines clinical innovation, research, and policy, aiming to transform longevity from a privilege into a scalable, evidence-based public health model.

Without intervention, in 2050, everyone in the US population will either have Alzheimer’s disease or be caring for someone with Alzheimer’s disease.

That’s the state of where we’re at with cognitive decline. Right now, if you reach the age of 85, your chances of developing cognitive decline are 1 in 2. That’s right, 50%. But, BUT, new research is helping us understand the hidden drivers of cognitive decline and creating hope at the same time. Because now that we understand the origin of risk for an individual, we can prescribe specific interventions to circumvent that risk and prevent the disease altogether.

This is the amazing work of James Maskell and Dr. Kristine Burke, my guests on the show today. Dr. Burke is Co-PI of the EVANTHEA Study, a clinical trial designed to look at the impact of a precision medicine approach to Alzheimer’s disease. The initial results are astounding – with intervention, 91% of participants saw improvement in cognitive function. That’s better than any drug, lifestyle medicine, or treatment protocol we have to date by a long shot. These two join me today to talk about what those hidden drivers are, how precision medicine can help, who’s going to pay for it, and why this is so critically important to society at large.

Dr. Kristine Burke is a triple board-certified precision medicine physician and the Founder and Executive Medical Director of True Health Center for Precision Medicine in Northern California. She is also the Co-Founder and Chief Medical Officer of TruNeura who is advancing a scalable model for brain health that integrates clinical insight, data, and AI-supported decision tools.

James Maskell has spent the past decade innovating at the cross section of functional medicine and community. To that end, he created the Functional Forum, the world’s largest integrative medicine conference with record-setting participation online and growing physician communities around the world.

“Health doesn’t just happen within the four walls of the hospital.”

Or, at least, it shouldn’t have to. The work of our guest today, Dr. Eve Cunningham, and her team at Cadence, ensures that patients with chronic conditions can continue to live and thrive at home. Through remote patient monitoring but also behavioral support, medication titration, and relationship building, they ensure that patients understand their condition, are able to manage it effectively at home, and have another set of eyes looking out in case something starts to go awry. It’s technology driven, but it’s human focused. 

Eve is the Chief Medical Officer of Cadence, a medical group and remote care delivery system that supports health systems, clinicians, and patients in delivering care beyond the four walls of a hospital or clinic. Dr. Cunningham has spent the last 20 years deploying transformational health system programs at scale, leading large multidisciplinary medical groups, and integrating AI into clinical care at some of the largest non-profit health systems in the country. She is a board-certified OB-GYN and leader in virtual care, clinical AI, and clinician burnout.

We’re quick to blame genetics for our health and wellness issues, but the reality is that genetics only makes up 18% of our health destiny. That means the rest is up to us. 

Our guest today, Dr. Grant Zarzour, has seen that first hand in his own family. When his son was diagnosed with moderate autism, he and his wife refused to accept the predictions for his future. They dove head first into the data and in so doing, revolutionized not just their son’s life, but their own. Now a relentless proponent of diet, sleep, and exercise for physical and mental health, Dr. Zarzour feels like we all have a hand in our own destiny. We just have to commit. 

Dr. Zarzour is a practicing hip and knee surgeon in Mobile, AL.  He is the president of the largest orthopaedic practice in Alabama. While treating thousands of patients a year, Grant has developed a passion for preventive medicine. In 2024, he founded Sperity Health, which offers personalized longevity coaching to help its members improve their diet, exercise, and sleep with expert MD guidance. Sperity Health’s mission is to lower its member’s risk of cancer, cardiovascular disease, and dementia by up to 50% based on data and science.

Forty percent of the time, oncology care is not being delivered in concordance with guidelines. FORTY PERCENT!

As our guest today explains, that’s not because of bad doctors. It’s because oncology care changes rapidly and because almost eighty percent of patients are being seen by a community oncologist, a physician who is responsible for treating ALL types of cancer, instead of a specialist. How can we address that? Well, as Dr. Yousuf Zafar explains, there are really three options.

Today’s guest is a practicing oncologist and adjunct professor at Duke University, and chief medical officer at AccessHope, where he focuses on expanding access to expert cancer care for patients treated outside of academic centers. While National Cancer Institute Designated Comprehensive Cancer Centers deliver superior outcomes, they treat only 20 percent of cancer patients. Dr. Zafar is working to extend that expertise to the remaining 80 percent.

It’s rare that an article title alone makes me want to stop what I’m doing and read it, but that’s what happened when I saw the title of Jess Craig’s recent article, “Why More Doctors are Billing Their Patients Like it’s the 1920’s.”

In this article, and subsequently, our conversation here on the podcast, Jess explains what she means, citing the growing number of physician practices organized around the concept of direct pay. That is, the practice or physician determines a set cash price for their services and the patient pays that price out of pocket. This model may seem like we’re going backwards, to a time when health insurance didn’t exist, but in fact, it’s starting to be seen as one of the most progressive ways of managing rapidly inflating costs and concern about quality. While there are still questions around accessibility, as Jess points out, it may be one of the first advances we’ve seen in over a decade that could actually move the needle. 

Jess Craig is a health reporter for Straight Arrow News (SAN). Prior to joining SAN, Jess worked as an infectious disease epidemiologist and health security technical advisor for international research institutes and US government agencies, including the CDC, USDA, and USAID. Jess worked as a freelance journalist for eight years, covering science, health, and world news for various outlets. She also served as a reporting fellow for NPR in 2020 and for Vox in 2024.