The Astonishing Healthcare Podcast

This episode of Astonishing Healthcare features three members of The Judi Group's leadership team: Jeff Hogan (Co-Founder & Managing Director), Chris Deacon (Director, Growth & Strategy), and Julie Selesnick (Director, Legal & Compliance). The Judi Group is a new venture - a premier advisory firm in healthcare on a mission to help companies evaluate the totality of their health vendors and contracts, deliver insights that lead to more responsible action, and ultimately improve the overall cost picture and health outcomes for their health plans and plan members, respectively. But why now? What steps can employer plan sponsors take to improve their contracting and access data? How do you set up a sustainable fiduciary process? For the answers to these and many more questions, like our guests' personal reasons for embarking on this journey, you'll have to listen in!

Highlights

• We've reached a boiling point - everyone is tired of how the US healthcare system operates,, the misaligned incentives throughout the supply chain, and the unnecessary complexity of it all.
• There's a growing willingness among employers to challenge the status quo, embrace transparency, and create customized benefit plans that better serve their unique populations.
• Jeff is driven - in part - by his experience as a public servant, Julie tends to fight for the underdog, and Chris is inspired by the opportunity to make a tangible difference in healthcare.
• The RFP process must be redesigned for each employer, with their unique needs in mind.
• Access to claim-level data is critical if employers are to fulfill their fiduciary duties, make informed decisions, and ensure prudent use of employees' healthcare dollars.

Related Content

• AH041 - ERISA Litigation Outlook and Meeting CAA Requirements: What Can Plan Fiduciaries Do?
• Health Benefits 101: The Importance of a Transparent PBM Model
• Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness
• Judi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform

To learn more about the Judi Group, the team, and its mission and services, please visit www.judi.group.

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

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.

For Episode 97 of Astonishing Healthcare, we sat down with three team members who interned with Judi Health (Capital Rx) and recently joined our mission as full-time employees! Jakob Deel, Lisa Yu, and Bryan SebaRaj discuss their respective paths to Judi Health, from why they chose healthcare and how they found their internships to why they decided to join a newer, disruptive health tech company over larger "hyperscalers." So, this episode has something for every undergrad and graduate student.

That said, Episode 97 isn't just about landing an internship or transitioning from an intern to full-time employee. The trio also discusses the engineering, development, and operations/policy work they are doing to help advance our industry. Our goal is really to raise awareness of the different paths the next generation of healthcare disruptors can take, how to prepare if you're on that path, and highlight the reward at the end of this first step in what will undoubtedly be long and successful careers!

To learn more about life at Judi Health, check out our Careers Page, and keep an eye out for our 2026 summer internship program openings, which will be posted there soon.

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

For Episode 96 of Astonishing Healthcare, Jason Barretto, our SVP of Government Programs, returns to the show for a discussion about what's happening on the health plan side of the business. As a company, we spend a lot of time talking about and showing how modern technology streamlines benefit administration workflows and overall operating efficiency, solves longstanding problems, and helps clients stay nimble to meet the intent of new regulations. Well, Jason's experience managing PBM relationships at health plans helps him - and our team - add real value when working with our clients. And, thankfully, he loves to talk about it!

During this episode, we discuss:

• Intensifying demand for transparency (beyond just price transparency)
• The Inflation Reduction Act (IRA) and the implementation of Maximum Fair Prices (MFP)
• Slow adoption of the Medicare Prescription Payment Plan (MPPP) and how CMS is removing barriers
• A streamlined approach to managing Dual Special Needs Programs (D-SNPs), something Jason "wanted to solve" when he started here
• A really interesting observation about the popularity of GLP-1s
• CMS changing its audit approach and the importance of audit readiness in 2026

Related Content

• How Our Favorite New Judi® Features Aid Government Programs
• Judi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform
• Judi® is a Tech-Enabler – A Case Study
• AH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya Lomsadze
• Partnership & Collaboration: Why PBMs and Health Plans Should Sync on Regulatory Change Management

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

Episode 95 of Astonishing Healthcare features six previous guests on the show who share astonishing observations from 2025 and some bold predictions for the New Year! Industry veteran Jeffrey Hogan, our General Counsel and Chief Compliance Officer, Lloyd Fiorini, ERISA law expert Nick Welle, two of our clinical leaders – Sarra Izadi, PharmD, Chief Clinical Officer, and Bonnie Hui-Callahan, PharmD, CDCES, Sr. Director, Clinical Programs, and our Chief Technology Officer and Co-Founder, Ryan Kelly, joined us for this round-robin discussion that’s packed with insightful reflections and optimism about the future.

We won’t ruin it in the show notes, but based on what we saw in 2025:

• Everyone has finally had enough of the costs and opacity of the U.S. healthcare system – a $70k family premium is truly astonishing
• It’s surprising that, despite the lawsuits, warnings, and reform efforts, the proverbial hammer didn’t drop on anyone for not being a good health plan fiduciary
• The speed and impact of AI have broadly been more positive than expected
• The rise of cardio-diabesity
• How GLP-1s helped shift the balance of power in the pharmaceutical supply chain

And in 2026, we may see:

• Employers fight back – they take agency over their plans, and for first movers that started with transitioning to aligned PBMs, it’s “game on” for the rest of their health plans
• The cash price – or acquisition cost – of drugs in the U.S. becomes the baseline – i.e., we finally see a real change in how drugs are priced
• ICHRAs and other alternative models become more popular
• Employers look to new clinical programs and models that demonstrate a return on their spending
• AI become more important for clinical workflows (not decision-making, at least not yet)
• Pharmaceutical manufacturers find themselves with increasing bargaining power vs. traditional PBMs
• A new Stanley Cup champion, and a Super Bowl ring for…

Related Content

• Judi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform
• Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness
• AH094 - How Unified Claims Processing Evolved from Pharmacy: Improving Member Care & Operating Efficiency
• Health Benefits 101: The Importance of Clinical Programs
• How to obtain Rx data and what to do with it

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

We got the ball rolling in 2025 with this episode, and it ended up at the very top of the activity list, so we'll close out the year with it as well! Thank you, Dr. Eric Bricker for joining us in the studio for Episode 48 of the Astonishing Healthcare podcast. Known for his entertaining and educational videos covering all sorts of hot topics in and around healthcare and employer/employee benefits, Dr. Bricker and host Justin Venneri discussed the issues of high-cost drugs and access to claims data - two topics he covered on AHealthcareZ - Healthcare Finance Explained - that should [still] be top of mind for plan sponsors as pharmacy costs continue to rise.

Dr. Bricker shared several ways employers, depending on their size and risk tolerance, may be able to navigate the challenge of rising pharmaceutical costs for orphan and other expensive drugs - including GLP-1s. He also explains how the RFP process can be used to secure the plan's claim data, which is necessary to meet fiduciary obligations. While every plan is unique, most plan sponsors face similar challenges that the traditional PBM model isn't flexible or aligned enough to solve.

Lastly, Dr. Bricker expressed astonishment by the complacency out there, but he was right! The setup was perfect for an acceleration in the pace of change in 2025, and we see the momentum carrying over into 2026 - so, tune in to hear why, if you didn't catch Episode 48 the first time around.

AHealthcareZ Reference Videos

• High Cost Orphan Disease Drugs Explained
• Do Employers Own Their Claims Data? It's Complicated.

Related Content

• AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff Hogan
• How to obtain Rx data and what to do with it
• AH093 - Health Benefits that Work for Everyone: Aligning Incentives & Focusing on Members’ Needs, with Susana Villegas Spillman
• Why Savings Don't Materialize: The Truth About Pharmacy Benefit Procurement eBook (Free)

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

In this Best of '25! episode of the Astonishing Healthcare podcast, Lisa Ellerhorst (Sr. Director, Customer Care Operations) and Sonia Pettis (Manager, Customer Care Operations) discuss our approach to member care! Lisa and Sonia have been with Judi Health (Capital Rx) since 2020 and have helped Will Tafoya develop our unique contact center model from the ground up.

Building on Episode 34 - Customer Care in Healthcare: Setting a Higher Bar, and the questions plan sponsors and benefits consultants often ask during the RFP process (Episode 84), this episode covers:

• Several of the most frequent reasons plan members call and how those questions are handled, including switching a prescription from retail to mail and vice versa, prior authorizations for GLP-1s, and more.
• How to navigate transitions and focus on quality care (over speed).
• What it takes to maintain a high level of customer satisfaction (99%) while handling a 50% spike in call volume year-over-year.
• The communication strategy used to educate members and help them navigate new offerings effectively.
• The role of AI and how agentic AI can support member care and free up our skilled, PTCB-certified reps to handle more complex issues.
• Future-proofing the service model and preparing for the 2026 welcome season.

Related Content

• Pharmacy Benefits 101: Building an Award-Winning Call Center from Scratch
• AH017 - Pharmacy Benefits 101: Prior Authorization
• How employers can take back control of unnecessary pharmacy spending
• Capital Rx’s Customer Care Team Wins 5 Stevie® Awards for Customer Service
• Watch: Are Your Prior Authorizations Actually Working?

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

Episode 94 of Astonishing Healthcare features two members of our product team, Liya Lomsadze (Sr. Director) and Jake Mulkey (Director), who explain how building a next-generation pharmacy claim adjudication system (Judi®), known for its split-second accuracy and streamlined workflows, served as the perfect foundation for building a unified platform that now includes medical claims, and will integrate vision and dental, too. Liya and Jake explain the contrast between pharmacy’s real-time nature and medical’s weeks-or-months-long lag, and how this gap impacts the experience for members and providers of care.

The discussion covers the challenges behind supporting complex plan designs, opportunities around automating prior authorizations with real clinical data, and benefits of reducing manual interventions that slow down or interfere with care coordination. Liya and Jake also share stories about launch day, lessons learned from pharmacy claim adjudication, and their vision for a real-time future with integrated benefits. This episode is a must listen for anyone interested in how enterprise health technology can improve health benefit administration and focus resources on what's most important: plan members' experience and improving health outcomes.

Related Content

• Replay – The Bridge to Better Healthcare: Uniting Medical and Pharmacy Services on One Platform to Achieve Value-Based Care
• AH080 - Health Benefits 101: The Importance of "Smart" Care Navigation, with Andy Kageleiry
• Medicare Transition Benefits & How Judi®’s Modern Design Enables Faster Results and Reliable Compliance
• Health Benefits 101: The Importance of Clinical Programs
• This Startup Hit A $3.25 Billion Valuation Building Software To Fix Drug Pricing (Forbes)

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

Episode 93 of Astonishing Healthcare features Susana Villegas Spillman, who brings over 20 years of health benefits plan management experience to the studio for a discussion about what works, what’s broken, and what employer plan sponsors deal with day in and day out. This “unfiltered perspective” from the plan sponsor’s seat is welcome and timely. If you’re one of the increasingly large percentage of benefits directors, CHROs, CFOs, et al. out there looking to transition from a traditional benefits experience to a new, transparent, aligned, unified model, this episode is for you!

Susana explains how a fragmented system fails members, and while we’ve evolved from the default “call the number on the back of the card” - which directs you to the emergency room - point solutions create more silos, and data is too scattered and stale to drive meaningful change. This forces employers to take control, which leads to her “most astonishing thing,” which is a critical reminder for every benefits leader: “Know what’s in your contracts.”

Episode 93 covers:

• The importance of centering the strategy around long-term goals and member experience (with ruthless accountability).
• The upside of unbundling services from carriers and using independent navigation partners to guide members to high-quality care; why culture fit and flexibility matter when evaluating vendors.
• Why qualitative measures of success offer a better gauge of program effectiveness vs. empty promises of ROI.
• The evolving role of benefits consultants, and how to evaluate consultant relationships.
• The outdated RFP processes and how to run a better RFP.
• GLP-1 coverage for weight loss.

Related Content

• Health Benefits 101: The Importance of a Transparent PBM Model
• Why this benefit leader switched to a more modern, transparent PBM
• Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness
• AH078 - More About Judi Health™ & the Unified Benefits Experience, with Dr. Sunil Budhrani and Mike Tate
• Check out our Health Benefits 101 Content

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

The level of interest in Episode 84 of Astonishing Healthcare made this one an easy choice to lift it to "best of" status. We'll be back with fresh new episodes in early December, and then we'll close out the year with two more Best of '25s. For those of you who didn't check this one out, Josh Golden, SVP of Strategy, and RFP Content Manager, Nic Bolitho, joined host Justin Venneri in the studio for a discussion about trends they're seeing in the market and how to run a better request for proposal (RFP) process to select a pharmacy benefit management (PBM) partner. Long story short, the "old way" of running a PBM RFP is broken, but, as Josh describes, there are some "tectonic shifts" happening as plan sponsors demand to see more options (i.e., transparent PBMs) and benefits brokers and consultants upgrade the questions and scoring used to force accountability and drive meaningful results for plans and plan members.

Highlights

• Unit-cost-based spreadsheet comparisons and marketing fluff are "out;" evaluating drug mix and how the PBM manages the plan (the 'M' in PBM) or makes money off of the plan are "in."
• Plan sponsors and benefits consultants must demand flexibility - the PBM contract should not be a "house of cards." For example, agreements should provide the freedom to add new vendors or carve out services without collapsing your financial arrangement.
• Legacy tech platforms are a barrier to innovation; ask potential partners if their technology can handle customizations and integrations with agility to avoid being told, "We just can't do that."
• Precise questions about member experience are a must; RFPs should move beyond open-ended questions that invite marketing fluff. Use specific, binary questions to obtain an accurate measure of the member experience and the effectiveness of clinical programs (e.g., NPS, turnaround times for prior authorizations, etc.).

Related Content

• Replay: PBM Procurement Decoded: Insights from a Pharmacist and an Actuary 
• Why Savings Don't Materialize: The Truth About Pharmacy Benefit Procurement eBook 
• AH034 - Customer Care in Healthcare: Setting a Higher Bar, with Will Tafoya
• AH035 - Pharmacy Benefits 101: Clinical Programs, with Bonnie Hui-Callahan, PharmD
• 5 ways to improve PBM procurement (EBN) 

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

In this episode of Astonishing Healthcare, Judi Health's Sam Custer, who leads the member communications team, shares tips and insights on how to communicate effectively with plan members - around open enrollment and throughout the year. Sam last joined us for Episode 39, which highlighted how the communications and product teams collaborated to ensure we provide clear, compliant communication materials to Medicare members to meet CMS requirements, and this time, we dive into how to educate plan members at open enrollment and throughout the year. After all, as Marsha Perry, our head of benefits and compensation, explained during Episode 72 - The Benefits You Probably Didn't Know You Have, benefits-related education is more than just a once-a-year thing (during open enrollment).

Sam describes how we approach understanding each client's unique needs and the importance of consistent messaging across all channels. We dive into ways to keep members informed throughout the year, the benefits of in-person/on-site events, and much more. If you're a "benefits nerd" like us (and Marsha 😀), this episode is for you.

The Articles that Prompted the Episode

• Employers prepare for disruptive and transformative health plan changes, WTW survey finds
• Benefit managers share their 7 open enrollment best practices

Related Content

• AH050 - PBM Pain Points and Overcoming the Fear of Change, with Hope Nakazato, PharmD
• 12 New Judi® Features Innovating Pharmacy Benefit Administration
• AH082 - Pharmacy Benefit Implementations: Have No Fear, Alignment & Process are Here

For more content and information about this episode, including the show notes and transcript, please visit Judi Health - Insights.