The Astonishing Healthcare Podcast

Hosted by Judi Health

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117

Latest episode

Jun 2026

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EN-US

About the show

If you’ve ever wondered what pharmacy benefit managers (PBMs) do, why the pharmaceutical supply chain is so complicated or the pace of change in healthcare seems so slow, how vendor purchasing decisions are made, or why our nation’s electronic claim administration infrastructure must be updated, Astonishing Healthcare by Judi Health (Capital Rx) is the podcast for you. Covering everything from niche and broad pharmacy and health benefit topics to regulatory change, disruptive technologies, and macro issues like the trend for drug prices or the total cost of care, we’ve got the information and insights you need. For show notes and additional resources from Judi Health, visit https://www.judi.health.

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60 recent

June 12, 202625 min

AH109 - Unlocking PGx: Evidence, Use Cases, and Implementation

On episode 109 of Astonishing Healthcare, host Justin Venneri explores pharmacogenomics (PGx) with a trio of experts: Caitlin Munro, PharmD (Clinical Partnerships Lead, Judi Health); Haleh Campbell, PharmD (Clinical Programs Administration Manager, Judi Health); and Houda Hachad, PharmD (Vice President of Clinical Operations, Aranscia). Together, they break down what PGx is, why now is the right moment for broader adoption, and how genetics can shape the way each of us processes and responds to medications.The conversation moves from the basics to the practical: where the evidence is strongest, which patients stand to benefit most, and what it takes to apply PGx in a way that's clinically responsible and genuinely useful for patients and providers. They also dig into findings from a study the Judi Health team recently presented at the Pharmacy Quality Alliance (PQA) annual meeting and explain why pharmacist support and clinical decision support, not just a lab report, make all the difference.Key TakeawaysPGx adds a piece to the puzzle; it's not a silver bullet. Pharmacogenomics looks at how inherited genetic differences affect the way a person processes or responds to medications. It narrows uncertainty and supports clinical judgment, but it doesn't replace it.Several forces are converging to make this the right moment. Testing costs have dropped, evidence-based guidelines from expert consortia are now widely adopted, and hundreds of FDA labels include pharmacogenomic information.The strongest use cases involve complexity and risk. Patients on multiple medications, those starting new therapies, and people who've had treatment failures or unexpected side effects often benefit most, especially across common drug classes like antidepressants, cardiovascular medications, and pain therapies.Human support drives engagement and trust. Rx Helix data showed that testing adoption was significantly higher among members who received clinician-led, pre-test telephone outreach.The future is proactive. With unified claims processing that combines pharmacy and medical data, leaders see a path toward PGx-enabled medication management, identifying patients before therapy begins to optimize treatment earlier in their journey.Related ContentHealth Benefits 101: The Importance of Clinical ProgramsAH073 - How Low Cost Alternative Programs Can & Should Work, with Jackie Lolos, PharmD, and Haleh Campbell, PharmDReplay – The Bridge to Better Healthcare: Uniting Medical and Pharmacy Services on One Platform to Achieve Value-Based CareAH060 - A New Approach to Colorectal Cancer (CRC) Screening, with GeneoscopyFor more information about this episode and its transcript, please visit Judi Health Insights.

May 29, 202622 min

AH108 - Fixing Healthcare Interoperability and Modernizing Digital Workflows, with Brendan Keeler

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.Key TakeawaysInteroperability 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 ContentHow to obtain Rx data and what to do with itReplay - Unified Care Navigation: A Critical Component of the Future of Health Benefits DesignAH064 - Empowering Plan Sponsors: Data Access & Analysis, with Bridget MulvennaJudi Health Policy Update – It’s a Tangled Web of ProgressDisclaimerThis 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.

May 15, 202623 min

AH107 - How Good UX/UI Design Transforms Healthcare, with Adam Murphy and Michelle Chambers

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.HighlightsIn 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 ContentTop 10 New Judi® Updates Improving Health Benefits AdministrationHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center ModelAH027 - What is Pharmacy Benefit Management? With Jillian Lonson and Jean Beman, Part 1AH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya LomsadzeFor more information about this episode, please visit Judi Health - Insights.

May 1, 202625 min

AH106 - What You Need to Know About the DOL’s Proposed PBM Rules, with Julie Selesnick

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.HighlightsJulie 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 & ResourcesFact Sheet: Proposed Pharmacy Benefit Manager Fee Disclosure RuleJudi Health Partner Summit Highlights: Progress is Impossible to IgnoreAH102 - PBM Reform Update: Health Policy Changes Slowly, Until it Doesn't, with Lloyd FioriniClick 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.

April 17, 202622 min

AH105 - The Perfect Storm Driving the Future of Drug Pricing, With Josh Golden

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.HighlightsJosh 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 ContentWhat is NADAC & How Does It Differ From AWP?Why this benefit leader switched to a more modern, transparent PBMWhat Is the Role of a Pharmacy Benefits Manager (PBM)?Health Benefits 101: The Importance of a Transparent PBM ModelFor more information about Judi Health and this episode, please visit Judi Health - Insights.

April 3, 202627 min

AH104 - Biosimilars, GLP-1s, PBM Reform, and Other 2026 Pharmacy Drivers, with Bridget Mulvenna

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.HighlightsBridget 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 Content6 recommendations for PBM procurement and Rx benefits optimizationAH102 - PBM Reform Update: Health Policy Changes Slowly, Until it Doesn't, with Lloyd FioriniReplay - PMPM vs Clinical Guarantees: A Pharmacist and an Actuary Explain How to Create Predictability Around Pharmacy SpendAH064 - Empowering Plan Sponsors: Data Access & Analysis, with Bridget MulvennaFor more information about Judi Health and this episode, please visit Judi Health - Insights.

March 20, 2026Episode 10321 min

AH103 - Proactive, Personalized, and Powerful: The Future of AI in Health Benefits, with Amit Srivastava

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 HighlightsAmit 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 ContentAH086 - Balancing Technology and a Human Touch in Member Service, with Lisa Ellerhorst and Sonia PettisHealth Benefits 101: The Importance of Clinical ProgramsJudi Health wins 7 2026 Stevie® Awards for Sales & Customer ServiceHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center ModelPharmacy Benefits 101: Prior AuthorizationsFor more information about Judi Health and this episode, please visit Judi Health - Insights.

March 6, 202614 min

AH102 - PBM Reform Update: Health Policy Changes Slowly, Until it Doesn't, with Lloyd Fiorini

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 HighlightsThe Department of Labor’s historic proposed rules on PBM disclosures fills a gap left by the CAA of 2021The 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 aboutTrumpRx signals a broader shift toward transparent, cost-plus pricing models, but it's just for cash-paying customers, at least for nowDelinking and efforts to block vertical integration are hotly contestedRelated ContentAH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHow to obtain Rx data and what to do with itAH096 - A Quick Government Programs Update: The IRA & MPPP, Managing D-SNPs, and More, with Jason BarrettoSigns it is time to change your PBM vendor, and how to overcome common hesitationsReference LinksUS 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.

February 20, 202628 min

AH101 - Health Benefits 101: What's a Third-Party Administrator (TPA)?

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 ContentAH080 - Health Benefits 101: The Importance of "Smart" Care Navigation, with Andy KageleiryReplay: The Future of Health Benefit Design: How Judi® Powers Seamless Care and Better OutcomesAH067 - Aligned Health Benefits and the Freedom to Unbundle, with Kristin Begley, PharmDJudi Health™ Earns Best Healthcare InsurTech Solution in the 9th Annual MedTech Breakthrough Awards ProgramFor more information about Judi Health and this episode, please visit Judi Health - Insights.

February 6, 202631 min

AH100 - The End of the Age of Confusion, It's Time for Acceptance, with AJ Loiacono

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 ContentReplay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and WellnessJudi Health’s Capital Rx Surpasses Five Million Contracted PBM Lives as America’s Largest Employers, Unions, and Leading Health Systems Evolve Their Health Benefits StrategiesAH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center ModelFor more information about Judi Health and this episode, please visit Judi Health - Insights.