PAC & Forth

What does an independent physician bring to the sidelines?

In this episode of PAC & Forth, we sit down with Dr. Michael Leathers, a second-generation orthopedic surgeon and sports medicine physician who runs his own practice in Midtown Sacramento. Trained at USC, UCLA, and UCSF, Dr. Leathers also volunteers as team physician for Christian Brothers High School and Sacramento State, bringing independent care from the clinic to the field.

Dr. Leathers shares:

• Why owning his own practice gives him the freedom to choose community work, like covering Sac State games into the early morning.
• How he helps families keep young athletes healthy, from the benefits of multi-sport play to concrete guidance on pitch counts and rest.
• How he takes the emotion out of sideline calls and treats every player like his own kid.
• What falling reimbursement means for independent practices compared to his father's era, and why he's still all in.

A look at how independent physicians show up for their communities, on the field and in the clinic.

If you’re interested in learning more about the independent physicians who keep local athletes and families healthy, this is a must-listen.

Tune in to hear why Dr. Leathers hopes he never leaves private practice.

Will your malpractice carrier stand by you when it matters?

In this episode of PAC & Forth, we sit down with Dan Cavanaugh, Senior Vice President of Business Development at the Cooperative of American Physicians (CAP). With more than 35 years in the industry, Dan knows California's malpractice landscape better than almost anyone.

Dan shares:

• What changed under AB 35, including the roughly 80% increase in exposure per case.
• The questions every physician should ask before choosing a carrier, from AM Best ratings to consent to settle.
• How CAP supports independent practice with consulting, HR resources, and a start-your-own-practice guide.

A grounded, practical guide to picking the carrier that will actually have your back.

If you're a physician trying to make sense of malpractice coverage in the post-AB 35 era, this is a must-listen.

Tune in to hear what 35 years inside the industry has taught Dan about protecting what you've built.

What good is innovation if patients can't get it?

In this episode of PAC & Forth, we sit down with Sam Chung, Senior Vice President of Government Relations and External Affairs at California Life Sciences, which represents 1,300 organizations across the state's biopharma, biotech, medical device, and research community.

Sam unpacks:

• How prior authorization is driving real harm, with one in three patients facing adverse outcomes.
• Why vertical integration of PBMs, insurers, and pharmacies is fueling cost and access problems.
• The push behind SB 41 and broader PBM reform, and why rebate transparency matters.
• The effort to eliminate prior auth for FDA-approved rare disease treatments, where delay can be catastrophic.

A clear view of where breakthrough treatments stall and what it would take to get them to patients faster.

If you've ever watched a patient wait for a treatment that's already on the shelf, this episode is essential listening.

Tune in to hear why physicians and innovators have to push together.

What does a new health care mandate really cost?

In this episode of PAC & Forth, we sit down with John Shirikian, President and CEO of the Association of California Life and Health Insurance Companies (ACLHIC), and Steffanie Watkins, the association's Senior Vice President. ACLHIC represents 50 member companies, including the big six health insurers.

This episode dives into:

• Why every new benefit mandate has a downstream premium cost that adds up fast.
• The difference between coverage and cost sharing, and why Sacramento often blurs them.
• Vertical integration and what happens when payers, providers, and PBMs share one roof.
• Where physicians and health plans actually agree, including prior auth and credentialing reform.

A rare look at the system from the payer side and where physicians and insurers can find common ground.

For physicians who've been told payers and providers can never agree on anything, this is essential listening.

Tune in to hear where the path to fixing the system actually runs.

Why is California debating health care while patients can't see a doctor?

In this episode of PAC & Forth, we sit down with Assemblymember Greg Wallis (Coachella Valley) and Assemblymember Heath Flora, the Assembly Republican Leader from the northern San Joaquin Valley. Both bring a frontline view of inland California, where access to healthcare is shrinking and physicians are leaving.

This conversation pulls back the curtain on:

• The access-to-care crisis where the nearest specialist can be hours away.
• The coastal versus inland divide and why one-size-fits-all policy fails.
• Why the ACA's promise to reduce ER reliance never fully materialized.
• Why physicians must engage legislators early, not after a bill is moving.

A grounded look from two legislators at the gap between what gets debated in Sacramento and what actually reaches the clinic.

If you care about access in inland California and the policymakers willing to fight for it, this is a must-listen.

Tune in to hear how two legislators on the front lines are pushing for policy that actually reaches patients.

Why does your premium keep climbing even in a clean year?

In this episode of PAC & Forth, we sit down with Vincent Catalano, Founder and CEO of Clear Healthcare Solutions. Vincent brings decades of experience in employee benefits and insurance brokerage and now helps organizations manage cost and strategy across health care.

We unpack:

• How brokers actually get paid, and why flat percentage commissions give them a raise when premiums rise.
• Why small practices under 20 employees have almost no negotiating power in the ACA risk pool.
• PEOs, level-funded plans, and the tools small practices can use to take back control.
• The rise of direct primary care and why employers are routing around traditional insurance.

A no-nonsense look at the misaligned incentives baked into how benefits are bought and sold.

For any physician who pays for benefits and wonders where the money actually goes, this is a must-listen.

Tune in to hear how a longtime insider thinks physicians can start winning the benefits conversation.

What does it take for a physician to finally say enough?

In this episode of PAC & Forth, we sit down with Dr. Todd Otten, board-certified family physician, former U.S. Navy flight surgeon, co-author of Ripple of Change, and executive producer of the documentary Suck It Up, Buttercup. After two decades in practice and his own experience with burnout, Dr. Otten is one of the most candid voices on what is breaking the people who deliver care.

Dr. Otten shares:

• The moment he walked away from a 13-year practice and what it taught him about moral injury.
• Why the "quadruple aim" must include the well-being of those providing care.
• Physician suicide, the stigma around getting help, and why speaking up feels risky.
• Direct primary care, Mark Cuban Cost Plus Drugs, and the workarounds physicians are building.

A raw, honest look at what corporate medicine costs the people inside it. 

If you've ever wondered why so many physicians are quietly stepping back from medicine, or what it would take to bring them back, this conversation is for you.

Tune in to hear why change starts with physicians willing to draw a line in the sand.

What if staying independent didn't have to mean going it alone?
In this episode of PAC & Forth, we sit down with Tyler Tracewski, President of Astrana Care Partners, to unpack PAC's new collaboration with Astrana and what it means for independent primary care physicians navigating Medicare's shift to value-based care.
This episode dives into:

• What an Accountable Care Organization (ACO) is, how shared savings work in traditional Medicare, and why Astrana's model carries no downside risk for participating physicians
  
  
• The real financial picture: in 2024, participating providers supplemented their fee-for-service income by an average of 50%, with top performers more than doubling it
  
  
• Why independence is protected in this model, with no changes to clinical workflows, networks, or patient choice
  
  
• How prior authorization, reporting, and administrative burdens get absorbed by the ACO so the practice doesn't carry them
  How independent physicians can join Medicare's value-based future without giving up autonomy, taking on risk, or adding to their administrative load. Tyler shares Astrana's track record of shared savings and why its wraparound model is built to keep small practices independent.

For any primary care physician trying to stay independent in a consolidating system, this is essential listening.
Tune in to hear what value-based care looks like when it's built around the physician, not the payer.

What happens when TikTok becomes your second opinion?

In this episode of PAC & Forth, we sit down with Dr. Hailey MacNear, OB-GYN and partner at Sacramento Women's Health, for an honest conversation about health misinformation, patient trust, and the growing challenge of navigating medicine in the age of social media, from menopause advice on Instagram to "doctor versus Google" debates in the exam room.

This episode dives into:

• Why patient research can be helpful and when it becomes a barrier to care
  
  
• The biggest myths she wishes patients would stop believing
  
  
• How social media has fueled anxiety around perimenopause and menopause
  
  
• Why so much online "health advice" is really just marketing in disguise
  
  
• How private practice creates stronger physician-patient trust
  
  
• The balance between patient autonomy and good medical care
  
  

This episode explores how physicians can build relationships with their patients strong enough to cut through noise, fear, and bad advice. It's about getting back to what medicine should be: trust, expertise, and real conversation.

If you care about women's health, private practice, and how physicians can navigate a world where everyone has "done their own research," this episode is a must-listen.

In this episode of PAC & Forth, we go inside the Capitol with John Latimer, founder and managing partner of Capital Advocacy — one of Sacramento’s most influential lobbying firms — for a no-nonsense look at how decisions really get made.

This conversation pulls back the curtain on:

• Why health care policy is dominated by big institutions — and how smaller voices can still break through
• The real meaning of “affordability” in Sacramento (and why it’s more complicated than it sounds)
• How California’s budget deficit is already reshaping health care debates
• What the next governor’s race could mean for single-payer, access, and quality
• Why grassroots physician voices matter more now than ever

A candid, insider’s view of power, politics, and persuasion and how independent physicians can stop being spectators and start being heard.

If you’ve ever wondered why common-sense health care fixes are so hard to pass or how PAC turned a brand-new association into a legislative win, this episode is essential listening.