In this recap episode, host Lester Morales breaks down the powerful conversation with Rachel Strauss — widely known as the “PBM Princess” and one of the clearest, boldest voices exposing how pharmacy benefit managers (PBMs) really work.

Rachel spent much of her career inside a leading PBM that didn’t play the traditional rebate and spread-pricing games. Today, she’s on a mission to educate employers, advisors, and everyday consumers on the hidden mechanics of drug pricing — and why most people have no idea what they’re actually paying for.

In this recap, Lester dives into:

• The emotional, financial, and human cost of a broken pharmacy system

• How PBMs actually make money (and why the incentives are completely misaligned)

• Why a $10 copay tells you nothing about the true price of a drug

• The spread-pricing “black box” and how it hurts patients, employers, and local pharmacies

• The shocking reality: 1–3% of plan members drive up to 60% of total pharmacy spend

• Why employers can reduce costs by 50–70% on high-cost drugs using modern, patient-first strategies

• The false belief that “employees won’t understand change” — and how it delays real solutions

• Real-world paths to get the exact same medication for employees at zero cost

Rachel and Lester outline a simple but powerful truth: If the PBM profits when drug prices stay high, the game will never change.

This episode is a must-listen for employers, advisors, CFOs, HR leaders, and anyone who wants to understand why pharmacy costs are exploding — and what to do about it.

👉 Listen to the full conversation with Rachel Strauss in the main episode.

The pharmacy benefit world is broken — and it’s costing employers millions while pushing families into medical debt.
In this eye-opening episode of the Disrupt Healthcare Podcast, Lester Morales is joined by Rachel Strauss, founder & CEO of PBM Princess Consulting and one of the most outspoken pharmacy reform advocates in the country.

After 23 years inside a major PBM, Rachel has seen every angle of how drugs are priced, discounted, rebated, repackaged, and marked up — often leaving patients confused, employers overcharged, and advisors in the dark.

Together, Lester and Rachel unpack:

• Why 5% of members drive 80–90% of pharmacy spend
• How fully insured carriers inflate drug prices in reporting
• The truth about rebates and why they almost never benefit employers
• Why employers are told “there’s nothing you can do” — even when there absolutely IS

• International sourcing (Canada, Israel, UK, NZ)
• 340B pharmacy partnerships
• Patient assistance programs
• Medication recycling (90% cost reduction)
• How Rachel saved a Texas city 60% on their top 7 drugs within 30 days

Rachel breaks down why this exploding class of drugs is the single biggest threat to employer healthcare budgets — and how to prepare before 2030 hits.

Rachel and Lester share the emotional stories behind their work — from medical bankruptcy to life-saving treatments — and why pharmacy reform isn’t just financial… it’s deeply personal.

If you are an employer, advisor, HR leader, or healthcare innovator, this conversation will completely shift how you think about pharmacy benefits and what’s possible.

🔥 What PBMs don’t want employers to know💊 Real pharmacy strategies that work — today⚠️ The GLP-1 Problem (Ozempic, Wegovy, Mounjaro)❤️ Why this matters: the human impact

In this recap of the Disrupt Healthcare Podcast, host Lester J. Morales breaks down a powerful conversation with Dean Jargo, CEO of Fair Market Health, whose personal story and financial background expose a truth most employers never hear:

👉 Healthcare isn’t a healthcare problem. It’s a finance problem.

Dean—longtime CFO and free-market advocate—shares how his wife’s cancer and emergency heart surgery forced him into the system as a consumer, not an executive. In that vulnerable moment, even a numbers expert couldn’t make sense of the bills, the stress, or the total lack of transparency. And that’s the point.

The system is designed to be confusing.
But it doesn’t have to be.

Lester recaps the key themes of the conversation, including:

• Why the real payers of healthcare (employers & employees) are separated from the sellers of healthcare (hospitals & providers)

• How misaligned incentives make premiums go up every year—while benefits get worse

• The insane friction created by deductibles, out-of-pocket costs & denied access

• Why direct contracting and fair-market pricing consistently save 35–40% on big-ticket procedures

• The emotional and financial toll on families navigating the system while dealing with serious medical events

• Why CFOs need to stop delegating benefits decisions and start treating them like the massive P&L line item they are

• Why the status quo carriers have no incentive to change—and why real reform must come from inside the industry

This episode is a must-listen for employers, CFOs, benefits advisors, HR leaders, and anyone tired of feeling powerless in the healthcare system.

If you’ve ever thought:
“There has to be a better way…”
—this recap outlines exactly what that better way looks like.

Most CFOs would never tolerate sloppy spending anywhere else in the P&L… except in the second-largest expense of the business: healthcare.

In this episode of the Disrupt Healthcare Podcast, host Lester J. Morales sits down with Dean Jargo, former CFO and founder of Fair Market Health, to unpack why the traditional fully-insured model is structurally misaligned — and how employers can use free-market, direct contracting strategies to pay less while giving employees better access to care.

Dean shares how his perspective shifted after his wife’s cancer and emergency heart surgery threw his family deep into the healthcare system. From there, he breaks down why insurance networks aren’t really negotiating “for” employers, how minimum loss ratio rules (MLR) incentivize higher claim costs, and why CFOs must get directly involved instead of delegating everything to HR and big brokerage firms.

You’ll also hear how Fair Market Health helps employers buy services like MRIs, surgeries and other procedures directly from providers at a fair price, often:

• Saving 35–45% on individual services purchased direct

• Reducing total plan spend by 10–20%

• Waiving member out-of-pocket costs while still paying providers fairly and quickly

If you’re a CFO, CEO, HR leader or advisor, this conversation will change how you think about your health plan, your broker — and your responsibility to your people.

Show Notes

• Why fully-insured carriers are structurally incentivized for higher claim costs, not lower

• What a fair market, direct-pay model looks like for hospitals, employers and employees

• How deductibles & out-of-pocket for employees show up as accounts receivable on the hospital side

• Why hospital systems obsess over revenue instead of net profit, collection costs and time value of money

• The biggest mindset blocks for hospital administrators and employer C-suit

  Timestamps

• 00:00 – 01:04 | Intro: From Impact to Disrupt Healthcare — and why the Y matters

• 01:05 – 03:21 | Meet Dean Jargo: finance background, free-market mindset, and his wife’s cancer + emergency heart surgery story

• 03:22 – 04:57 | What is Fair Market Health? Creating a truly “fair price” marketplace between buyers and sellers of healthcare

• 04:58 – 08:32 | Who really decides the price of an MRI? The illusion of “negotiated discounts” in traditional networks

• 08:33 – 12:08 | Why carriers don’t benefit from lowering costs: MLR rules, revenue growth and misaligned incentives

• 12:09 – 14:06 | Dean’s biggest surprise: how many high-quality vendors already exist to run better, partially self-funded plans

• 14:07 – 17:46 | The “cost of change” myth and why disruption is actually what employees are begging for

• 17:47 – 20:20 | Transparent pricing + waived out-of-pocket: how buying direct actually increases access to care

• 20:21 – 22:43 | Deductibles vs A/R: the moment Lester realized member cost-sharing is just hospital accounts receivable

• 22:44 – 25:04 | Hospitals chasing revenue vs. focusing on net profit, collection costs and time value of money

• 25:05 – 27:26 | The win–win–win triangle: hospital, employer and employee all benefit in a direct model

• 27:27 – 29:38 | The emotional toll: EOBs, confusing bills and stress stacked on top of serious illness

• 29:39 – 32:00 | On the provider side: revenue myopia and “we’ve always done it this way” thinking

• 32:01 – 33:05 | On the employer side: how CEOs & CFOs delegate benefits decisions into misaligned hands

• 33:06 – 35:08 | Claims analysis 101: what Dean finds when he reprices 12–24 months of claims data

• 35:09 – 36:19 | Access advantage: why direct-pay patients move to the top of the schedule

• 36:20 – 37:36 | Dean’s message to CFOs: get engaged — your health plan is probably your highest-ROI project

• 37:37 – 38:22 | Lester’s example: $3.5M in Rx savings vs $25–30M in extra sales

• 38:23 – 39:23 | Where to find Dean and final call to action for financial leaders

• 39:24 – 40:23 | Closing: why we must disrupt healthcare before it breaks

In this quick recap of the Dysrupt Healthcare Podcast, host Lester J. Morales distills key takeaways from his interview with Heath Potter, Chief Growth Officer at Six Degrees Health—a leader in reference-based pricing (RBP) and transparent reimbursement.

Lester challenges the industry’s fear of RBP, calls out incentive conflicts that keep employers in the dark, and explains (in plain English) how bottom-up “Medicare-plus” pricing gets to a fair price—without the games behind “big network discounts.” He also shares real-world wins, access myths vs. facts, and why collaboration (not litigation) is the sustainable path.

You’ll learn:

• Why many advisors still resist RBP—and how to sanity-check that bias

• Top-down (billed charges minus “discount”) vs. bottom-up (Medicare-plus) pricing

• How modern RBP uses data + negotiation to reach fair provider payments

• Access & member experience: what’s changed from RBP 1.0 to today

• Case stories: open access, community contracts, and keeping dollars local

• How to request a no-obligation impact/savings analysis to compare models

If you’re a self-funded employer, HR/benefits leader, or advisor, this recap gives you the essentials in minutes—so you can decide whether to dive into the full episode.

00:00 – “This podcast has been disrupted.”
00:07 – What these recap episodes are (and why)
00:40 – Guest context: Heath Potter, Six Degrees Health (RBP leader)
01:03 – Love it? Hate it? Why advisors feel strongly about RBP
02:24 – Gut-check your bias: incentives, overrides, and “follow the money”
03:27 – Hundreds of RBP implementations: wins vs. rare rough patches
05:23 – The core value of RBP: transparency and bottom-up pricing
06:38 – “Discount off what?” Charge master, billed charges, and the game
06:55 – RBP in one line: get to the price (Medicare-plus)
07:05 – Why Six Degrees’ data-driven, collaborative model works
09:17 – Many hospitals already use RBP-ish logic internally
10:10 – Imagine a fair-price roundtable… and the reality today
10:39 – Six Degrees’ posture: start fair, show data, negotiate
10:51 – Real examples: open access, family stories, local community wins
11:37 – When carriers and hospitals fight… the member/employer loses
11:58 – Strategy: collaborate with good actors; limit exposure to bad ones
12:21 – Employers: if your advisor won’t teach RBP, reconsider
12:45 – If we don’t solve it, government will—lead the change
13:09 – CTA: request an impact analysis to compare savings
13:46 – Listen to the full episode with Heath Potter; share/like/feedback
14:00 – Thanks for listening to the Dysrupt recap

Guest: Heath Potter, Chief Growth Officer — Six Degrees Health
Host: Lester J. Morales — Dysrupt Healthcare Podcast

reference based pricing, RBP, Medicare plus pricing, Six Degrees Health, Heath Potter, Lester J Morales, self funded employers, healthcare transparency, cost containment, medical claims, employer health plans, open access, negotiation not litigation, benefits advisors, Dysrupt Healthcare Podcast

🕒 Timestamps🔗 Guest & Host🔍 SEO Keywords / Tags

In this special recap episode of the Dysrupt Healthcare Podcast, host Lester J. Morales breaks down the key lessons from his powerful conversation with Kimberly Carlson, CEO of U.S. Beacon — an independently owned medical claims integrity review company helping employers reclaim millions lost to billing errors.

Using a simple grocery-store analogy, Lester exposes the shocking truth: nearly every medical bill in America contains mistakes — and most employers never audit them.
He shares actionable strategies for self-funded employers and advisors to take control, demand transparency, and protect their plan dollars.

You’ll learn:

• Why 99% of healthcare bills have errors — and how much that’s costing you.

• How independent audits recover 2–6 % (or more) of total claim spend.

• The contractual traps that limit employers’ ability to audit their own data.

• How to write “audit-friendly” RFP clauses that guarantee full access to your claim data.

• Why transparency and leadership are essential to fixing a broken system.

💡 Whether you’re an employer, HR leader, or benefits advisor, this quick recap gives you the insights — and the “why” — to disrupt the way healthcare billing has always been done.

00:00 – “This podcast has been disrupted.”
00:07 – What are Dysrupt Healthcare recap episodes?
00:53 – The Kimberly Carlson conversation in context
01:03 – The grocery-store analogy: transparency in billing
02:39 – What if every checkout had errors?
03:05 – Translating that to healthcare
03:41 – 99 % of medical bills contain errors
04:05 – How U.S. Beacon audits hospital claims
05:10 – The employer’s right (and responsibility) to audit
06:26 – Why large hospital stays create bigger audit opportunities
07:03 – Taking back control: this is your money
08:17 – How to write audit clauses into your RFPs
09:02 – The hidden gag clauses in contracts
09:25 – Consolidated Appropriations Act (CAA) and data ownership
09:42 – Make audits a condition to win the bid
09:57 – Free resources from Kimberly Carlson in the show notes
10:25 – Why independent claim reviews matter for every employer
10:37 – Auditing your plan = protecting your people
10:54 – Final call to action: Disrupt the status quo

🎧 Full Interview: [How Kimberly Carlson Is Fixing Broken Medical Billing | Dysrupt Healthcare Podcast]
with Lester J. Morales & Kimberly Carlson, CEO of U.S. Beacon

🕒 Timestamps🔗 Referenced Episode

In this episode of the Dysrupt Healthcare Podcast, host Lester J. Morales sits down with Heath Potter, Chief Growth Officer and founding member of Six Degrees Health, one of the leading innovators in reference-based pricing (RBP) and transparent cost-containment solutions.Heath shares how a personal family tragedy—his father’s life-changing injury—became the spark behind his mission to make healthcare affordable, transparent, and fair for every patient and employer.Together, Lester and Heath unpack how Six Degrees Health uses data, analytics, and negotiation—not litigation—to redefine RBP, allowing employers to save an average of 30–40 % on medical claim spend while improving member experience and access to care.From the evolution of RBP 1.0 to today’s member-first model, this episode explores:Why most employers are still overspending on healthcareThe myths about balance billing and access issuesHow transparency and independent negotiation build trust between plans and providersReal case studies where employers saved millions without sacrificing careIf you’re a self-funded employer, benefits advisor, or HR leader who’s ready to rethink healthcare costs, this conversation will show you what true disruption looks like.Dysrupt Healthcare Podcast (yes—with a Y) is where Lester J. Morales talks with leaders who are challenging the status quo of American healthcare.Each episode digs into the WHY—the purpose behind the movement—to make healthcare more transparent, affordable, and human.Timestamps00:00 – “This podcast has been disrupted”00:07 – Welcome to Dysrupt Healthcare: Why the Y matters00:52 – Meet Heath Potter, Chief Growth Officer at Six Degrees Health03:02 – The personal story that ignited a mission to fix healthcare04:26 – How transparent pricing helps families and employers05:36 – Real impact: saving $12 million for a client plan06:43 – A physical therapy story that proved the model works08:28 – Reference-Based Pricing (RBP) explained in simple terms10:56 – Lester’s $90K knee surgery example vs. RBP pricing13:34 – Why hospitals accept fair RBP rates15:40 – RBP 1.0 vs. the Six Degrees model: what’s changed18:21 – Data and analytics as the core of modern RBP21:10 – The real stats: 99 % claim acceptance rate first pass24:00 – How negotiations resolve balance bills without litigation26:10 – The next frontier of RBP: member access to care28:02 – Open access plans and real family examples31:00 – Average employer savings of 25–40 %32:54 – Sustainability and flattening the renewal curve34:50 – Case studies: firefighters, manufacturers, and local communities37:13 – Where to learn more and get a free savings analysis39:21 – Final message to employers: “These are real dollars, not smoke and mirrors”Connect with the GuestsGuest: Heath Potter – Chief Growth Officer, Six Degrees Health📧 [email protected]🔗 LinkedIn: Heath PotterHost: Lester J. MoralesFollow on LinkedIn, YouTube & Spotify for more conversations that #Dysrupt the status quo.

Welcome to the first guest episode of the newly rebranded Dysrupt Healthcare Podcast, hosted by Lester J. Morales.
Formerly known as Impact Healthcare, this show has evolved with a clear mission to remember the WHY behind disrupting healthcare.

In this episode, Lester sits down with Kimberly Carlson, CEO and founder of US Beacon, a company transforming how medical billing integrity is handled in America. Kimberly shares her powerful story — from advocating for her husband during his battle with stage IV cancer to building a company that helps employers and patients uncover costly billing errors that most people never even notice.

They expose shocking facts about the system — like why over 90% of medical bills contain errors, how self-funded employers can save millions, and why independent claim reviews are the hidden key to fixing a broken healthcare system.

Whether you're an employer, advisor, or healthcare professional, this episode will change how you see medical billing, fiduciary responsibility, and the real cost of care in America.

🔹 Learn how to protect your organization from overpayments
🔹 Discover what “Disrupt with a Y” really means
🔹 Get practical insights from real case studies saving millions

Hosted by Lester J. Morales, Dysrupt Healthcare (yes, spelled with a “Y” on purpose) highlights the WHY behind fixing a broken system. Each episode shares stories of leaders, innovators, and disruptors making healthcare more human, transparent, and affordable.

00:00 – Attention: This podcast has been disrupted
00:10 – From Impact Healthcare to Dysrupt Healthcare: the WHY behind the rebrand
00:46 – Meet Kimberly Carlson, CEO of US Beacon
03:04 – The personal story that started US Beacon
03:48 – 99% of medical claims have errors — why it happens
06:14 – Understanding medical coding and billing complexity
08:16 – The mechanic analogy: bundling vs. unbundling in healthcare
10:30 – Patients’ right to request an itemized bill
12:20 – Why every consumer should care about billing errors
13:43 – How billing errors drive up premiums
14:43 – Real-world example: $12,000 a night for a semi-private room
15:43 – Self-insured vs. fully insured: who’s responsible?
17:17 – Fiduciary risk and why employers should audit claims
18:20 – $5.5 million in savings: real case results
20:16 – “Fox guarding the henhouse”: when carriers audit themselves
21:44 – Why independent audits matter
22:45 – Contracts, RFPs, and clauses that protect employers
26:00 – Billing under CMS guidelines and avoiding illegal charges
28:10 – How one surgery led to $70,000 in avoidable costs
30:13 – Healthcare billing = buying a car without knowing the price
31:38 – City government case study: recovering taxpayer money
33:11 – Why you need an independent TPA
34:39 – The human side: the system isn’t evil, just broken
35:26 – The role of AI and automation in claims integrity
36:45 – US Beacon’s 1% appeal rate and what makes them different
37:00 – The meaning behind “US Beacon” and being a light in darkness
37:41 – Final thoughts and call to action

Guest: Kimberly Carlson – CEO, US Beacon
LinkedIn: Kimberly Carlson

Host: Lester J. Morales
Follow on LinkedIn, YouTube, and Spotify for more stories that disrupt the status quo.

🧠 About Dysrupt Healthcare Podcast🕒 Timestamps🔗 Connect with the Guests

In this inaugural episode of the Dysrupt Healthcare Podcast, Lester J. Morales opens up about rebuilding not just the podcast, but the entire company and mission behind it. After years of leading Impact Healthcare Podcast, Lester realized that the vision had outgrown the name. “Impact” was never the limit it was just the beginning.

The new Dysrupt Healthcare Podcast was born with purpose: to go deeper, to reach farther, and to create real change in how we see and experience healthcare. This isn’t just a new season it’s a reawakening of a movement.

Lester shares what this transformation means, personally and professionally from redefining his company’s purpose to reimagining how conversations in healthcare should sound. The new format will bring you closer to the real stories, the emotional journeys, and the case studies of leaders who are dysrupting the system for good.

This episode sets the tone for what’s to come: honest dialogue, bold ideas, and stories that remind us that healthcare isn’t just about numbers it’s about people.

The movement continues louder, deeper, and more human than ever before.

In this powerful solo episode, Lester Morales reflects on the journey of the Impact Healthcare Podcast and shares why it’s time for an evolution. For years, Impact Healthcare has been a platform to highlight innovative ideas, bold strategies, and the leaders willing to push against the broken healthcare system. But as Lester explains, the word “impact” was never big enough to capture the true scale of the movement he and so many others are building.

This is not an ending — it’s a transformation. The podcast is entering a new chapter as the Dysrupt Healthcare Podcast. With a sharper focus and a fresh format, this next phase will go deeper into the conversations that matter most: how employers, advisors, and changemakers can dysrupt the status quo, lower costs, and deliver better care for employees and their families.

In this transitional episode, Lester shares:

• Why the shift from “Impact” to “Dysrupt” represents more than just a name change.

• What listeners can expect from the new content, structure, and tone of the podcast.

• How the larger movement for healthcare disruption is growing — and why your voice and participation matter now more than ever.

This episode isn’t a goodbye. It’s an invitation to continue forward — to be part of the movement, to challenge what’s broken, and to help create a system that truly works for people. The Impact Healthcare Podcast opened the door. The Dysrupt Healthcare Podcast will break it wide open.