The Astonishing Healthcare Podcast

How can interoperability, policy, and technology come together to solve some of healthcare's most stubborn challenges? On episode 108 of Astonishing Healthcare, host Justin Venneri sits down with Brendan Keeler, Interoperability Practice Lead at HTD Health and author of the popular Health API Guy Substack. Brendan shares his journey from working at Epic Systems to becoming a leading voice in healthcare interoperability, offering insights into the intersection of policy, technology, and workflows.

Together, they explore the current state of interoperability in healthcare, the impact of CMS rulemaking on prior authorizations, and the challenges of modernizing entrenched systems of record. Brendan also highlights the importance of empathy in solving healthcare's complex problems and shares his thoughts on the future of digital identity and patient data access.

• Interoperability is about ubiquity, not just standards. While digital standards like FHIR and NCPDP are important, true interoperability requires widespread adoption across all stakeholders to ensure seamless data exchange.
• CMS rulemaking is driving change in prior authorizations. New regulations aim to digitize and standardize prior authorization processes, reducing manual burdens while potentially increasing overall transaction volumes.
• Modernizing healthcare infrastructure is a monumental challenge. Systems of record like EHRs and claims processing platforms are deeply entrenched, making change costly and complex. Leaders often opt for incremental improvements, such as layering AI on top, rather than full-scale replacements.
• Empathy is key to solving healthcare problems. Bridging the "empathy gap" by making complex issues like benefit design and regulation accessible to non-experts is essential for attracting talent and driving innovation.
• Digital identity is foundational for the future of healthcare. Strong identity verification systems unlock trust and enable secure, seamless data sharing between patients, providers, and payers, paving the way for better outcomes.

Related Content

• How to obtain Rx data and what to do with it
• Replay - Unified Care Navigation: A Critical Component of the Future of Health Benefits Design
• AH064 - Empowering Plan Sponsors: Data Access & Analysis, with Bridget Mulvenna
• Judi Health Policy Update – It’s a Tangled Web of Progress

Disclaimer

This podcast is for informational and entertainment purposes only. The views expressed are those of our guests, do not constitute professional advice, and may not represent Judi Health's/Capital Rx's position on any matters discussed. We make no representations or warranties regarding the accuracy or completeness of the content; information is subject to change and may not be updated.

What makes a healthcare experience feel simple, trustworthy, and effective, even when the work behind it is anything but? On episode 107 of Astonishing Healthcare, host Justin Venneri sits down with Judi Health's Adam Murphy, Senior Director of Design, and Michelle Chambers, Director of UX/UI, to explore how thoughtful UX/UI design can transform healthcare from the inside out.

Adam and Michelle share a practical, behind-the-scenes look at designing for enterprise health tech, where complexity is high, workflows are critical, and poor design can slow decisions, increase errors, and erode trust. They explain why reducing cognitive load matters so much in healthcare, how strong design supports speed and accuracy, and why better user experiences can lead to better outcomes for both operational teams and health plan members.

• In healthcare, design must solve real problems, not just look good, because good UX means smoother workflows and fewer mistakes.
• Human-centered design, driven by genuine user pain points, leads to stronger, more intuitive solutions in health tech.
• Reducing cognitive load is essential, as strong UX/UI in healthcare platforms improves speed, accuracy, and outcomes under pressure.
• Designing with clarity and intention—such as using clear labels and wayfinding—prevents user errors and builds trust and efficiency throughout complex healthcare workflows.

Related Content

• Top 10 New Judi® Updates Improving Health Benefits Administration
• Health Benefits 101: Service Excellence & Scaling an Award-Winning Call Center Model
• AH027 - What is Pharmacy Benefit Management? With Jillian Lonson and Jean Beman, Part 1
• AH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya Lomsadze

For more information about this episode, please visit Judi Health - Insights.

Julie Selesnick, Executive Director of Legal and Compliance at Judi Group, joins the Astonishing Healthcare podcast for an in-depth discussion on the Department of Labor's proposed rules aimed at enhancing PBM transparency. Julie shares the highlights of Judi Group's submitted comments and explains how the Department could help reshape the healthcare landscape, improve fiduciary practices, and drive systemic change in the pharmacy benefits ecosystem - but it shouldn't stop there.

Julie dives into the arguments for and against the proposed rules, highlighting the importance of transparency in PBM compensation and the need for plan sponsors to understand the true costs associated with their health plans. She also discusses the potential impact of these regulations on reporting, which should get easier over time, and the medical side of drug spending, which is projected to outpace PBM-side drug spending in the near future. Julie's expertise and passion for improving fiduciary management make this episode a must-listen for anyone navigating the evolving worlds of healthcare policy and benefits.

Highlights

• Julie explains why the DOL's proposed rules are a critical step toward improving PBM transparency and enabling plan sponsors to make informed decisions.
• She emphasizes the need for clear disclosures on rebates, clawbacks, and indirect compensation to help plans verify reasonable compensation and minimize litigation risks.
• The discussion explores the growing importance of addressing medical-side drug spending, which could surpass PBM-side spending within the next five years.
• Julie shares insights on how machine-readable file disclosures could simplify compliance and create pricing benchmarks, enabling plan sponsors to evaluate whether costs are reasonable.
• State laws, the CAA 2026, these DOL proposed rules, and the recent FTC settlements all reinforce one another.

Related Content & Resources

• Fact Sheet: Proposed Pharmacy Benefit Manager Fee Disclosure Rule
• Judi Health Partner Summit Highlights: Progress is Impossible to Ignore
• AH102 - PBM Reform Update: Health Policy Changes Slowly, Until it Doesn't, with Lloyd Fiorini

Click HERE for more information on Judi Group.

Get in touch with Julie on LinkedIn.

For more information about this episode, please visit Judi Health - Insights.

Josh Golden, SVP of Strategy at Judi Health, returns to the Astonishing Healthcare podcast for a timely discussion about the world of drug pricing and what's shaking things up. Josh shares insights from his two decades of experience working with many of our country's largest employers and navigating [very heavy, sometimes scary] pharmacy benefit manager (PBM) contracts. He explains why the industry still relies on Average Wholesale Price (AWP) despite its known flaws, how Maximum Allowable Cost (MAC) lists have been used to drive hidden pricing arbitrage, and why the market is shifting so rapidly toward transparency and alignment.

The discussion covers the need for plan sponsors to understand the true cost of pharmaceuticals and how four massive forces are colliding to form "lightning in a bottle" that will drive systemic change in the pharmacy ecosystem. As reforms across the state and federal levels pressure the industry to adapt, plan sponsors must seek forward-thinking PBM partners that prioritize transparent pricing and decisions that benefit the plan and lead to better care for members.

Highlights

• Josh emphasizes the sordid history of AWP manipulation and explains why it remains a predominant, yet deeply flawed, pricing benchmark in PBM contracts.
• PBMs frequently deploy MAC lists to extract hidden value, creating wide pricing variations for plan sponsors, pharmacies, and patients.
• The healthcare industry is moving toward cost-plus economics, making more realistic and reliable pricing benchmarks even more important.
• Four major trade winds are accelerating PBM reform: state regulations, retail pharmacy closures, transparent cash prices for expensive drugs like GLP-1s, and plan sponsor class action lawsuits.

Related Content

• What is NADAC & How Does It Differ From AWP?
• Why this benefit leader switched to a more modern, transparent PBM
• What Is the Role of a Pharmacy Benefits Manager (PBM)?
• Health Benefits 101: The Importance of a Transparent PBM Model

For more information about Judi Health and this episode, please visit Judi Health - Insights.

On this episode of the Astonishing Healthcare Podcast, we sit down with return guest Bridget Mulvenna, Vice President of National Business Development at Judi Health, to break down the biggest pharmacy drivers of 2026. Bridget offers insights into how plan sponsors and benefits brokers and consultants can strategically evaluate pharmacy benefit managers (PBMs) by looking beyond unit costs and focusing on drug mix - formulary decisions and the shift to biosimilars, prior authorization approval rates, the generic dispensing rate (GDR), and much more.

The discussion covers the growing need to understand what challenges employer plan sponsors face, and why bringing a consultative approach to the table to help solve them is so important. How will moving to a biosimilar-first approach lower net drug costs for plan sponsors? How can a plan cover GLP-1s given their evolution and greater price transparency, expanding clinical indications, and direct-to-plan pricing models? And of course, Bridget shares her views on the sudden acceleration of state and federal PBM reform. As new legislation forces the industry to adapt, plan sponsors must seek forward-thinking platforms already aligned with the changes to provide better pricing and care for members.

Highlights

• Bridget emphasizes the financial advantages of adopting a biosimilar-first approach, which can significantly lower net drug costs for plan sponsors despite smaller rebate checks.
• GLP-1s are transformative medications - price transparency, expanding clinical indications, and direct-to-plan pricing models will influence future plan designs.
• Evaluating PBMs beyond unit costs is critical: formulary management, prior authorizations, and other clinical programs have the greatest impact on total pharmacy spend.
• The rapid acceleration of state and federal PBM reform is astonishing, and alignment with future proof organizations is essential, because there's more to come.

Related Content

• 6 recommendations for PBM procurement and Rx benefits optimization
• AH102 - PBM Reform Update: Health Policy Changes Slowly, Until it Doesn't, with Lloyd Fiorini
• Replay - PMPM vs Clinical Guarantees: A Pharmacist and an Actuary Explain How to Create Predictability Around Pharmacy Spend
• AH064 - Empowering Plan Sponsors: Data Access & Analysis, with Bridget Mulvenna

For more information about Judi Health and this episode, please visit Judi Health - Insights.

In this episode of the Astonishing Healthcare Podcast, we sit down with Amit Srivastava, Vice President and Head of AI at Judi Health and dive into the practical applications of artificial intelligence (AI) within the US healthcare system.

Have you ever wondered how AI can streamline notoriously manual clinical workflows? Amit shares his extensive background in AI, from early government projects to leading AI at tech giants, and explains why he joined Judi Health to help fix healthcare. Justin and Amit discuss the top use cases for AI today, including intelligent document processing that tackles the stubborn persistence of fax machines and paper claims, and the evolution of customer service through advanced, human-like AI agents. Finally, Amit offers a compelling glimpse into the future of proactive, personalized healthcare management, aided by AI.

Episode Highlights

• Amit discusses the massive potential AI offers to streamline manual clinical workflows, specifically by automating the ingestion of complex faxed documents, written text, and prior authorization forms.
• Intelligent document processing algorithms can achieve near-perfect accuracy, which reduces the time to response for prior authorizations and lowers operational costs.
• The deployment of customized AI agents in customer service can handle routine member inquiries, deflecting simple calls while assisting human representatives with complex issues.
• The future of healthcare AI lies in proactive, personalized systems that unify pharmacy, medical, dental, and vision data under a single platform.

Related Content

• AH086 - Balancing Technology and a Human Touch in Member Service, with Lisa Ellerhorst and Sonia Pettis
• Health Benefits 101: The Importance of Clinical Programs
• Judi Health wins 7 2026 Stevie® Awards for Sales & Customer Service
• Health Benefits 101: Service Excellence & Scaling an Award-Winning Call Center Model
• Pharmacy Benefits 101: Prior Authorizations

For more information about Judi Health and this episode, please visit Judi Health - Insights.

On this episode of Astonishing Healthcare, Lloyd Fiorini, General Counsel & Chief Compliance Officer at Judi Health, returns to the studio for a discussion about the barrage of regulatory changes shaping the pharmacy benefit manager (PBM) landscape in early 2026. Within just two weeks, the Department of Labor announced new proposed PBM rules, the Consolidated Appropriations Act of 2026 (CAA 2026) became law, and the FTC announced a settlement with Express Scripts. Then, to top it all off, TrumpRx went live.

Lloyd offers clear, helpful explanations of the key takeaways from each of these concurrent reforms aimed at improving transparency and how PBMs operate and interact with the other stakeholders in the supply chain, from independent pharmacies to patients and plan sponsors (employers). Whether you're responsible for a self-funded plan or overseeing a Medicare Part D plan, this episode provides the detail and insights about where the puck is going that you need. As Lloyd said, "I think we've made a great step forward, but the work isn't done."

It's also worth giving a shoutout to previous guest Jim Winkler, as "Change is Imminent" is in the title of AH090!

Episode Highlights

• The Department of Labor’s historic proposed rules on PBM disclosures fills a gap left by the CAA of 2021
• The CAA 2026 redefines the financial alignment of pharmacy benefits beyond just Medicare Part
• Patient/plan member protection seems to be what the FTC’s recent settlement was all about
• TrumpRx signals a broader shift toward transparent, cost-plus pricing models, but it's just for cash-paying customers, at least for now
• Delinking and efforts to block vertical integration are hotly contested

Related Content

• AH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing Healthcare
• How to obtain Rx data and what to do with it
• AH096 - A Quick Government Programs Update: The IRA & MPPP, Managing D-SNPs, and More, with Jason Barretto
• Signs it is time to change your PBM vendor, and how to overcome common hesitations

Reference Links

• US Department of Labor proposes historic pharmacy benefit manager fee disclosure rule (January 29)
• PBM Reforms Signed Into Law, Reshaping Medicare Part D Drug Pricing Transparency (February 3)
• FTC Secures Landmark Settlement with Express Scripts to Lower Drug Costs for American Patients (February 4)
• TrumpRx Launches (February 6)

For more information about Judi Health and this episode, please visit Judi Health - Insights.

On this episode of Astonishing Healthcare, Judi Health's Mike Tate (VP, National Business Development) and Mark Pearce (Director, TPA Operations) join us in the studio to discuss the role of Third-Party Administrators (TPAs) in the self-funded employer market. As Mike explains, TPAs act as the "enforcers" of an employer's plan document, responsible for pulling everything together and ensuring claims accuracy, network access, and financial stewardship. Mark dives into the distinction between carrier-owned (ASO) and independent TPAs, explaining how independent models offer greater flexibility in plan design. And of course, they highlight a significant industry challenge: legacy technology.

Many administrators rely on antiquated systems that limit customization and data visibility. In contrast, modern platforms empower plan sponsors to integrate point solutions effectively, customize networks for high-value care (e.g., through centers of excellence), and drive better member engagement. If you've ever asked yourself, "What does a TPA really do?" or "Should I look at different TPAs?" this episode will be worth your time to listen to.

Ultimately, successful healthcare administration relies on managing "hundreds of little things" correctly for each benefit (Rx, medical, vision, and dental) - from provider payments to member support. That's how you create positive financial and clinical outcomes.

Related Content

• AH080 - Health Benefits 101: The Importance of "Smart" Care Navigation, with Andy Kageleiry
• Replay: The Future of Health Benefit Design: How Judi® Powers Seamless Care and Better Outcomes
• AH067 - Aligned Health Benefits and the Freedom to Unbundle, with Kristin Begley, PharmD
• Judi Health™ Earns Best Healthcare InsurTech Solution in the 9th Annual MedTech Breakthrough Awards Program

For more information about Judi Health and this episode, please visit Judi Health - Insights.

For the 100th episode of Astonishing Healthcare, we welcomed AJ Loiacono, our co-founder and CEO, back to the show for a lively discussion about the evolution of our industry and business. What started as a transparent pharmacy benefits manager (PBM) in the "age of indifference" is now a more comprehensive health benefits manager (HBM), and we've entered the "era of acceptance." It's been an incredible 8+ years of growth, fueled by innovation and an unwavering commitment to our clients and delivering on our mission: to build the infrastructure our country needs to deliver the healthcare we deserve. But we had to endure an "age of confusion" to get here!

AJ explains why traditional healthcare giants are facing a "BlackBerry moment" - trying to emulate a conflict-free challenger when "it’s already too late." The balance of power is shifting away from the traditional PBMs, as the industry now demands full transparency - buyers of health benefits today are smarter than ever before. We also discuss how and why the U.S. wastes [at least] a trillion dollars annually by trying to deliver care using inefficient, fragmented systems; we built the infrastructure to stop it. This episode isn't just a retrospective; it’s a blueprint of sorts, and we've got the cultural DNA required to bring about sustainable change (vs. just daydreaming about it).

Related Content

• Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness
• Judi Health’s Capital Rx Surpasses Five Million Contracted PBM Lives as America’s Largest Employers, Unions, and Leading Health Systems Evolve Their Health Benefits Strategies
• AH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing Healthcare
• Health Benefits 101: Service Excellence & Scaling an Award-Winning Call Center Model

For more information about Judi Health and this episode, please visit Judi Health - Insights.

For Episode 99 of Astonishing Healthcare, we welcome Hannan Allen, SVP of Consultant Relations to the company and show! The discussion builds on Episodes 90 and 93, with Jim Winkler of Business Group on Health and Susana Villegas Spillman, respectively, by explaining why "pharmacy benefit consultants have a really tough job right now" and tackling some timely questions, including how has the role of the benefits broker or consultant evolved? What's making the job so complex lately? And, are plan sponsors' primary needs changing? We cover these questions and many more - including who will win Super Bowl LX. - with Hannan, so if you're working in the pharmacy and health benefits space, you won't want to miss this one.

Tune in to hear about:

• Biosimilars - the big opportunity and challenges PBMs have created
• The push for transparency, and what it means for consultants
• How to weigh price/cost, and why drug mix is so important
• Prioritizing member care and programs that benefit members
• The opportunity cost of sticking with the status quo (is astonishing)

Related Content

• How employers can take back control of unnecessary pharmacy spending
• Judi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform
• Replay: PBM Procurement Decoded: Insights from a Pharmacist and an Actuary
• Health Benefits 101: Service Excellence & Scaling an Award-Winning Call Center Model

For more information about Judi Health and this episode, please visit Judi Health - Insights.