Podcast appearances and mentions of Vinay Patel

In this episode of ShiftShapers, host David A. Saltzman sits down with Vinay Patel, PharmD, founder of MakoRX, to expose why prescription pricing remains so confusing—and what can be done to fix it.Patel breaks down how pharmacy benefit managers (PBMs), vertical integration, and opaque pricing structures are driving up costs for patients—while limiting access and undermining local pharmacies. From subscription pharmacy programs to cash-pay and compounding models, Patel shares bold, practical solutions for bringing real transparency back into the healthcare system.

Bo welcomes CEO of SREE Hotels to discuss how the business landscape has changed in Charlotte following the Covid pandemic.See omnystudio.com/listener for privacy information.

In this episode of Healthcare Happy Hour, David Saltzman speaks with Vinay Patel, founder of MakoRx, about the evolving role of community pharmacies in the healthcare landscape. They discuss the challenges faced by these local pharmacies as they compete with big box competition, the importance of transparency in drug pricing, and innovative models like subscription services that aim to improve access and affordability. The conversation also touches on the potential for legislative reform to create a more equitable healthcare system.

In this episode of The Common Sense MD, Dr. Rogers speaks with Vinay Patel, PharmD, about the challenges of making pharmaceuticals affordable. They explore staggering price disparities, such as a narcolepsy patient facing a $750 bill at CVS versus $35 via GoodRx at Food City, and discuss why such differences occur. Vinay introduces MakoRx, his company using a cost-plus model to promote transparency and affordability in medications, particularly through local mom-and-pop pharmacies. Dr. Rogers and Vinay also tackle the role of PBMs and the importance of personalized pharmacy care. This episode is a must-listen for anyone interested in the intersections of healthcare, pharmaceuticals, and patient advocacy. For more insights, visit makorx.com. Tune in now for practical solutions to drug pricing issues. Check out our brand new online vitamin store: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://performancemedicine.net/shop/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ What did you think of this episode of the podcast? Let us know by leaving a review! Connect with Performance Medicine! Sign up for our weekly newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://performancemedicine.net/doctors-note-sign-up/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@PMedicine⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@PerformancemedicineTN⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Performance Medicine⁠

In this episode of the Future Processing US Spotlight Series, Vinay Patel and Bernard Williams from OIC Advisors, bringing their extensive corporate leadership experience, sit down with Mike Zamarski and Konrad Bałys, our tech and digital transformation consultants, to explore the evolving role of consultancy and technology in delivering business value. Hosted by Paula Lipnick, the conversation dives into:the best methods of achieving the right mix of consultancy and tech expertise to deliver measurable outcomes and business value,the advantages of tackling increasing business complexities with a tech-driven consultancy,strategies to enhance communication and streamline collaboration between tech and business teams,predictions for the future in an AI-driven, hybrid-work environment.This discussion sheds light on how organisations can combine strategic advisory with technical expertise to achieve measurable, long-term results.

For a full transcript of this episode, click here. In this healthcare podcast we're talking about pharmacy acronyms or terms like AWP and WAC, and, not really an acronym, but we'll also talk pharmacy list prices, rebates, discounts. We also have NADAC, but that's slightly off to the side for reasons we'll get to in a sec. Most of these acronyms refer to a number with a dollar sign in front of it, and it's hell on wheels to figure out if and/or to what extent that number reflects what is going on in the real world, especially if you are a patient or a plan sponsor and all you see is the list price that Pharma puts out on one side of the storyboard, and then what the patient pays or (if you're lucky) what the plan pays for the drug on the way other side of the whole chain of events. What's a black box a lot of times for patients and plan sponsors is what goes on in the middle, wherein many middle people get their mitts on the transaction. Real quick here, let's run through the Mister Rogers' neighborhood of all of these middle people right now; and we're gonna do this really briefly. Most of you are already going to know most of this, but I just want to remind you so that when my guest today, Luke Slindee, and I kick into the conversation about the acronyms and the terms and we try to follow the dollar … yeah, you can put a name to a face. Alright, so first we have pharma manufacturers. The pharma manufacturer—and this is largely gonna be true whether it's a branded drug or a generic pharma manufacturer—but the manufacturer sets a list price. This list price is gonna be called an AWP or a WAC price, and we're gonna get into the differences and what those terms actually mean in the show that follows. But Pharma decides their price point. They go to wholesalers with that price. Wholesalers say they want a discount to purchase the product. Some kind of rebate or discount is negotiated. Now the wholesalers have the drug, and they get calls from pharmacies. Pharmacies have patients who have scripts for that, so the pharmacies need to buy the drug. What price does the pharmacy now pay the wholesaler for the drug? Short answer: It's nuts. It's nuts how the wholesalers decide what to charge the pharmacies for the drug. We talk about that in the interview that follows, but suffice to say that now we have the list price turning into whatever price the pharmacies wound up paying to get the drug from the wholesalers for. Any way you cut it, the wholesalers are making some money. Okay … now we get to the part where we're figuring out how much the patient or the plan sponsor will pay to pick up that drug that started at the pharma manufacturers and went to the wholesalers and now is at the pharmacy. How much are the patients gonna pay? How much are the plan sponsors gonna pay? If you spend any time in the real world (not the drug supply chain world), what you'd expect to happen next is that the patient would go into the pharmacy and the pharmacist would charge a markup and/or a dispensing fee on the price that they bought the drug from the wholesaler for. That'd be normal. And this can be the case when patients pay cash. Listen to the show with Mark Cuban (EP418, along with Ferrin Williams, PharmD, MBA), who started a pharmacy called Cost Plus Drugs. Get it? Their prices are cost plus. You have had other pharmacies for years doing similar things, like Blueberry in Pittsburgh. They get the drug. They buy it from a wholesaler or etc. But they buy the drug for some price, and then they sell it to their customers (ie, patients) at their cost plus. But most of the time in pharmacy supply chain world, things don't work that way because many patients have insurance. When a patient walks into the pharmacy, someone has to figure out how much the patient owes and how much their insurance will cover, right? So, enter PBMs (pharmacy benefit managers). They originally started out doing this math (ie, adjudicating claims), figuring out what the out-of-pocket will be for the patient and then what the insurance will cover. Then drugs started to get really expensive and a few other developments, and then, all of a sudden, we have PBMs negotiating with Pharma for how much of a rebate the PBM is going to demand for the PBM to put the manufacturer drug on formulary. The PBM also is determining how much they will pay the pharmacy for said drug on behalf of plan sponsors, in addition to doing the math for how much the patient will pay. So, let me say that again because it kind of begs a “what now?” with eyebrows sky-high as the appropriate response to what I just said, especially if you think through the ramifications here, ramifications which I discuss at length with Vinay Patel (EP241); Benjamin Jolley, PharmD (EP422); Scott Haas (EP365); Paul Holmes (EP397); and others. So, again, the PBM is not just adjudicating claims. They are also negotiating rebates from Pharma so plan sponsors do not have to pay the full amount that the wholesalers paid Pharma and that the pharmacies paid the wholesalers, which maybe is a lot of money. The PBMs are like, “Hey, Pharma. You need to give me a piece of your action because we, the PBM, have big market power. I serve 100 million patients or something. So, if you want access to my 100 million lives, you gotta shell it out. You gotta shell me out some rebates.” So, fine, Pharma gives the PBM some amount of money in the form of a rebate. And it has to work that way, if you think about it, because the drug was originally sold to the wholesaler. You see what I'm saying? So, the pharma company has to give the PBMs a separate rebate amount. This is in addition to how much the PBM told the plan sponsor the plan sponsor owes for the drug, which is also paid to the PBM. But now, PBM is also still in charge of adjudicating the claim. So, they're telling the pharmacy how much to charge the patient. Somehow or another also, the PBM also got itself in charge of deciding how much money the pharmacy itself would be reimbursed by that PBM. In the rest of the world, the pharmacy might tell the PBM, “Hey, this is the price.” But not in pharmacy supply chain world. In pharmacy supply chain world, the PBM tells the pharmacy how much it's gonna pay. The end. And this, my friends, is how so often pharmacies get themselves in the pickle of having to pay the wholesaler one price to get the drug while they get reimbursed a totally different price to dispense the drug. And because independents have very little negotiating leverage on actually either side of that equation, they so very often buy high and sell low. Please listen to the shows with Benjamin Jolley (EP422) and Vinay Patel (EP241), where we get into this in a lot of detail. But I just want to emphasize this point: All of that whole drug supply chain I just went through, where the manufacturer sells to the wholesaler who sells to the pharmacy and the PBM pays the pharmacy and the patient is paying something and the plan sponsor is paying something—many of the middleman transactions in there happen under the cover of darkness a lot of times. If I'm a plan sponsor, do I have any idea how much the PBM paid the pharmacy for any particular drug? Unless you're good at looking at the NADAC numbers (more on this coming up), no. I do not have any idea what a fair price for that drug actually is and how much people are making on the back of that drug as it goes through the supply chain. And this, my friends, is how come spread pricing can exist. Because spread pricing is when the PBM charges the plan sponsor more than they are paying the pharmacy, pocketing the difference, and then calling what they pocket a trade secret—even if it's the plan sponsor whose butt is on the line to make sure that what the PBM is pocketing is fair and reasonable compensation. I mean, if only J&J had listened to this show (EP428). Here's a link to the lawsuit, which is about J&J paying ridiculous amounts in spread pricing. If what I just said is really confusing, I'm gonna validate that and say, “Yeah, it is really confusing.” And to a certain extent, that might be the main point. Where there's mystery, there's margin and all of that. Here's what Dawn Cornelis said on LinkedIn in response to an article about the lawsuit: “Data accessibility lies at the heart of mitigating a fiduciary lawsuit. It all begins with gaining access to your data. But let's be clear—it's not an easy feat. The major hurdle? Procuring accurate data from your TPA [third-party administrator]. And that's just the first step. The subsequent challenge involves analyzing this data, a task best handled by a skilled healthcare data analyst—yet another formidable undertaking.” The one acronym in this whole stew that is not questionable at all is the NADAC. So, let's talk about the NADAC for a moment, the National Average Drug Acquisition Cost Price Benchmark. I was really thrilled to get Luke Slindee to be my guest today—or one reason I was so thrilled—is because Luke works for the accounting firm who, on behalf of CMS (Centers for Medicare & Medicaid Services) and the federal government, administers this NADAC, the National Average Drug Acquisition Cost. (Here's a good NADAC explainer if you're interested.) In brief, NADAC was jointly developed by the Centers for Medicare & Medicaid Services, and it calculates the average price that pharmacies pay for prescription drugs. NADAC is based on a retail price survey. My guest today, as aforementioned, is Luke Slindee. He is a second-generation pharmacist. His family owned a pharmacy in Minnesota when he was growing up. Now he is a senior pharmacy consultant for Myers and Stauffer, which is the accounting firm that calculates the NADAC Price Benchmark on behalf of CMS and the federal government. Also mentioned in this episode are Mark Cuban; Ferrin Williams, PharmD, MBA; Blueberry Pharmacy; Vinay Patel; Benjamin Jolley, PharmD; Scott Haas; Paul Holmes; Dawn Cornelis; Capital Rx; Myers and Stauffer LC; Adam Fein; Joey Dizenhouse; Steven Quimby, MD; and Antonio Ciaccia.   For additional information, go to data.medicaid.gov. You can also follow Luke on LinkedIn.   Luke Slindee, PharmD, is a second-generation pharmacist with a background in independent pharmacy, chain pharmacy, data analytics, and prescription drug pricing. He currently supports public drug pricing transparency benchmarks and is an advocate for pharmacy reimbursement reform and antitrust enforcement in healthcare.   09:52 Why is it important for plan sponsors to understand the going rate for every point in the supply chain? 10:21 How do manufacturers come up with a list price? 10:40 What does AWP stand for? 10:59 What does WAC stand for? 11:06 How are AWP and WAC numbers chosen by the manufacturer? 13:22 What is the difference between AWP and WAC? 14:54 How much are wholesalers paying to manufacturers? 16:43 How much is the pharmacy paying for branded drugs from a wholesaler? 17:34 Why might pharmacies be buying drugs for less than what wholesalers are paying? 18:17 Substack article by Benjamin Jolley, PharmD, on this topic. 19:22 EP423 with Joey Dizenhouse. 20:33 Why do things get weird when a PBM gets involved? 21:58 How does all of this work for generic manufacturers? 25:20 EP344 with Steven Quimby, MD. 26:15 How did Civica Rx come about? 32:21 What's the difference between the NADAC and the AWP value? 36:04 Luke discusses the downstream effects to pharmacies.   For additional information, go to data.medicaid.gov. You can also follow Luke on LinkedIn.   Luke Slindee discusses #followingthedollar through #WAC, #AWP & #NADAC on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Julie Selesnick, Rik Renard, AJ Loiacono (Encore! EP379), Nina Lathia, Marshall Allen, Stacey Richter (INBW39), Peter Hayes, Joey Dizenhouse, Benjamin Jolley, Emily Kagan Trenchard (Encore! EP392)

Vinay Patel - Head Men's Basketball Coach at Angelo State University

Vinay Patel - Head Men's Basketball Coach at Angelo State University

Vinay Patel - Head Men's Basketball Coach at Angelo State University

Vinay Patel - Head Men's Basketball Coach at Angelo State University

Vinay Patel - Head Men's Basketball Coach at Angelo State University

"I think the action and the continuity of the coalition from Prop S to Prop E went from 40 organizations to 140 organizations. That was something that was huge” - Vin SeamanIn this seventh episode of our series focusing on the arts and culture sector's recovery from the Covid-19 pandemic, we bring you highlights from the Co-Production of Arts For A Better Bay Area (ABBA) State of The Arts Summit, held at the Strand Theatre in San Francisco on June 28th, 2023. The summit centered around rebuilding communities through the arts.This episode features a community conversation from the ABBA Summit, discussing the status of Proposition E from 2018, the Arts Impact Endowment, and Grants for the Arts. Our panel includes voices from:- Joe Landini, Founder and Director of Giving at Safe House Arts- Vinay Patel, Executive Director of the Asian Pacific Islander Cultural Center- Denise Pate, Director of Community Investments for the San Francisco Arts CommissionThe second part of our discussion features an interview with ABBA Summit attendee, Shrey Purohit an artist and cultural worker at Arts Span; Along with a One on One Interview with Vallie Brown, the Director of the City of San Francisco's Grants For The Arts, along with our wonderful co-host Isa Nakazawa, the Director of Community Engagement of BAVC Media.To find out more information about our guests and their respective organization's programs, and services, how to volunteer and make a donation please visit our episode landing page with links to resources for the arts and culture sector. And if you have been enjoying the show, please leave us a rating and review on the podcast platform of your choiceWe welcome your participation in our next virtual and live in-person community dialogue event. You can also watch this episode on our YouTube Channel and please Sign Up for our Newsletter to stay up to date on future episodes and to participate in our next live show. We would love to hear from you with feedback and show ideas, so send us an email to george@georgekoster.com.Please consider donating to Voices of the Community - Voices of the Community is fiscally sponsored by Intersection for the Arts, a 501(c)(3) nonprofit organization, that allows us to offer you tax deductions for your contributions. Please consider making a donation to help us provide future shows just like this one. Dive Into More Information on Each Episode, Speakers, Organizations and Resources at our Voices of the Community's Special Arts & Culture Series Web Landing Page https://georgekoster.com/voc-series-arts-cultures

For a full transcript of this episode, click here. Listen to this show as either a follow-on or a prequel to the shows with Mark Cuban and Ferrin Williams, PharmD, MBA (EP418) and Ge Bai, PhD, CPA (EP420). And if you're interested in this “what's going on in the world of PBMs, pharmacies, and employers” topic, also listen to the show with Joey Dizenhouse coming out on January 11, 2024. If you need the 101 on what's going on out there for indie pharmacies in your community, I'd recommend the show with Vinay Patel (EP241). What would you do if you owned an independent pharmacy and you discovered that most of your profit was coming from dispensing 10% of prescriptions? That if you just stopped filling 90% of the drugs; fired all your staff except, like, one person; and just filled the drugs that you made money on? If you did this, you would actually make more money in the pharmacy than you're currently making filling every single prescription. What would you do? This is the math that Benjamin Jolley, PharmD, my guest in this healthcare podcast and a multigenerational pharmacy leader and consultant to other pharmacies, discovered and wrestles with on the show today. And oh, by the way, a pharmacy is not gonna make it up in extra toilet paper sales or chewing gum sales when patients come into the pharmacy to pick up their meds. I asked Benjamin this, and he basically laughed at me. [What are the 10% of drugs that an indie pharmacy can make money on? You're going to find this to be a shocking coincidence. It's the same drugs that many of the consolidated PBM/pharmacies mandate are filled at their own pharmacies or mail order. And many self-insured employers maybe unwittingly sign contracts enabling this to go down, which, in effect, enables these consolidated PBM/pharmacies to essentially corner the market on profits from commercial purchasers.] So, turning our attention now to how to lose money in the pharmacy business, there's two ways to lose money: either outright losing money because the acquisition costs of the meds are actually more than the PBM (pharmacy benefit manager) mandates the indie pharmacy can charge its insured members. So, that's one way to lose money. A second way to lose money as an indie pharmacy is because generics are so cheap. The cost of providing the pill bottle might exceed the profits on a 47-cent generic, even if the profit margin is 100%—again, because the PBM sets the price. Now, you might be thinking the same thing I was thinking when Benjamin Jolley talked about this: Okay, well maybe … ugh! We want the patient to save money here, so … ? Here's the really big point that Benjamin Jolley knows because he sees this every day: What the patient pays and what the pharmacy gets paid has no relationship to each other or to what an employer plan may or may not pay. So, if the patient/member pays more and the independent community pharmacy gets paid less, that doesn't mean it will be a better deal for the employer. It doesn't mean it will be a better deal for the patient. Why? Because there's a PBM in the middle. Ge Bai talks about this in episode 420. For every $100 that is spent on generic drugs, $41 goes to the PBM. Seventy-nine percent of the time, if a plan member is in their deductible phase, it's cheaper to pay cash than to use the insurance that member is paying for. As someone said on LinkedIn the other day talking about patients paying premiums and paying more for generics than if they'd just gone in and paid cash, here's the quote: “You can pay more to pay more.” With so many deductibles as high as they are and with so many people who never reach their deductibles, as Benjmain Jolley says during the show today, we're giving this third party a lot of control over a transaction that they literally have nothing to do with something like three out of four times that any given patient picks up their generic med. How'd we get here as a society? It's weird. If you've listened to most of the shows that I've been doing lately largely spiraling around the whole “what's going on with the prices that patients/members are paying for generic drugs,” you might be thinking the same thing I am: It's such an egregious situation that it becomes an opportunity because the bar is so darn low and so many in the supply chain or the demand chain are getting royally screwed by the PBMs, not just patients. I mean, there's a lot of possible win-win collaborations, at least situationally. Local pharmacies and local businesses, for example, would seem to have a natural alliance. I'm reminded of the collaboration from a couple of years ago that Drew Leatherberry and Dan Strause talked about in episode 313. I'm super sure that you in the Relentless Health Value Tribe has or could come up with all kinds of innovative collaborations to help patients get affordable generic drugs, and I'd be super psyched to hear about them. Benjamin Jolley is a pharmacist by training. His pharmacy consulting company is Apex Pharmacy Consulting. Also mentioned in this episode are Ge Bai, PhD, CPA; Mark Cuban; Ferrin Williams, PharmD, MBA; Joey Dizenhouse; Vinay Patel; Drew Leatherberry; Dan Strause; Kyle “Transparently Kicking PBM Ass” McCormick and his pharmacy, Blueberry Pharmacy, in Pittsburgh. Also, AJ Loiacono from Capital Rx (EP379) and CPESN Networks.   You can learn more at benjaminjolley.substack.com and through Apex Pharmacy Consulting. You can also connect with Benjamin on LinkedIn.   Benjamin Jolley, PharmD, is a third-generation independent pharmacy operator. Since 2019, he has been dedicated to supporting pharmacy operators across the nation in unraveling the complexities of the financial systems that drive their businesses. Through his occasional blog at benjaminjolley.substack.com, he shares insights derived from his experience. In 2023, he partnered with Joe Williams to launch Apex Pharmacy Consulting. Their goal is to provide comprehensive and personalized consulting services tailored to enhance pharmacy operations.   04:47 Benjamin Jolley's recent revelation. 06:14 What are the 10% of drugs that provide all the profit for pharmacies? 09:21 What's happening with the other 90% of drugs that pharmacies are filling? 11:05 What is the breakdown of costs when fulfilling prescriptions and running a pharmacy? 18:50 EP379 with AJ Loiacono. 21:42 What is the “cost savings” within the “insane system” of PBMs not sharing profit with independent pharmacies? 23:00 What is one of the things that PBMs and pharmacies don't often talk about? 26:39 What can employers do so that patients aren't getting overcharged by PBMs? 27:51 “How do I make the PBMs irrelevant?” 33:30 What's the difference between an independent pharmacy delivery service and a service like Express Scripts? 34:36 What's the other potential solution in solving the problems independent pharmacies face, and why does Benjamin Jolley feel that it's not the best solution to pursue?   You can learn more at benjaminjolley.substack.com and through Apex Pharmacy Consulting. You can also connect with Benjamin on LinkedIn.   Benjamin Jolley of Apex Pharmacy Consulting discusses #indiepharmacy on our #healthcarepodcast. #healthcare #podcast #pharma #healthcareleadership #healthcaretransformation #healthcareinnovation   Recent past interviews: Click a guest's name for their latest RHV episode! Emily Kagan Trenchard (Encore! EP392), Cora Opsahl (Encore! EP372), Jodilyn Owen, Ge Bai, Andreas Mang, Karen Root (Encore! EP381), Mark Cuban and Ferrin Williams, Dan Mendelson (Encore! EP385), Josh Berlin, Dr Adam Brown  

Threaded through the entire 60+ years of Doctor Who there lurks a handful of stories that drop mountains into what we think of as the placid waters of the show's 'canon' or 'lore'. Stories such as The Time Meddler, which first introduced us to another fugitive from the Doctor's home planet, or The War Games which transported viewers to its hallowed halls for the very first time, or The Deadly Assassin which gave us a whistle-stop tour of Gallifrey and established much of what has since been taken as the unshakeable truth of the Time Lords' heirarchy, history and way of life.There are others too: The Three Doctors introduced us to one of the Time Lords' founders whilst The Five Doctors explored the hitherto unheard-of Dark Times of Gallifrey. There's Remembrance of the Daleks too, and Silver Nemesis, both of which suggested there may be more to the Doctor than we thought we knew.Let's not forget 1976's The Brain of Morbius, which first posited the possibility that there may have been more incarnations of the Doctor which existed prior to what we fans think of as his first.Fugitive of the Judoon arguably drops the most explosive bombshell into the canon of Doctor Who than any of these, not only confirming that the Doctor has more faces than she can remember, it's a story which showed us one of those faces in action!And no one outside of the production cast and crew knew it was coming!Grab your disc, queue the story and join us in real-time as Paul, Geoff and Freya relive the events of what we all thought was going to be a fun romp with Space Rhinos in Glastonbury. The return of Captain Jack? Pah! Fugitive of the Judoon had many more suprises waiting to unfold in its mere 50 minutes of run-time than that...Support the show Subscribe to Who Corner to Corner on your podcast app to make sure you don't miss an episode! Now available to watch on YouTube! Join the Doctor Who chat with us and other fans on Twitter and Facebook! Visit the Who Corner to Corner website and see our back catalogue of episodes! Enjoying what we do? Consider joining our Explorers Subscription plan for more content! Who Corner to Corner: Great guests and 100% positive Doctor Who chat!

Show Notes Introduction: Mike hosts Vinay Patel, the founder of MakoRx, a company aiming to integrate telemedicine and local community pharmacies for improved healthcare access and affordability. Role of Local Pharmacies: Delve into the potential of local pharmacies to function as community healthcare hubs, offering essential services and bridging the gap between traditional in-person care and modern telemedicine. Telemedicine in Action: Understand how telemedicine can cater to the healthcare needs of diverse demographics, particularly in rural areas, forming an important piece in the puzzle of comprehensive healthcare access. Overcoming Challenges: Discuss hurdles encountered while introducing novel healthcare services and the importance of early adopters and real-time market feedback for strategy refinement. Innovative Pharmacy Benefit Models: Discover an innovative cost-plus model for pharmacy benefits administration and learn about strategic partnerships that contribute to success. Entrepreneurial Growth Journey: Learn about the transition from being an employee to owning a Pharmacy Benefit Management (PBM) company, how strategic partnerships have fueled growth, and how initial ideas evolved into concrete healthcare solutions. Membership Healthcare Services: Understand the structure and benefits of a membership program, a subscription model offering basic healthcare services, providing a distinctive alternative to traditional insurance. Artificial Intelligence in Medicine: Engage in a thought-provoking conversation on the potential and ethical implications of AI in healthcare and beyond. Personal Reflections: Gain insights from personal experiences and challenges faced by both Mike and Vinay in their careers, alongside thoughts on managing a growing company and advice to fellow pharmacists. Value-based Healthcare: Wrap up with a discussion on the importance of patient investment in their own healthcare, the value proposition of cash pay services, and the role of the internet in accelerating the cycle of value assessment. https://www.makorx.com/ Connect with Mike: Instagram:⁠ https://www.instagram.com/bizofpharmpod/⁠ Facebook:⁠ https://www.facebook.com/BizOfPharmPod⁠ YouTube:⁠ https://www.youtube.com/c/TheBusinessofPharmacyPodcast⁠ Twitter:⁠ https://twitter.com/bizofpharmpod⁠LinkedIn:⁠ https://www.linkedin.com/company/bizofpharmpod⁠ Website:⁠ https://www.bizofpharmpod.com⁠ Loved this episode? Leave us a review and rating here:⁠ https://www.bizofpharmpod.com/reviews/new/⁠

Well, this episode is suddenly incredibly relevant again just with all the stuff going on with co-pay maximizers. If you're gonna understand maximizers, though, you really have to start here. In a nutshell, this whole thing is a battle royale between co-pay cards and patient assistance programs offered by pharma companies versus co-pay accumulators and co-pay maximizers deployed by health plans and PBMs (pharmacy benefit managers). I just want to start by getting everyone grounded on a few really key points. #1: Drug abandonment is a thing. Patient goes into the pharmacy to pick up their Rx and the out of pocket is too expensive, so they leave without their drug. This can happen on the first fill, like, “Oh, wow, I guess I don't really need that new drug my doctor just told me I should pick up.” Or it can happen downstream, like in January when, all of a sudden, a deductible kicks in. But in all cases, we have a patient getting sticker shock on the out of pocket for a med and then going without the drug … or pill splitting or rationing or doing other things to save money. #2: How PBMs shake rebates out of pharma manufacturers is to use what I just said (that whole abandonment possibility) as a leverage point. Pharma goes into a PBM that controls access for drugs for, I don't know, 100 million lives. The PBM says, “Hey, you, Pharma! If you want to be on our formulary, you gotta kick out this much in rebates.” Pharma says, “No, that is too much rebate. I cannot pay it.” PBM says, “Well, then … OK, you're not on formulary or you are poorly positioned on formulary. And let me translate what that means. Now the out of pocket for your drug will be so expensive that patients are gonna walk out of the pharmacy without your drug because I, the PBM, have control over patient out of pocket and I will make it very expensive.” From a pharma's standpoint, all those patients that aren't picking up the drug … that means a loss of market share. And that market share can translate into a lot of lost revenue for the pharma company. And thus begins the whole war of the co-pays/out of pockets. So now, let's fast-forward through the past, say, 10-plus years. It'll be like one of those movie montages with the action sped up so fast you don't need words to see what's going on … except this is an audio podcast, so I guess you do need words. Alright, so this is what happens next: Pharma starts raising its prices combined with there's more super expensive specialty pharmacy drugs. Reaction by the PBMs to this was to try to get more aggressive with Pharma demanding increasingly high rebates and other concessions, keeping in mind the prize and leverage point that the PBMs offered Pharma to secure those PBM rebates was lower co-pays or out of pockets for patients. Again, it's a well-known fact that the higher the patient out of pocket, the lower the market share of the drug because the higher the patient cost, the more patients abandon at the pharmacy counter. It's the old supply and demand curve at work. At a certain point here in all of this, the pharma companies start to get really pissed about their dwindling net prices as rebates start going up and up and their market share kind of doesn't because the PBMs are keeping the money and maybe not passing it along to plan sponsors or patients. It's a zero-sum game fight over the money, and Pharma feels like the PBMs are getting more than their share. And they're pretty smart, these pharma manufacturers. So, Pharma comes up with a Houdini move to escape PBMs holding Pharma hostage for rebates by using their control over how much patients pay or don't pay at the pharmacy counter. Fasten your seatbelts and let the games begin. Pharma decided to hand out co-pay discount cards. Then Pharma doesn't have to pay PBM rebates to get lower patient out-of-pocket costs. They can finesse lower patient out-of-pocket costs all by themselves. Take that, PBMs! Except now, the PBMs see this—and they raise. Enter co-pay accumulators and also co-pay maximizers. For this part of the extravaganza of game theory at its finest, I'm gonna let Dea Belazi, PharmD, MPH, my guest in this episode, explain further. However, one more thing to point out before we begin. In the olden days, this whole war of who has leverage over who transpired in the context of small molecule drugs in competitive markets a lot of times. So, like Lipitor versus Crestor and the brands all cost, like, $100 a month and, maybe, there was a generic equivalent. If the health plan made it too expensive for a patient to get one of those drugs, they usually made another one in the same class attractive financially. So, the patient had (theoretically, at least) options; and the stakes were also a lot lower. The dollar volumes that we're talking about here were a lot lower. Now this same war is being fought on the specialty side of the house, where drugs cost thousands or tens of thousands a month and the patient may have but one option. So, if it's made to be financially toxic for a patient to get that one drug, the patient has to choose between their family's health and dipping into their 401k in order to afford their out-of-pocket costs. Or going bankrupt. Or dying. And when I say “or dying,” that is not hyperbole. There are studies that clearly show the mortality rates for patients who have trouble affording their meds are worse. In these cases, Pharma can be, sort of authentically, a hero who steps in and helps patients who are functionally uninsured because they can't afford the co-pays and deductibles that their plan sponsors have put in place to actually use the insurance that they are paying handsome premiums to have. Pharma can step in and help via these co-pay discount cards or coinsurance programs or through patient assistance programs helping those with lower incomes. So, there's no question in the short term that when a patient desperately needs a drug and their insurance is insufficient, a pharma manufacturer can be a knight in shining armor financially. But only if this were so simple, like this is some kind of spaghetti western with the good guys and the bad guys. Now let's think about this co-pay/out-of-pocket assistance offered by Pharma with a longer timeframe or a more systemic timeframe in mind. How is it that Pharma can have prices that are as high as we all know they are? Right?! It's because enough patients don't abandon the med at the pharmacy counter or, these days, in the infusion clinic. So, the lower Pharma can drive the patient out of pocket for a really expensive drug, the more they have a certain amount of impunity to raise the drug prices. This is a lot of the argument against price caps on out of pockets just in general, by the way. They matter for patients. They save lives. But they also have the consequence of kind of getting rid of what is often seen as a big control point checking pharma prices from zinging even higher than they already are. Bottom line, we have a catch-22 on our hands—and the patient is stuck in the middle. If you're a patient and you need your miracle drug (and a lot of patients call these drugs their miracle drugs), Pharma is your hero … at least right now. However, Pharma is also now able to raise their prices even more next year; and now you really need their out-of-pocket support because the price of the drug is so high your employer/taxpayers can't afford the rising drug spend and even more cost gets shifted onto patients. It becomes like Stockholm syndrome. But again, no white hats and black hats here. This whole thing is one of those incomprehensible art house films with lots of plot twists and in every other scene, you start to feel for the character you just hated 10 minutes ago … because while Pharma is getting busy raising prices, you have PBMs and nothing-for-nothing plan sponsors also up to their own machinations. Like, hey, here's one that's quite a marvel: PBM double-dipping. If the PBM can get Pharma to pay the patient deductible and then also get the patient to pay the patient deductible … Hmmm … By the way, that was a backdoor introduction to accumulators. And then later on, maximizers showed up on the scene. I just want to say that with maximizers, not all are created equal. I can certainly see their value for patients when they are deployed by companies and plan sponsors as part of their benefit designs with an explicit goal of helping members and the plan itself (nothing for nothing) afford expensive drugs it's clear that the patients need. But … I have to say, and I'm not well versed enough yet in how this maximizer business has evolved to comment on whether some of what is going on is still a net positive for some members and patients. Some of these PBMs have opened up entirely separate maximizer companies, which, for sure, they are upcharging employer plan sponsors to use. And the whole point of these separate entities is to get as much cash out of Pharma as possible while they, I don't know, may or may not pass that cash on as savings to patients and members. I need to do a show on this coming up. There's a new bill in the House, by the way. It's called the HELP Copays Act, which I don't think is just aimed at accumulators. If you didn't understand what I just said, you will after you listen to this episode. With that, here's Dea Belazi. Dea is president and CEO over at AscellaHealth. He is a pharmacist by training who has worked for Pharma, and then he worked at a health plan, spending a lot of time in the PBM space. In other words, he's seen this tangled web from pretty much every angle. We kick right into the conversation talking about accumulators.   You can learn more at ascellahealth.com.   Dea Belazi, PharmD, MPH, has led the development and management of AscellaHealth's global specialty pharmacy benefit and healthcare services for nearly a decade. As a visionary and architect of change, leading the AscellaHealth shift from pharmacy benefit management to specialty pharmacy solutions, he has played a key role in the company, achieving a staggering four-year growth of more than 1556%. Previously, he served as a senior executive and played a key role in the growth and expansion of PerformRx, a PBM owned by Keystone First Health Plan. Additionally, Dea held a leadership position at FutureScripts, an Independence Blue Cross company that was sold to Catamaran. A respected industry professional and thought leader, Dea is often invited as a reviewer for multiple medical journals and holds a seat on the board of directors for numerous healthcare-related companies. Based on his impressive career and growing reputation, he was chosen to serve on FierceHealthcare's Editorial Advisory Council. Dea was most recently recognized as an Ernst & Young Entrepreneur of the Year 2022 Greater Philadelphia Award Finalist; he is also a 2022 Philadelphia Titan and a 2021 Philadelphia Business Journal Most Admired CEO honoree. Dea holds a PharmD from the University of Rhode Island. He completed his dissertation at Brown University, earned a Master of Public Health from Johns Hopkins University, and served as a post-doc health outcomes research Fellow at Thomas Jefferson University.   11:06 “The concept of co-pay accumulators wasn't just a … PBM thought, but it also came from their customers, whether it was health plans or employer groups.” 15:50 “[This is] literally a math problem based on, ‘Do I spend it now? Do I spend it later?'” 17:20 What reason do employers and payers have for doing this? 21:13 “This is another mechanism for payers to push down additional cost to both the patient and now the pharma company.” 22:24 EP241 with Vinay Patel. 22:59 “I don't think accumulators are really forcing Pharma to be more competitive.” 25:06 How co-pay maximizers are different from co-pay accumulators. 28:09 Who doesn't like co-pay accumulators and maximizers? 30:01 How patient advocacy groups are a different model. 32:10 What is the biggest challenge facing employers right now?   You can learn more at ascellahealth.com.   Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers on our #healthcarepodcast. #healthcare #podcast #digitalhealth #healthtech #copay   Recent past interviews: Click a guest's name for their latest RHV episode! Brennan Bilberry, Dr Vikas Saini and Judith Garber, David Muhlestein, Nikhil Krishnan (Encore! EP355), Emily Kagan Trenchard, Dr Scott Conard, Gloria Sachdev and Chris Skisak, Mike Thompson, Dr Rishi Wadhera (Encore! EP326), Ge Bai (Encore! EP356)

Nicole LeFave, Vinay Patel and Garrick Chan share their experience with Jenny Schwendemann of working on a collaborative effort through the Law Firm Antiracism Alliance. Littler attorneys provide pro bono services in a variety of areas, depending on the interests of individual attorneys. The firm values and encourages the community-minded and pro bono efforts of our lawyers and staff.

This week, Neha discusses a few examples of films and television shows that depict Partition. She speaks with Shanti Thakur (Terrible Children) and Fatimah Asghar (Ms. Marvel). Sources/Links:  Shanti Thakur Fatimah Asghar The Crown - Corgi Thread Richard Attenborough - Gandhi Sabiha Sumar - Silent Waters M.S. Sathyu - Garm Hava Gurinder Chadha - Viceroy's House Dr. Who  The Crown  Voiceover for Vinay Patel is provided by Raghav Ravi Social Links: https://twitter.com/1947pod https://www.instagram.com/partitionpodcast/ https://www.instagram.com/nehaaziz/ https://twitter.com/NehaAziz13 See omnystudio.com/listener for privacy information.

**In this Episode of the Becoming a Badass Pharmacy Owner Podcast; Dr. Lisa Faast with Vinay Patel talk about Cost Plus Pharmacy Network Model** **Show Notes:** 1. **About MakoRx** [1:21] 2. **Targeted Employers** [2:52] 3. **Working With Employers** [4:15] 4. **Employer Groups** [6:30] 5. **How To Be Part of MakoRx** [8:29] 6. **Contact Information** [12:30] **Links mentioned in this episode:** [MakoRx Website] (https://mako-rx.com/) [Email Address - Vinay Patel] (vpatel@makomedical.com) [Contact Number] (855-562-5679) ----- #### **Becoming a Badass Pharmacy Owner Podcast is a Proud to be Apart of the Pharmacy Podcast Network** Learn more about your ad choices. Visit megaphone.fm/adchoices

We speak to Vinay Patel about his year as Chairman, and then speak with Neal Patel on the even of his ascension to Chair.

We speak to Vinay Patel about his year as Chairman, and then speak with Neal Patel on the even of his ascension to Chair.

[CLIC] is the only Hotel Conference that focuses on the California Hotel Market and [CLIC] Connect is our interview show. Joining us today is Vinay Patel, Chairman of AAHOA and we are talkin Hotels, AAHOA, [CLIC] 5 & the Hunter Conference and AAHOACON.... Please tour our website at cliconference.com.

Over the holiday season here, we're running some of our favorite episodes from years past. This one is with Mike Schneider, who actually has taken another role since this show was recorded. Other than that, the information that Mike shares during this episode from 2020 is all good. So, let's do this thing. Disclaimer before we get started here: This show is probably a 300-level class in pharmaceutical/PBM relations. If you are tuning in for the first time and you aren't pretty familiar with the role of PBMs, I would go back and listen to, say, episode 241 with Vinay Patel or episode 166 with Tim Thomas from Crystal Clear Rx. OK, now that that's out of the way, if you're still with me, this episode is like a ride on a roller coaster. I talk with Mike Schneider. And we get into, you know, kinda deeply, the what and the why behind the “Big Three” traditional PBMs deciding that now might be a fantastic time to set up GPOs. PBMs are pharmacy benefit managers—there's three huge ones. GPO stands for group purchasing organization. Traditionally, these GPOs have purchased drugs and supplies for hospitals and other providers at, according to their marketing materials, volume discounts. So, the unfolding story here, in a nutshell, is that ESI (Express Scripts) set up a GPO called Ascent in Switzerland. Optum has had an Ireland operation going in full swing for a while. And now we have CVS Caremark setting up a GPO called Zinc. These GPOs are not like normal GPOs working with hospitals, but instead, these GPOs are the entity which is now going to negotiate with pharma companies. In the past, it was the PBM that was negotiating with the pharma company to get rebates. Now it's this GPO entity. “But wait,” you may say. “Wasn't there an executive order the other day requiring PBMs to, for example, pass through all of the rebates that they're collecting to patients?” Indeed, there was. And that rule doesn't say anything about GPOs having to do the same, especially GPOs in, let's just say, Switzerland. It's a tangled web we weave. You can learn more by connecting with Mike on LinkedIn.  Mike Schneider is an experienced healthcare executive with over 20 years of experience in the pharmaceutical manufacturer, pharmacy benefit manager, and payer side of healthcare. He previously spent 9 years at CVS Caremark, where he was a director of industry relations with responsibility for trade strategy development, rebate negotiations, and contract execution for CVS Caremark's own Medicare Part D plans and that of its clients. He held a similar position at Universal American (UA) before it was acquired by CVS Health, where he also negotiated UA's commercial business. Mike has held various sales and market access roles with pharmaceutical manufacturers with increasing responsibility. Before entering healthcare, Mike began his career as a researcher at the Procter & Gamble Company in Cincinnati, where he worked on hair care product formulation development focusing on the key markets of China and Japan, and then moved on to work in drug development. Mike holds a BS degree from the University of Illinois and an MBA from the University of Akron. 02:48 What does a GPO add to a PBM? 05:23 Rebates vs driving more revenue. 10:39 PBMs vs safe harbors. 12:25 The net impact on the commercial side. 14:07 PBMs vs pharmaceutical manufacturers. 14:54 How the “Big Three” PBMs compete with each other, and how employers would choose between them. 15:56 What the net-net is here. 18:06 How PBMs are shifting their models. 20:42 How GPOs may be making things even less transparent. 21:31 “The PBM world as a whole is not very transparent.” 25:00 “One of the biggest beneficiaries of this whole rebate [system] is the government.” 25:46 “The question is, ‘Who's paying those costs?'” 26:02 EP216 with Chris Sloan.27:00 A better way to move money from Pharma to employers and plan sponsors. 28:04 “Put your money where your mouth is.” You can learn more by connecting with Mike on LinkedIn.  Check out our newest #healthcarepodcast with Mike Schneider as he discusses #PBMs and #GPOs. #healthcare #podcast #digitalhealth #healthcarefinance #pharma What does a GPO add to a PBM? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma Rebates vs driving more revenue. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma PBMs vs safe harbors. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma What is the net impact on the commercial side? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma PBMs vs pharmaceutical manufacturers. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How do the “Big Three” PBMs compete with each other? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How do #employers choose between the “Big Three” PBMs? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma What's the net-net here? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How are PBMs shifting their revenue models? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How are GPOs making things even less transparent? Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “The PBM world as a whole is not very transparent.” Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “One of the biggest beneficiaries of this whole rebate [system] is the government.” Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “The question is, ‘Who's paying those costs?'” Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma A better way to move money from Pharma to employers and plan sponsors. Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “Put your money where your mouth is.” Mike Schneider discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma Recent past interviews: Click a guest's name for their latest RHV episode! Peter Hayes, Paul Simms, Dr Steven Quimby, Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis

The Rising Coaches Podcast sits down with Vinay Patel - Northwestern OSU.

I was on LinkedIn, and someone was saying, “Oh, there's no real money in generic drugs. It's not a huge issue if patients are paying 10 bucks instead of 93 cents for something. It's not like anyone is getting rich off of that, and it's not like patient impact here is super meaningful.” This is a pretty common refrain, actually; and from a conventional wisdom perspective, I get it, especially for those living comfortable middle- or upper-middle-class lives where an extra $9.07 for a prescription isn't a huge deal—except there are big-time issues with the generic supply chain that are worth billions and billions of dollars and that have a major impact on patient health. So, let's discuss. I started casting my eye over to what was going on on the generic drug front mainly because of the huge lawsuits in the news lately that were either filed and/or settled. Generic drug manufacturers are and have been the defendants in these lawsuits, accused of price collusion amongst other things. These lawsuits aren't fighting over chump change either, unless you consider hundreds and hundreds of millions of dollars as chump change, that is. The number of zeros on the table in these lawsuits may strike you, as they did me, as a factor of interest. I mean, we're talking about generic drugs here. The cost of goods on these drugs—there was a WHO study on this—and the cost of goods to manufacture a small molecule generic is, a lot of times, pennies. Further, there's no innovation undertaken by generic manufacturers in their manufacture of generic meds. Just so no one gets confused here, the rationale branded pharma manufacturers tout for high-cost branded (ie, new) drugs is that branded pharma manufacturers have to spot the R&D (research and development) dollars to come up with the new therapies and they take a lot of risk therein. Generic manufacturers, on the other hand, are getting a recipe that has been handed down to them. There is no R&D. There is no innovation. So, to restate the situation analysis, we have generic manufacturers spending no money on innovation and enjoying, many times, a low cost of goods. If the price were set using a cost plus methodology, you'd expect the prices paid by payers and patients to be correspondingly low—except they aren't. Depending on what study you look at, somewhere between 29% and 44% of patients who have been prescribed a med say they aren't taking it because it is unaffordable. Considering that 90% of the prescriptions written in this country are for generics, one could logically assume that there's some generics in that mix that are unaffordable due to their high prices.   But there's a compounding factor here: The patient affordability problem has another aspect to it beyond just patients having to pay a portion, or all, of the price of generic meds that may be, let's just say, higher than one might expect them to be given the cost of goods. But here's this other factor: The share of patient out of pocket is weirdly high when it comes to generics. Consider that generics and branded generics account for 19% of invoice-level spending but represent 65% of patient out-of-pocket costs (IQVIA National Prescription Audit, 12/2020). So, that seems out of whack. But keep in mind, as I mentioned earlier, that 90% of prescriptions written in this country are for generics. That's five billion scripts a year. As my guest in this healthcare podcast, Steven Quimby, MD, says, generic medications touch many more lives than new branded drugs. Obviously, GoodRx comes up in the conversation in this episode. If you want to learn more about pharmacy list prices and how GoodRx makes money, listen to the conversation I had with Ge Bai (EP306 and AEE13). Several people actually mentioned on LinkedIn and Twitter that hers was one of the best explanations they had heard on these topics, so I recommend those shows.  The show also with Vinay Patel dives pretty deeply into the “what's the what” between PBMs and pharmacies (EP241) if you're looking for more on that.   Dr. Quimby also mentions how important it could be for providers to know at the point of prescribing what the cost of medications are for a patient and get this information right in their EHR system. Refer to the episode with Carm Huntress (EP284) for more info on that.  My guest, as I said, Steven Quimby, MD, is an author and newly retired physician. His father was a pharmacist with a little drugstore that thrived in the late 1960s and early 1970s, so he literally grew up in the business. Dr. Quimby recently wrote a book called Billions in Your Generic Drugs. In sum, it's a supply chain where not only is nobody watching the henhouse, but everybody within that supply chain has a very, very vested interest to see prices go up. This is kind of a theme in healthcare, but nonetheless. Oh, and one last point to ponder before we get started here: Dr. Quimby mentions at one point that 86% of Americans believe that their health insurance plan always offers the lowest price for a generic and 67% (two-thirds) of people in this country have never heard of GoodRx or other shopping tools. So, yeah … really makes you realize you live in a bubble. You can learn more by reading Dr. Quimby's book Billions in Your Generic Drugs.   You can also reach Dr. Quimby on Twitter and LinkedIn.  Steven Quimby, MD, is a physician who has worked in academic medicine at the Mayo Clinic and in private practice. He has been involved in drug treatment studies, including major pharmaceutical trials, and maintained an active interest in the interface of corporate business, pharmacy, and medicine for over 50 years. Dr. Quimby is concerned escalating prices for generic drugs, which fill 90% of our prescriptions, threaten access to needed medications and patients going without treatment risk worsening of their medical conditions and further costs. Too often controversies over high new drug prices and the funding of new drug development and innovation obscure addressable problems in the generic drug supply and financing chain. 05:54 What are the current lawsuits involved in the generic drug space right now? 06:52 How is price fixing happening in the generic drug space? 07:58 “If I was the major payer for drugs … I'd want to know answers.” 08:06 What's the scale on new and generic drugs? 09:02 What's the problem with using price tools for generic drugs? 10:22 “I think right now, virtually everyone should be checking [those sites vs] their insurance price.” 10:47 Are payers paying too much for generic drugs? 11:53 Who are these generic manufacturers? 12:10 “They're distinctly different corporations than those that we have called Big Pharma.” 13:55 Why is it important to have adequate numbers of manufacturers for generic drugs? 17:03 “We just can't get legitimate acquisition and then sale prices of the actual drugs.” 17:17 “The industry's opaque to all of these things.” 19:39 “The prices that patients are getting at the prescription counter are so high that some studies say a third of them or more are walking away without buying the drug.” 20:02 AEE13 with Ge Bai, PhD, CPA, on the GoodRx model.20:50 EP241 with Vinay Patel.22:05 What and who should be on formulary? 26:24 “If they'd give us the numbers, we could see when it happens.” 28:58 How can we overcome the challenges of these high generic drug costs? 30:38 EP284 with Carm Huntress.30:46 EP334 with Sunita Desai, PhD.  31:26 “How can we judge value when we don't know price?” You can learn more by reading Dr. Quimby's book Billions in Your Generic Drugs.   You can also reach Dr. Quimby on Twitter and LinkedIn.  @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing How is price fixing happening in the generic drug space? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “If I was the major payer for drugs … I'd want to know answers.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing What's the problem with using price tools for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing Are payers paying too much for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “They're distinctly different corporations than those that we have called Big Pharma.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing Why is it important to have adequate numbers of manufacturers for generic drugs? @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “We just can't get legitimate acquisition and then sale prices of the actual drugs.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “The industry's opaque to all of these things.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “The prices that patients are getting at the prescription counter are so high that some studies say a third of them or more are walking away without buying the drug.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “If they'd give us the numbers, we could see when it happens.” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing “How can we judge value when we don't know price?” @QuimbyMD discusses #genericdrugpricing on our #healthcarepodcast. #healthcare #podcast #genericdrugs #drugpricing Recent past interviews: Click a guest's name for their latest RHV episode! Dr David Carmouche (EP343), Christin Deacon, Gary Campbell, Kristin Begley, David Contorno (AEE17), David Contorno (EP339), Nikki King, Olivia Webb, Brandon Weber, Stacey Richter (INBW30), Brian Klepper (AEE16), Brian Klepper (EP335), Sunita Desai, Care Plans vs Real World (EP333), Dr Tony DiGioia, Al Lewis, John Marchica, Joe Connolly, Marshall Allen, Andrew Eye, Naomi Fried, Dr Rishi Wadhera, Dr Mai Pham, Nicole Bradberry and Kelly Conroy, Lee Lewis, Dr Arshad Rahim, Dr Monica Lypson, Dr Rich Klasco

Religious tensions, post-colonialism, court intrigue,  unimaginable slaughter. It should be a right bloody laugh as Ben and Mark discuss 2018's 'Demons of the Punjab' and 1966's 'The Massacre of St Bartholomew's Eve'. Ben and Mark have nothing but praise for Vinay Patel's powerful portrayal of a historical moment that is woefully untaught in the history curriculum. It's Doctor Who at its most Reithian and leads to a discussion that takes in legacy, religious extremism and the Doctor's policy of 'no interference'.Meanwhile, the Lash Lads find it harder to speak highly of John Lucarotti and Donald Tosh's flawed historical 'The Massacre of St Bartholomew's Eve'. Might this be better if we could see it? How on Earth were they portraying such a grisly and grotesque historical event on teatime telly? And what happened to the little boy on Wimbledon Common? Support the show (https://www.buymeacoffee.com/onthetimelash)

Two plays recorded live at HighTide Festival in Aldeburgh, set on the edge of the world, weaving myth and archaeology, telling stories of humanity and sacrifice. Created in tandem and with a playful rapport, the plays were presented with live foley. Silver Darlings Rita ..... Cassie Layton Reggie ..... Simon Ludders Sam ..... Joel MacCormack Val ..... Anastasia Hille Writer: Tallulah Brown The Shores Mammoth ..... Clare Perkins Kenny, Shul ..... Joel MacCormack Erin, Dena ..... Cassie Layton Oxir, Carrotson ..... Simon Ludders Thorpe ..... Anastasia Hille Writer: Vinay Patel Sound: Anne Bunting, Peter Ringrose Director: Jessica Dromgoole Tallulah Brown is a published playwright and screenwriter from Suffolk. Her plays have included Songlines, Sea Fret and When the Birds Come. Vinay Patel is best known for writing BAFTA-winning single play 'Murdered by my Father', and Demons of the Punjab for Doctor Who. His stage plays included True Brits, and An Adventure.

As the official podcast of #AAHOCON21, we're excited to be broadcasting live from the show next week.  Incoming chair Vinay Patel stops by to share what we can expect when we all see each other next week in Dallas.

AAHOA (Asian American Hotel Owners Association) Show #92 - featuring Vice-Chairman, Vinay Patel • Find out how you can win a free membership & free registration to the upcoming convention • Discover hot topics that are affecting hotels right now • Plus I have huge news to share with you!!! + Sarah Dandashy Dandashy will be on to share the latest news in hospitality & travel + SHE HAS A DEAL with Tracy L Prigmore & Susan Deluzain Barry I'm giving away $1000 - Find out more details during the show! LIVE FEEDS: LinkedIn: https://lnkd.in/dBETKt6 Facebook: https://lnkd.in/d5cZine YouTube: https://lnkd.in/duyTkTR Clubhouse: https://lnkd.in/d7AvuVG LIKE + COMMENT Thanks for watching!

This episode seemed particularly relevant right now because it gives insight into how large self-insured employers are prioritizing their efforts to disrupt health care revenue streams that do not provide adequate health outcomes for dollars spent. This episode’s conversation is with Lee Lewis. This is an encore episode. The original was recorded when Lee was the newly minted chief strategy officer at the Health Transformation Alliance, otherwise known as HTA. The HTA is a group of 50 major corporations that have come together in an alliance to do one thing: fix our broken health care system. Anybody who knows Lee knows he knows a lot about how to improve health and health care benefits for large employers. The most amazing thing I always find about improving health and health care benefits is that it’s like having your cake and eating it, too. On one hand, both employer and employee save money. On the other hand, employees get better care and spend less time away from work struggling to navigate the health care jungle all by themselves. Lee’s playbook consists of three chapters which we get into here. The first chapter covers the “how” of health benefits, including what Lee calls the “administrative superstructure.” The second chapter in Lee’s playbook is the “what,” which usually comprises drug spend and then, on the medical side, how care is delivered for specific clinical conditions like musculoskeletal, cardiometabolic, etc. There are a few conditions that tend to rack up the most costs categorically. The last chapter in Lee’s playbook is the “who,” meaning where employees are steered for care, especially in those high-cost areas. If you’re looking for actual examples of forward-thinking employers doing some—or more than some—of the general categories of things that you’ll hear about in this health care podcast, let me drop a few names. Because they may not get as much credit as they often deserve, I wanted to highlight the amazing progress made by some state employee health plans. So let me spotlight the work being done in New Jersey, Connecticut, and Montana, led by Christin Deacon, Thomas Woodruff, and Marilyn Bartlett and their teams. So, to all of you and everyone else working on these endeavors, thank you very much for your service as both a taxpayer and also someone keenly interested in the other things that that money could be used for instead of low-value care like, for example, teachers and firefighters and students and everything else in the budget. Finally, I just want to toss in a mention here of the upcoming Aspirational Healthcare Conference, which will be held on July 14 and 15, 2021 (virtually). Go to the Relentless Health Value Web site because I got you a promo code for free entry that you’ll find there. Lee Lewis, my guest today, is the keynote moderator for Day 1; and yours truly will step up to the microphone on Day 2. This conference will kind of be a who’s who of employer benefit design for the forward thinking looking to do the best they can for their employees at least, and it’s gonna highlight really the Aspirational Healthcare Systems like Southcentral Foundation’s Nuka System of Care in Alaska, for example. You can learn more by visiting htahealth.com and by connecting with Lee on LinkedIn.  Register here for the July 14-15 Aspirational Healthcare Conference and have the registration fee waived using the promo code: !RICHTER$  Lee Lewis serves as chief strategy officer and GM medical solutions for the Health Transformation Alliance. He leads efforts across over 50 large and jumbo employers and six million employees to save lives and save millions of dollars through improved health delivery, outcomes, and experience. Key initiatives in this role include new models of health benefits administration, curated provider steerage, and improved clinical delivery and outcomes. He has advised health care strategy at Fortune 10 employers, insurance companies and administrators, medical associations, and the Departments of Justice and Labor. He incubated and helped form two dozen health benefit start-up companies and has been quoted and featured in Bloomberg and the Wall Street Journal. Lewis is a founding, charter member of the Health Rosetta organization and is credited as a co-founder of the Health Value Exchange. Before joining the HTA, Lewis was a consultant at Gallagher, where he founded Gallagher’s innovation lab and national jumbo employer practice. In 2019 he was recognized with the industry’s top honor as the Outstanding National Consultant for Large & Jumbo Employers Award by the independent Validation Institute. His consulting clients won Diamond Innovation Awards at the World Healthcare Congress, Innovation Awards from the Texas Business Groups on Health, Top 20 Innovator Awards from Healthcare Revolution Conference, and Financial Innovation and Large Group Management Innovation accolades from the Validation Institute. Lee is a Rhodes Scholar nominee. He graduated second in his class, magna cum laude with university honors in accounting from Brigham Young University. 04:00 A playbook to reduce health care spend and achieve better outcomes. 04:08 The “how,” or “administrative superstructure.” 05:19 What Lee typically does when working with companies. 08:57 The “what” of delivery—connecting the “what” to the “clinical.” 10:52 Overseeing the pharmacy benefit manager (PBM). 12:37 EP241 with Vinay Patel. 12:50 Looking at the medical side of health. 15:46 Improving spend and improving quality simultaneously. 18:10 EP240 with Olivia Ross.18:53 Why centers of excellence make sense. 21:54 The “who”—who is providing the care. 24:06 Enabling and empowering PCPs and improving PCP pay to compensate for that. 26:57 Lee’s advice for brokers. 28:02 Lee’s advice for provider organizations, hospitals, and centers of excellence. 29:07 “Hospital systems are not [a] monolith.” You can learn more by visiting htahealth.com and by connecting with Lee on LinkedIn.  Register here for the July 14-15 Aspirational Healthcare Conference and have the registration fee waived using the promo code: !RICHTER$  Check out our newest #healthcarepodcast episode with Lee Lewis of #HealthTransformationAlliance (#HTA). #healthcare #podcast #digitalhealth #employerhealth Reducing #healthcarespend and improving #healthoutcomes. Lee Lewis of #HealthTransformationAlliance (#HTA) discusses his “playbook.” #healthcare #podcast #digitalhealth #employerhealth #AdministrativeSuperstructure and the “how” of Lee Lewis’s #employerhealth “playbook.” #HealthTransformationAlliance (#HTA) #healthcare #podcast #digitalhealth #employerhealth What does Lee Lewis of #HealthTransformationAlliance (#HTA) do to reduce #healthspend and improve #healthoutcomes when working with large employers? #healthcare #podcast #digitalhealth #employerhealth Connecting the “what” to the #clinical. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth How do you oversee the #pharmacybenefitmanager in all of this? Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Looking at the #medical side of #health. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM How reducing #healthcarespend actually improves #healthcareoutcomes and #healthcarequality. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Why do #CentersofExcellence make sense? Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Enabling and empowering #PCPs. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Lee Lewis of #HealthTransformationAlliance (#HTA) offers his advice for #healthcarebrokers. #healthcare #podcast #digitalhealth #employerhealth #PBM Lee Lewis of #HealthTransformationAlliance (#HTA) offers his advice for #healthcareproviders, #hospitals, and #COEs. #healthcare #podcast #digitalhealth #employerhealth #PBM “Hospital systems are not [a] monolith.” Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM

Interview with BAFTA nominated writer, Vinay Patel (10/04/21).

It's time for another Comfort Who pick -- this time from Erika! Join Deb, Erika, and Liz as we talk about a comfort story in a comfort Doctor Who season in a real-world season that demands as much comfort as possible. Do you take comfort in this story? Why or why not? Drop us a tweet or let us know in the comments! ^E Happy Things: Liz - Peake Season - a Big Finish release with TOM BAKER that LIZ WROTE! Erika Steven's Doctor Who theme with the "Wilkinson shift"! Erika on Galactic Yo-yo! Vinay Patel on Writing and Breathing! Deb - Reality Bomb Episode 088 – The Shelter In Place Live Edition 4! Extra-special thanks to this week's editor, Steven Schapansky of Castria! Support Verity! on Patreon

Vinay Patel (Doctor Who, Murdered by My Father) joins Antony to talk about using practice to push yourself, focusing on nailing the parts only you can do, and the balance between empathy and sympathy.

Usually at this time of the week, at this time of the year, we would be kicking off Gallifrey One with a live show featuring a number of guests attending the convention that year. So this year, as part of our Tales of Gallifrey One series, we present a "greatest hits" selection from our various live shows of years past. Here is Peter Davison (2016), Philip Hinchcliffe (2013), Terrance Dicks (2014), Pete McTighe, Vinay Patel, and Joy Wilkinson (2020), Julian Glover (2016), Patricia Quinn (2016), and Chip Sudderth's Two-Minute Time Lord presentation from 2015. Enjoy!

Here’s a trigger warning: This show gets pretty deep into some of the nether regions of PBM (pharmacy benefit manager) contractual terms with pharmacies. If you are not, I’m gonna say, pretty familiar with PBM goings-on, I’d suggest you listen to EP241 with Vinay Patel first or skip the first third of this show.   In this health care podcast, I am speaking with Ge Bai about Amazon’s pharmacy business. Ge Bai, PhD, CPA, is an associate professor of accounting at Johns Hopkins Carey School of Business. She is also associate professor of health policy and management at Johns Hopkins Bloomberg School of Public Health. Ge trained as an accounting researcher who originally started looking into chargemasters for her dissertation. From there, she started checking out health care pricing and contracting issues. Who knew chargemasters were like a gateway drug into health care? I ask Ge questions such as, “Why the heck does Amazon need a PBM for cash pay patients?” and “What’s this Amazon Pharmacy model that some self-insured employers are talking about?” And then we get into rebates and the impact that Amazon will have on rebates. Right up front, I want to just say flat out, I learned a mind-blowing detail from Ge. There’s a contracting term that PBMs put in their contracts with pharmacies. Basically, a pharmacy cannot sell a drug to a cash pay patient for an amount that is less than the price a PBM pays the pharmacy for the drug or the pharmacy charges the PBM for the drug—I guess it depends how you perceive that relationship. So, the pharmacy’s list price paid by cash pay patients can’t be less than the contracted price that it has with any third-party payer. The PBMs will always have to get the better price than cash pay patients. There’s one exception, though: unless the cash pay patient wanders in with a coupon (like a GoodRx coupon, for example). There are a whole lot of implications to this if you start to think about it. Spoiler alert: There will be an “Ask an Expert” with Ge Bai coming out after the show, where Ge and I get deeply into GoodRx’s business model. So, stay tuned for that if you are interested. You might be subscribed to the show on iTunes, but I’d also encourage you to sign up for our newsletter on relentlesshealthvalue.com. Every week, you get a transcript of the introduction to the show that’s coming out that week, so you can prioritize your listening accordingly.   You can connect with Ge on LinkedIn and Twitter. You can also learn more on her Web site at Johns Hopkins University. Ge Bai, PhD, CPA, is an associate professor of accounting at the Johns Hopkins Carey Business School and associate professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. She is an expert on health care pricing, policy, and management. Dr. Bai has testified before the House Ways and Means Committee, written for the Wall Street Journal, and published her studies in leading academic journals such as the New England Journal of Medicine, JAMA, JAMA Internal Medicine, Annals of Internal Medicine, and Health Affairs. Her work has been widely featured on ABC, CBS, NBC, Fox News, CNN, and NPR and in the Los Angeles Times, New York Times, Wall Street Journal, Washington Post, and other media outlets and used in government regulations and congressional testimonies. 03:27 Why is Amazon in the pharmacy space a big deal? 04:03 “I view Amazon Pharmacy as a combination of GoodRx and mail-order pharmacy.” 05:07 What’s the difference between Amazon and other pharmacies? 06:14 Why does the third-party payer health care system keep Amazon from cutting out the PBM? 07:49 “We don’t have insurance companies, we don’t have PBMs.” 09:21 “Who’s really using prescription drugs? The majority is Medicare patients.” 11:46 Is Amazon doing anything innovative in the pharmacy space? 12:37 What options do self-insured employers have now with Amazon? 14:42 Why employees and employers might choose to use Amazon Pharmacy over other mail-order pharmacies. 21:27 Will Amazon affect pharmacy rebates? 25:28 “Fundamentally, employers want to have more power in the whole process.” 27:41 What should you be doing as a self-insured employer? 28:58 “If we do not put out effort to make the private market work, then the next option would be single payer.” You can connect with Ge on LinkedIn and Twitter. You can also learn more on her Web site at Johns Hopkins University.   @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma Why is Amazon in the pharmacy space a big deal? @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “I view Amazon Pharmacy as a combination of GoodRx and mail-order pharmacy.” @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma What’s the difference between Amazon and other pharmacies? @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma Why does the third-party payer health care system keep Amazon from cutting out the PBM? @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “We don’t have insurance companies, we don’t have PBMs.” @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “Who’s really using prescription drugs? The majority is Medicare patients.” @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma Is Amazon doing anything innovative in the pharmacy space? @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma What options do self-insured employers have now with Amazon? @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “Fundamentally, employers want to have more power in the whole process.” @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma “If we do not put out effort to make the private market work, then the next option would be single payer.” @GeBaiDC discusses the Amazon Pharmacy model on our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma

  The most obvious statement we can make about the US health care system is that it's a mess. It's complicated, expensive, and rarely delivers what patients expect. A large part of the problem is because we use employer based insurance products where there is little incentive to control costs or provide the kind of care the patient wants. It's all about incentives and they are placed a long ways from those receiving the care - the patients. The unserious answer to how you fix the health care system is to blow it up and start over. As the largest sector of the economy that hires the most people, there are far too many interests in keeping the system just as it is. Although there might be a sizable electoral will to change things - there isn't any genuine appetite within the industry or politicians to truly start from scratch or honestly address the problems. The solution will have to come from entrepreneurs, employers, and patients. How Can Employers Fix Health Care? Katy Talento is a health care consultant at Allbetter.health and KFT Consulting with an extensive career in federal health care policy. She worked for 5 US senators and early with the Trump administration serving as the head of the domestic health care policy team. Simply put, she understands the US health care system. She knows the players and the hurdles faced by those looking to reform it. Through this extensive experience, Ms. Talento brings a lot of innovative ways to save money for employers and create a better experience for their employees. We all know that people have to pick their insurance either on the marketplace or through an employer. We've discussed the right way to pick insurance options before on the show. But Talento brings a way for employers to specifically save money by unbundling all of the components of the traditional insurance plans offered by carriers. What is Unbundling? Talento allows businesses of various sizes to self fund the insurance care for their employees by bidding out all of the aspects of a traditional plan. This means she acquires a company for processing the claims, a pharmacy benefit manager (that doesn't take kickbacks), deals with hospitals, specialists, imaging centers, and finds a cadre of direct primary care physicians to provide the bedrock for coordinating care. Savings from this technique usually save at least 20% for employers and often provides much better coordinated and personalized care. Also, the care can happen with much more reasonable deductibles and other incentives which will make the employees much happier. How Can You Protect Yourself? Finally, Talento says if you go to the hospital or emergency room, it is important to protect yourself from hidden or unexpected charges. Few people know that when you sign the release form entering the ER that it also includes a provision where you agree to pay your bills at whatever the hospital and their agents charge. She recommends that you fill out a battlefield agreement with the hospital or emergency room. Essentially, you agree to pay no more than 1.5 times the Medicare rate for any services you receive in while getting treated. An example emergency consent form can be found here. Katy Talento is a health care policy analyst with extensive experience dealing with the US health care system. She has worked under five US senators and a presidential health care policy team. She runs allbetter.health which provides solutions for businesses looking to save money and provide better care for their employees. show notes Episode 111: Today's show Allbetter.health: Katy Talento's consulting business. @KatyTalento: Katy's twitter feed. Episode 076: A PBM not looking to rip you off with Vinay Patel. Episode 007: Dr. Kevin Wacasey tells us how to pick the right health insurance plan. Episode 042: My earlier synopsis on how to fix the US health care system. Doctor Podcast Network: The home for the Paradocs and a number of other physician based podcasts. Samaritans Health Sharing Ministry: This is the ministry we use. Feel free to mention my name if you sign up - not sure if that helps you or not. Top 20 Physicians Podcasts Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

Let’s cut to the chase here for our conversation about co-pay cards offered by pharma companies versus co-pay accumulators and co-pay maximizers deployed by health plans. This whole war of the co-pays started back in the day when PBMs (pharmacy benefit managers) began to shake down Pharma for higher discounts. The prize that PBMs offered Pharma was lower co-pays for patients. It’s a well-known fact that the higher the patient out of pocket, the lower the market share of the drug—the old supply-and-demand curve at work. So, the PBMs and health plans kind of had an ace up their sleeve because they control how much the patient pays out of pocket. And so, they use that ace to pull in higher discounts from Pharma. “You’ll make it up in volume,” they told Pharma. “We’ll make sure you get lots of patients by putting your drug on a lower formulary tier and giving patients who take your drug the lowest possible co-pays.” At a certain point, pharma companies started to get mad about their dwindling net prices. And they’re pretty smart. So, Pharma came up with a workaround to PBMs holding them hostage for lower net prices. Pharma decided to hand out co-pay discount cards. Then, they don’t have to pay the PBM. They can finesse lower patient co-pays all by themselves. Except now, the PBM sees this and they raise. Enter co-pay accumulators and co-pay maximizers. For this part of the extravaganza of game theory at its finest, I’ll let Dea Belazi, PharmD, MPH, explain. Dea is the president and CEO over at AscellaHealth. He’s a pharmacist by training who has worked for Pharma, then at a health plan, then spent lots of time in the PBM space. Now he’s working to create a different kind of pharmacy benefit at AscellaHealth. He has seen this tangled web from pretty much every angle. One thing to point out here before we begin: In the olden days, this whole war of who has leverage over who transpired in the context of small molecule drugs in competitive markets. So, like, Lipitor versus Crestor versus simvastatin—and they all cost, like, $100 a month. If the health plan made it untenable to get one of those drugs, they usually made another one in the same class financially attractive. So, the patient had options, and the stakes were a lot lower. Now this same war is being fought on the specialty side of the house, where drugs cost thousands or tens of thousands of dollars a month and the patient may have but one option. So, if it’s made financially toxic for a patient to get that one drug, then the patient has to choose between their family’s health and dipping into their 401(k). In these cases, Pharma can be, sort of authentically (and the “sort of” is an important qualifier), a hero who steps in and helps patients who are basically functionally uninsured because they can’t afford the co-pays and deductibles to actually use the insurance they’re paying handsome premiums to have. Pharma can step in and help via co-pay discount cards or through patient assistance programs to help those with lower incomes. But let me point out an obvious but rarely-mentioned-in-the-same-sentence connection. If the patient cost share is really high, there are at a minimum two parties responsible for that: the insurance company, who set the patient cost share and may have created functionally uninsured members in the process, and the pharma company, who may have set the price of the drug untenably high, maybe way over what the value of the product was. Neither is an innocent bystander, and the patient, sadly, is caught in the middle of this war. You can learn more at ascellahealth.com.   Dea Belazi, PharmD, MPH, has more than 20 years of experience in the health care industry, mostly developing and managing pharmacy benefit management companies. He is currently the president and CEO of AscellaHealth, a national specialty pharmacy benefit manager (SPBM™) serving commercial, Medicare, and Medicaid segments. He was part of the development of PerformRx, a PBM owned by Keystone First Health Plan, as well as another, FutureScripts, an Independence Blue Cross company that was sold to Catamaran a few years ago. Dea holds a PharmD from the University of Rhode Island and completed his dissertational work at Brown University. He later completed a Master of Public Health from Johns Hopkins University and a post-doc health outcomes research fellowship at Thomas Jefferson University. He is a reviewer for multiple medical journals and sits on multiple boards. 05:03 “The concept of co-pay accumulators wasn’t just a … PBM thought, but it also came from their customers, whether it was health plans or employer groups.” 10:00 “[This is] literally a math problem based on, ‘Do I spend it now? Do I spend it later?’” 11:31 What reason do employers and payers have for doing this? 15:26 “This is another mechanism for payers to push down additional cost to both the patient and now the pharma company.” 19:57 EP241 with Vinay Patel. 20:33 “I don’t think accumulators are really forcing Pharma to be more competitive.” 22:49 How co-pay maximizers are different from co-pay accumulators. 25:57 Who doesn’t like co-pay accumulators and maximizers? 28:03 How patient advocacy groups are a different model. 30:14 What is the biggest challenge facing employers right now? You can learn more at ascellahealth.com.   Check out our newest #healthcarepodcast with Dea Belazi of @AscellaHealth as he discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay “The concept of co-pay accumulators wasn’t just a … PBM thought, but it also came from their customers, whether it was health plans or employer groups.” Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast “[This is] literally a math problem based on, ‘Do I spend it now? Do I spend it later?’” Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast “This is another mechanism for payers to push down additional cost to both the patient and now the pharma company.” Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast “I don’t think accumulators are really forcing Pharma to be more competitive.” Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast What reason do employers and payers have for doing this? Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast What is the biggest challenge facing employers right now? Dea Belazi of @AscellaHealth discusses #copayaccumulators and #copaymaximizers. #healthcare #podcast #digitalhealth #healthtech #copay #healthcarepodcast

Disclaimer before we get started here: This show is probably a 300-level class in pharmaceutical/PBM relations. If you are tuning in for the first time and you aren’t pretty familiar with the role of PBMs, I would go back and listen to, say, episode 241 with Vinay Patel or episode 166 with Tim Thomas from Crystal Clear Rx.  OK, now that that’s out of the way, if you’re still with me, this episode is like a ride on a roller coaster. In this health care podcast, I talk with Mike Schneider, who’s a principal over at Avalere Health. And we get into, you know, kinda deeply, the what and the why behind the "Big Three" traditional PBMs deciding that now might be a fantastic time to set up GPOs. PBMs are pharmacy benefit managers—there’s three huge ones. GPO stands for group purchasing organization. Traditionally, these GPOs have purchased drugs and supplies for hospitals and other providers at, according to their marketing materials, volume discounts. So, the unfolding story here, in a nutshell, is that ESI (Express Scripts) set up a GPO called Ascent in Switzerland. Optum has had an Ireland operation going in full swing for a while. And now we have CVS Caremark setting up a GPO called Zinc. These GPOs are not like normal GPOs working with hospitals, but instead, these GPOs are the entity which is now going to negotiate with pharma companies. In the past, it was the PBM that was negotiating with the pharma company to get rebates. Now it’s this GPO entity. “But wait,” you may say. “Wasn’t there an executive order the other day requiring PBMs to, for example, pass through all of the rebates that they’re collecting to patients?” Indeed, there was. And that rule doesn’t say anything about GPOs having to do the same, especially GPOs in, let’s just say, Switzerland. It’s a tangled web we weave. You can learn more at avalere.com. You can also connect with Mike on LinkedIn.  Mike Schneider is an experienced health care executive with over 20 years of experience in the pharmaceutical manufacturer, pharmacy benefit manager, and payer side of health care. He previously spent 9 years at CVS Caremark, where he was a director of industry relations with responsibility for trade strategy development, rebate negotiations, and contract execution for CVS Caremark’s own Medicare Part D plans and that of its clients. He held a similar position at Universal American (UA) before it was acquired by CVS Health, where he also negotiated UA’s commercial business. Mike has held various sales and market access roles with pharmaceutical manufacturers with increasing responsibility. Before entering health care, Mike began his career as a researcher at the Procter & Gamble Company in Cincinnati, where he worked on hair care product formulation development focusing on the key markets of China and Japan, and then moved on to work in drug development. Mike holds a BS degree from the University of Illinois and an MBA from the University of Akron. 02:30 What does a GPO add to a PBM? 05:05 Rebates vs driving more revenue. 10:20 PBMs vs safe harbors. 12:07 The net impact on the commercial side. 13:48 PBMs vs pharmaceutical manufacturers. 14:35 How the "Big Three" PBMs compete with each other, and how employers would choose between them. 15:37 What the net-net is here. 17:48 How PBMs are shifting their models. 20:23 How GPOs may be making things even less transparent. 21:11 “The PBM world as a whole is not very transparent.” 24:40 “One of the biggest beneficiaries of this whole rebate [system] is the government.” 25:25 “The question is, ‘Who’s paying those costs?’” 25:40 EP216 with Chris Sloan.26:40 A better way to move money from Pharma to employers and plan sponsors. 27:43 “Put your money where your mouth is.” You can learn more at avalere.com. You can also connect with Mike on LinkedIn.  Check out our newest #healthcarepodcast with Mike Schneider of @avalerehealth as he discusses #PBMs and #GPOs. #healthcare #podcast #digitalhealth #healthcarefinance #pharma What does a GPO add to a PBM? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma Rebates vs driving more revenue. Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma PBMs vs safe harbors. Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma What is the net impact on the commercial side? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma PBMs vs pharmaceutical manufacturers. Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How do the "Big Three" PBMs compete with each other? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How do #employers choose between the "Big Three" PBMs? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma What’s the net-net here? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How are PBMs shifting their revenue models? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma How are GPOs making things even less transparent? Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “The PBM world as a whole is not very transparent.” Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “One of the biggest beneficiaries of this whole rebate [system] is the government.” Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “The question is, ‘Who’s paying those costs?’” Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma A better way to move money from Pharma to employers and plan sponsors. Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma “Put your money where your mouth is.” Mike Schneider of @avalerehealth discusses #PBMs and #GPOs. #healthcarepodcast #healthcare #podcast #digitalhealth #healthcarefinance #pharma

It's day two of #AAHOCON20 and Vinay has a report on what was said during the general session, his thoughts on the convention, and insights on and project financing in the age of covid-19.

It's day two of #AAHOCON20 and Vinay has a report on what was said during the general session, his thoughts on the convention, and insights on and project financing in the age of covid-19.

Special guest Vinay Patel joins Caspar to talk about Tokyo Story (1953), directed by Yasujirô Ozu.

Presenting our live show from Gallifrey One 2020! Listen as we interview an astounding number of guests, including Peter Davison, Michael E Briant, Margot Hayhoe, Gary Russell, Tilly Steele, Mark Dexter, Matt Rohman, Sallie Aprahamian, Pete McTighe, Vinay Patel, and Joy Wilkinson, with the return of Chip Sudderth as the Two-Minute Time Lord! Links: Support Radio Free Skaro on Patreon! Radio Free Skaro Gallifrey One 2020 live show: These Go To Eleven! Peter Davison Margot Hayhoe Michael E Briant Gary Russell Mark Dexter Matt Rohman Tilly Steele Vinay Patel Pete McTighe Joy Wilkinson Sallie Aprahamian Two-minute Time Lord

Está no ar o TrenzaloreCast #159! Nesta edição conversamos sobre o 5º episódio da 12ª temporada temporada de Doctor Who, Fugitive of the Judoon, escrito por Vinay Patel e Chris Chibnall. Equipe nesta edição: Bruna, Karina, Jonathan e Pedro. Ajude-nos a crescer: http://patreon.com/trenzaloreblog https://apoia.se/trenzaloreblog Siga-nos: http://facebook.com/trenzaloreblog  http://twitter.com/trenzaloreblog http://youtube.com/trenzaloreblog Envie o seu comentário para trenzaloreblog@gmail.com www.trenzalore.com.br

  Pharmacy Benefit Managers (PBM) have been the villains in a number of earlier episodes of the Paradocs. Basically, PBMs are some of the largest health care corporations in the US and exert tremendous lobbying pressure in DC and state capitals. Although their role in health care is to efficiently settle claims with insurers, patients, and employers - that's not how they make the bulk of their money. Actually, they make their billions through a complicated series of kickbacks and rebates from drug companies meaning they pay more attention to that revenue stream than their core mission of serving to keep costs low for their clients. My guest today is Vinay Patel, a pharmacist who was frustrated by the actions of the PBMs and decided to do something about it. He saw that there was an opportunity to carve out space in the market for a PBM that is transparent to its clients. They are harnessing independent pharmacies around the country to keep costs low. Thanks to the internet it is easier than ever to collectively coordinate pricing for these pharmacies to help them compete against the large big box national chains. However, the big PBMs which comprise 80% of the PBM market, won't go down without a fight. They are continuing their price gouging and use their influence to move friendly regulations to the detriment of the upstart PBMs fighting for market share. Patel and his partners are hoping to break the stranglehold on health care from these big players in the pharmacy and PBM market with Mako Rx. The basic business model of Mako is to provide the adjudication process as a straightforward fee per transaction removing the incentives the larger PBMs have for driving up costs to employers, etc. According to Patel, Mako Rx is nearing the launch of its app that will help consumers find low cost drugs from the independent pharmacies in the US and hopes to expand to cover the entire country in a few years. Vinay Patel is the founder of Mako Rx - a pharmacy benefit manager company committed to bringing increased transparency to the market as well as strengthen independent pharmacies all over the country. show notes Mako Rx: The company website for Mr. Patel's PBM company. MakoRX: Mako on LinkedIn. Episode 005: How PBMs are largely responsible for drug shortages. Episode 043: How PBMs jack up drug prices with Dr. Feldman. Episode 071: Why that medical bill is so expensive. Made Simply Web Site Creations: This is the great, affordable website service that built my wife's podcast site. I cannot recommend this company more to someone looking for creating a website. Always Andy's Mom: Home of my wife, Marcy's, podcast for parents grieving or those looking to help them. YouTube for Paradocs: Here you can watch the video of my late son singing his solo on the Paradocs YouTube page. Patreon - Become a show supporter today and visit my Patreon page for extra bonus material. Every dollar raised goes towards the production and promotion of the show.    

Identifying affordable options to connect to the internet remains a challenge for billions across the globe. In urban areas, internet connectivity is usually provided by a high-speed cable or fiber direct to each home or business. However, a single-user-per-terminal model is not economically justifiable in areas unserved or underserved by terrestrial access. This is due to two primary obstacles to building out infrastructure for expanding broadband Internet access. First, capital costs of terrestrial fixed or wireless networks are directly proportional to distance. Second, the typical business model for deploying broadband to communities with a lower median income base ultimately equates to an unaffordable service as subscription revenue has to exceed the expansion investments.   In our second episode in the series “Connecting the Unconnected,” we’re joined by Wilson Azevedo, Hughes Network Systems’ Wifi Product Manager in Brazil, John Holguin, a Hughes Application Engineer in Colombia, and Hughes’ Senior Director of International Networks, Vinay Patel for a deeper dive on satellite-enabled community Wi-Fi solutions and how they are creating affordable internet access in South America and around the world. Vinay, Wilson, and John will examine the challenges and benefits to bringing remote communities online, the various models for community Wi-Fi, share stories/testimonials from communities and discuss the role Facebook is playing to expand access.

00:00 Intro00:40 Vinay Patel of Self-Insured Pharmacy Networks01:25 In last week's episode02:38 A day in the life of a community pharmacist03:32 Pharmacists in a big box format want to cater to patients just like community pharmacists do03:53 We're replicating the same model on the pharmacy side as DPC has done on the medical side04:41 Care coordination needs to happen all throughout the local care team (healthcare supply chain)05:41 Community pharmacist is just that--part of the community07:00 More tools, more attention to detail, more customization07:38 Less overspending, overtreatment, example = mail order07:58 Smaller is better, especially if you're trying hard not to overspend12:00 Is mail order even all it's cracked up to be?14:30 Those dealing with healthcare challenges could benefit by having another member of the local care team to help "tag team" with the physician18:24 When you have a chronic disease you need high-touch support and accountability19:00 Getting back to the basics might not be a bad thing20:00 We drifted away from relationship-based primary care but we're coming back to it20:32 www.sipharmacynetwork.com, Self-Insured Pharmacy Networks based in Raleigh, NC21:00 vinay.patel@sipharmacynetwork.com21:41 No one definition of "specialty drug". The definition your PBM gives it is in your contract22:15 Get an actual list of what specialty drugs are on your formulary22:26 Make sure you ask lots of questions22:47 There shouldn't be any generic drugs in the specialty category23:37 Allocate much more time to the PBM contract25:00 Spend more time to the upfront education about the prescription drug benefit and what goes into that design27:00 Crawl, walk, run strategy28:30 Employers need a co-fiduciary to be their partner30:00 Carriers glossed over Rx like there was "nothing to see here"31:00 Rockford, IL story32:00 You MUST read your PBM contract33:43 This is people's lives we are dealing with34:00 Municipality resources are deficient today because of the drainage into the healthcare system35:00 Thank you, www.custombenefits.work, #letsfixhealthcare

00:00 Intro00:40 In today's episode00:58 Vinay Patel of Self Insured Pharmacy Networks02:16 What is a PBM?02:32 PBM = claim processor just like a TPA on the medical side03:15 but also rebate management, clinical management, etc.04:17 what about the cost?04:42 episode 8, "transparency" 05:08 Tim Thomas, quote on transparency05:50 There's money in here, if you can find it--it's yours06:02 Do we just need transparency? Or do we need a fiduciary?08:00 It all depends on what's in the contract08:56 Fiduciary principles mean I'm acting in the best interests of my client09:57 NADAC = National Average Drug Acquisition Cost11:09 University of Lynchburg Master's Program in Health Benefits Design12:06 All things being the same, the price fluctuates by hundreds of dollars13:00 Supply & Demand still exists but Rx prices can still be normalized13:13 Manufacturers adjust brand names twice per year14:17 Average Wholesale Price (AWP) means wholesalers are setting the prices14:55 A little disruption might be in order here15:25 We should have a buyer's market, not a seller's market15:50 Direct Primary Care doctors are also dispensing Rx onsite16:40 Let's step back and highlight DPC17:20 Patients want a relationship with their providers, Providers want that too18:12 Now that DPC has primary care handled, let's give them better access to Rx18:57 A subscription model for Rx also20:00 How many pharmacies are locally owned?20:39 Answer = one third, about 22,000 pharmacies21:47 A superior customer experience with care catered to the patient23:40 Pharmacists in big box stores want to cater to patients but can't because of the system25:30 A "concierge" pharmacist? Yes, it's possible26:39 Local care team like Carl Schuessler says in the "Marcus Welby days"28:12 Quadruple Aim means the physician/provider experience is important too29:01 Cliffhanger--What's a day in the life of a community pharmacists?29:08 That's all for today29:16 Thank you, visit us at www.custombenefits.work, #letsfixhealthcare

The #WhoForSchools initiative has officially launched, and we have the list of commentators on hand for you! Special guests include Sophie Aldred, Andrew Cartmel, Vinay Patel, Peter Harness, and a veritable buffet of Doctor Who podcasters commenting on Series 26 and having fun for a good cause! We also have a release date for “The Edge of Time” VR game, alternate covers for the Thirteenth/Tenth Doctors crossover event from titan Comics, and an interview with Simon Guerrier about the newly released Doctor Who: The Target Storybook! Links: – Support Radio Free Skaro on Patreon! – #WhoForSchools initiative – #WhoForSchools commentary participant list – Series 11 supercut – Edge of Time release date – First look at Titan Comics Doctors 10 and 13 crossover – Upcoming Keith Barnfather releases featuring Sil – Target Storybook excerpt Interview: – Simon Guerrier – Target Storybook, released Oct 24  

In this health care podcast, I speak with Lee Lewis, who is the newly minted chief strategy officer at the Health Transformation Alliance, otherwise known as the HTA. The HTA is a group of 50 major corporations that have come together in an alliance to do one thing: fix our broken health care system. Anyone who knows Lee knows he knows a lot about how to improve health care benefits for large employers. He’s pretty much the perfect guy to be the chief strategic officer at the HTA. The most amazing thing that I always find about improving health care, the structure of health care benefits, and health care benefits for an employer is that it’s like having your cake and eating it, too. On one hand, both the employer and the employee save money. On the other hand, employees get better care and they spend less time away from work struggling to navigate the health care jungle all by themselves. Lee has a playbook for improving the structure of health care benefits or health care benefits for large employers, and this playbook consists of three chapters, which we get into in this podcast. The first chapter covers the “how” of health benefits, including what Lee calls the “administrative superstructure.” The second chapter in Lee’s playbook is the “what,” which usually comprises drug spend and then, on the medical side, how care is delivered for specific clinical conditions like musculoskeletal, cardiometabolic, etc. There are a few conditions that tend to rack up the most costs categorically, and those are the ones that Lee focuses on. The last chapter in Lee’s playbook is the “who,” meaning where employees are steered to for care—and that also includes an emphasis on PCPs (primary care providers). You can learn more by visiting htahealth.com and by connecting with Lee on LinkedIn.  Lee Lewis is an innovator and strategist helping large, national, self-funded employers save millions on health care through leading practices, vendor partnerships, and member engagement. He pioneers methods around the convergence of digital health, medical consumerism, biomedical supercomputing, and system reengineering. Lee runs Gallagher’s Innovation Lab practice, a mission-driven group devoted to improving the cost, quality, and design of American health care. Lee advises several health start-ups working to solve meaningful health care problems. The Innovation Lab has a track record of breakthroughs. It leads the effort to bring sophisticated health plan audits to private employers. It pioneered specialty drug direct purchasing without using a PBM. His team led a grassroots effort to identify all independent freestanding emergency rooms in Texas. The Innovation Lab developed the first HSA-compliant model for back and joint pain prevention and is piloting the first-ever ultra-high-value virtual networks in two major US cities. His current and past clients include American Airlines, Comcast NBCUniversal, Albertsons grocery stores, The Home Depot, Abbott Laboratories, and dozens of other large and jumbo employers. Lee is a Rhodes Scholar nominee. He graduated second in his class, magna cum laude with university honors in accounting from Brigham Young University. 02:30 A playbook to reduce health care spend and achieve better outcomes. 02:47 The “how,” or “administrative superstructure.” 04:11 What Lee typically does when working with companies. 09:41 The “what” of delivery—connecting the “what” to the “clinical.” 11:42 Overseeing the pharmacy benefit manager (PBM). 13:46 EP241 with Vinay Patel.13:59 Looking at the medical side of health. 17:02 Improving spend and improving quality simultaneously. 19:30 EP240 with Olivia Ross.20:13 Why centers of excellence make sense. 25:13 The “who”—who is providing the care. 27:27 Enabling and empowering PCPs and improving PCP pay to compensate for that. 30:45 Where the HTA is headed. 32:26 Lee’s advice for brokers. 33:15 Lee’s advice for provider organizations, hospitals, and centers of excellence. 34:48 “Hospital systems are not monolith.” You can learn more by visiting htahealth.com and by connecting with Lee on LinkedIn.  Check out our newest #healthcarepodcast episode with Lee Lewis of #HealthTransformationAlliance (#HTA). #healthcare #podcast #digitalhealth #employerhealth Reducing #healthcarespend and improving #healthoutcomes. Lee Lewis of #HealthTransformationAlliance (#HTA) discusses his “playbook.” #healthcare #podcast #digitalhealth #employerhealth #AdministrativeSuperstructure and the “how” of Lee Lewis’s #employerhealth “playbook.” #HealthTransformationAlliance (#HTA) #healthcare #podcast #digitalhealth #employerhealth What does Lee Lewis of #HealthTransformationAlliance (#HTA) do to reduce #healthspend and improve #healthoutcomes when working with large employers? #healthcare #podcast #digitalhealth #employerhealth Connecting the “what” to the #clinical. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth How do you oversee the #pharmacybenefitmanager in all of this? Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Looking at the #medical side of #health. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM How reducing #healthcarespend actually improves #healthcareoutcomes and #healthcarequality. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Why do #CentersofExcellence make sense? Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Enabling and empowering #PCPs. Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Where is the #HTA headed? Lee Lewis of #HealthTransformationAlliance explains. #healthcare #podcast #digitalhealth #employerhealth #PBM Lee Lewis of #HealthTransformationAlliance (#HTA) offers his advice for #healthcarebrokers. #healthcare #podcast #digitalhealth #employerhealth #PBM Lee Lewis of #HealthTransformationAlliance (#HTA) offers his advice for #healthcareproviders, #hospitals, and #COEs. #healthcare #podcast #digitalhealth #employerhealth #PBM “Hospital systems are not [a] monolith.” Lee Lewis of #HealthTransformationAlliance (#HTA) explains. #healthcare #podcast #digitalhealth #employerhealth #PBM

There are 65,000 community pharmacies in the United States today, and the total cost to locate, staff, and operate these pharmacies is about 9% of our total national drug spending. That’s less than 1% of our national health expenditure—and falling. This is despite the fact that about 85% of our nation’s something like 6 billion prescription fills are unbranded generics, and unbranded generics are a staple of community pharmacy business. These stats are courtesy of Troy Trygstad, by the way. Bottom line, and pharmacy benefit managers pushing mail order may beg to differ, but many patients rely on walk-in pharmacies to get their meds filled timely (same day). They rely on the pharmacist for advice. They rely on the pharmacist to be an extension of the care team. This is even more stark in rural settings where there may be a pharmacist nearby but potentially not a doctor. It would kind of stink for a lot of patients if these pharmacies were pushed out of business by the elephants of the supply chain or, more accurately, on the demand chain. I’m referring to traditional PBMs (pharmacy benefit managers) and the pressures that they are increasingly putting on pharmacies, resulting in what’s beginning to amount to an existential threat for these community pharmacies. In this health care podcast I speak with Vinay Patel, who is the founder of Self Insured Pharmacy Networks. He’s also a pharmacist, and he’s also an expert in these matters. To clarify a couple things before we dive in, PBM stands for pharmacy benefit manager. There are three main pharmacy benefit managers that process the vast majority of prescriptions in this country today. These three traditional PBMs are ESI (Express Scripts), CVS Caremark, and OptumRx. Who hires and pays these PBMs? Employers, for one. And also some insurance carriers and sometimes the government, as in Medicare Part D. These PBMs, by the way … these three are vast, and they’re powerful. You can learn more at sipharmacynetwork.com. Vinay Patel, PharmD, is a pharmacist executive with a 12-year career focused on population health and community pharmacy operations. His background includes integrating pharmacy programs within multifaceted health care teams, engineering effective clinical operations to meet HEDIS program measures, and initiating a pharmacist-led hospital discharge medication reconciliation program. In his current role as founder of Self Insured Pharmacy Networks (SIPN), Vinay is revolutionizing how plan sponsors pay for pharmacy benefit administration. SIPN’s simple, clear cost-plus model allows plan sponsors to generate significant savings over traditional PBM spread pricing through true invoice cost of drugs and a per member per month fee that is never tied to prescription claims volume or billed charges.   02:49 Do clients get discounts based on PBM buying power? 03:08 “PBMs don’t actually buy drugs.” 03:42 What are PBMs really doing? 04:13 “PBMs are supposed to control the cost of drugs.” 05:49 What processing a claim really means. 08:32 Why pharmacy and health care in general don’t abide by any free market rules. 09:47 The frequency of cost fluctuations and how this puts pressure on pharmacies. 12:32 Spread pricing. 15:40 How much money the state of Ohio was paying to PBMs that never made it to the pharmacy. 16:19 “It’s not how much PBMs are making … what we have a problem with is that it’s impossible for the purchaser of PBM services to know exactly how much they’re paying in spread when they’re signing that contract.” 17:07 What’s the value of a PBM’s service? 18:41 Branded drugs and PBMs. 19:46 Misaligned incentives in PBMs and Pharma. 20:29 How drug lists and formularies are driving patients to branded drugs when there might be a generic drug available. 21:12 Direct and indirect remuneration—DIR fees. 24:14 Pharmacy performance metrics. 26:51 What’s the repercussion of PBMs owning all pharmacies? 28:28 A new “breed” of PBMs improving the value of care delivered. 28:59 “What does transparent mean in this industry?” 33:02 What Self Insured Pharmacy Networks does. You can learn more at sipharmacynetwork.com. Do clients get discounts based on PBM buying power? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy “PBMs don’t actually buy drugs.” @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy What are PBMs really doing? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy “PBMs are supposed to control the cost of drugs.” @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy What does processing a claim really mean? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy Why don’t pharmacy and health care in general abide by any free market rules? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy How do cost fluctuations put pressure on #pharmacies? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy What is #spreadpricing? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy Why it’s not about how much the #PBMs are making. @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy What’s the value of a PBM service? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy What’s the connection between #brandeddrugs and #PBMs? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy What are the misaligned incentives in #PBMs? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy What are #DIRfees? @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy A new “breed” of #PBMs improving the value of care delivered. @RphVinay of @SIPNpbm explains in our #healthcarepodcast. #healthcare #podcast #digitalhealth #pharma #pharmamkg #PBM #pharmacy

Twitter: @CoachVinayPatel NCAA D2 Northwestern Oklahoma State, Head Coach The 2018 Sooner Athletic Conference, Coach of the Year.. 2018 Oklahoma Sports Net Coach of the Year Sooner Athletic Conference Champion 82-42 Overall Record..at Oklahoma City University.. Discusses his Pack-Line Defensive Principles.. What his program identity is about.. And what his input is on Applying for Jobs vs. Having Connections..  --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/tree-burks/support

A veritable avalanche of Doctor Who news hit us right in the probic vent this week with new Season 23 Blu-Ray news, annuals, books of fiction, audio plays, Fluxx (whatever that is) and so much more! In fact you could say all this news is doing double duty as we delay the inevitable, AKA the second part of the Gareth Roberts miniscope! Links:  – Support Radio Free Skaro on Patreon! – Gallifrey One 2020 tickets still on sale – Happy 37th birthday, Jodie Whittaker – Season 23 Blu-Ray debuts Sep 23 in the UK – Season 23 Blu-Ray trailer, written by Pete McTighe – Season 23 Blu-Ray clean artwork – 50th anniversary of The War Games finishing transmission – The End of Time cinema screening details – Doctor Who Annual 2020 due September 19 – Star Tales collection announced for release December 5 – Star Tales clean artwork – SDCC-exclusive Pting Funko Pop – Fluxx 13th Doctor expansion due August 7 – Big Finish day was June 22 – Big Finish Fourth Doctor series 9 to feature Adric, one story by Andrew Smith – WhoTalk commentaries for The Daleks and The Curse of Peladon – An Unearthly Convention, Nov 23-34 on Long Island – Mandip Gill won the Eastern Eye People’s Choice award – Vinay Patel won the Eastern Eye Best Scriptwriter award for Demons of the Punjab – William Simons died Miniscope: – Gareth Roberts – The Lodger – Closing Time – The Caretaker

Vinay Patel founder of Self Insured Pharmacy Networks (SIPN) talks about PBM reform and the new business model disrupting the status quo.  SIPN is a Pharmacy Benefit Management company founded by pharmacists Vinay Patel and Ritesh Patel who have over 20 years of combined experience in clinical practice and management/ownership of independent retail pharmacies. Here is the team that is working tirelessly to bring better solutions for the self funded employer marketplace. Vinay Patel, Pharm.D. Founder, Self Insured Pharmacy Networks LLC vinay.patel @ sipharmacynetwork.com 919-436-3359 ext 101 office www.sipharmacynetwork.com See omnystudio.com/listener for privacy information.

On this episode, we talk with Dr. Vinay Patel, founder of the Self Insured Pharmacy Network (SIPN). Vinay gives us an insightful review of PBMs and their role in healthcare. He also talks about how the SIPN plans to take a different approach to being a PBM and how they work with pharmacies. Hope you enjoy! Connect with Vinay: Phone: 919-436-3359 ext 101 Website: https://www.sipharmacynetwork.com/ Email: vinay.patel@sipharmacynetwork.com Who Vinay would take to dinner: https://en.wikipedia.org/wiki/Charlie_Munger Link to PBM graph: https://www.drugchannels.net/2017/08/follow-dollar-math-how-much-do.html Intro Music: https://soundcloud.com/dixxy-2/friday-night-beat Richard's book, The First Time Pharmacist, is now available on Amazon. Get it here: www.amazon.com/dp/1732381402 Like Rx Radio on Facebook: www.facebook.com/RxRadio.fm Check out our memes on Instagram: instagram.com/rxradio.fm Follow us on Twitter: twitter.com/rxradiofm Host: Dr. Richard Waithe Email: richard@rxradio.fm www.twitter.com/richard_waithe www.facebook.com/pharmacydude www.instagram.com/richiewaithe Podcast episodes are powered by VUCA Health, a company that has the largest library of medication education videos that serves to enhance patient engagement and provide an on-demand extension of pharmacists and other healthcare providers. Learn more at vucahealth.com

Conversation about witnessing history and how setting stories in a recent historical period shapes the narrative.Ben and David discuss witnessing history and the thematic elements of Vinay Patel's story. This was billed as Yaz story, but the Metebelis two think this was Graham's best showing of the season to date. David especially liked Bradley Walsh's reading of "all we can strive to be is: good men". Ben explains that what we're asked as an audience to think about has changed quite a bit from the Moffat years. Opening and closing music this week is from Segun Akinola's score for "The Demons of Punjab".

MUTTER'S SPIRAL Podcast is back (a few days late this week, our apologies) to talk about "Demons of the Punjab" (written by Vinay Patel and directed by Jamie Childs), the sad and affecting 6th episode of Series 11 of DOCTOR WHO.  We'll talk about what worked (Lots, it's a beautiful hour of television) and what didn't work (we did have some issues, though, especially concerning the Doctor) for us in the episode.  Plus, we'll speculate about the rest of the Series, including the finale; talk news (New Year's Day!) and ratings; and of course, there's trivia!  Please have a listen!

Golly, another lovely-but-heavy episode of Doctor Who. Join Erika, Lizbeth, and Tansy as we dig into this historical-with-aliens. We talk about the history of history in the show, the use (or not) of religion, and much, much, much more! (We did miss having Deb to wrangle us and keep us on track.) How did "Demons of the Punjab" strike you? Let us know in the comments! ^E Happy things: Tansy is excited that Australians are taking over Doctor Who! cheers on Big Finish's special International Women's Day release! Liz has a Big Finish Short Trips story coming in February, and it'll be read by Neve McIntosh! is thrilled that Doctor Who inspired her niece to learn about Rosa Parks! Erika can't wait to watch Doctor Who with Deb! can't wait to watch Doctor Who with Lynne (at Chicago TARDIS)! Article with Vinay Patel's research material "The Day India Burned" (documentary) Support Verity! on Patreon!

After last weeks divisive episode of Doctor Who, this week the lads take a look at Demons of the Punjab by Vinay Patel. In this non-Chibnall written story, has this got this series of Doctor Who back on track as far as Phil and Paul are concerned? And does this tale set during the partition of India in 1947 make Doctor Who too political and PC as some quarters are trying to suggest? Listen to find out what they thought! And in the news, Barrowman is going to enter the jungle, the Doctor Who Experience is making a comeback, there are the dreaded stats and in Omega's Tat Corner there is a 13th Doctor 5.5 inch figure heading our way and there is festive tat!

Asking Chris Chibnall to step away from the pen this week, we are given Vinay Patel's fascinating depiction of the 1947 Partition of India, in "Demons of the Punjab".

Tras media temporada escrita prácticamente solo por Chris Chibnall, llegamos a la tanda de guionistas invitados en la Temporada 11. Una tanda encabezada por VInay Patel, que nos ha traído el segundo historical de la temporada, centrado en la Partición de India. ¿Qué ha pensado Dylan de esta historia personal de la familia de Yaz situada en un momento tan marcado de la historia de India?El programa volverá en una semana con el comentario de Kerblam!, por Pete McTighe.Podéis escuchar el programa a través de Ivoox: También podéis escuchar el programa directamente a través de este enlace.¡Si disfrutáis del programa, podéis mostrar vuestro apoyo a través de Ko-Fi!Los temas musicales usados en este programa se distribuyen a través de whomix:2014 Redux - DalekiumDelia Derbyshire Restoration - Joel Schelfhout

Está no ar o TrenzaloreCast #145! Nesta edição comentamos sobre o 6º episódio da 11ª temporada, Demons of the Punjab, escrito por Vinay Patel. CONTÉM SPOILERS!

This week on Doctor Who, we were hit with a heartbreaking look at partition, a horrifying and pivotal moment in history. Writer of the episode, Vinay Patel, sat down with me to chat about the pressures one feels doing not just their first episode of Who ever, but an episode that has such a weight behind it. We also talk about how much of a dish David Tennant is. Less important, clearly, but fun.And in this week's Companion Piece: Doctor Martha Jones! Our GDPR privacy policy was updated on August 8, 2022. Visit acast.com/privacy for more information.

It's another grab-bag style week, as Sean and Jonathan give updates on their progress in Red Dead Redemption 2, Jonathan reviews the outstanding Tetris Effect for PS4, and we go over some recent weird news about Final Fantasy XV. Jonathan tells the story of his nearly-doomed trip to Illinois to see a concert, and Sean gives us a mini-lecture on the (surprisingly gay) delights of Herman Melville's Moby Dick. And finally, we at last have a good episode of Doctor Who to talk about this season, as Vinay Patel's “Demons of the Punjab” proved to be the first 13th Doctor outing with a strong story and solid character work, with a fascinating historical and cultural perspective to boot. Time Chart: Intro: 0:00:00 – 0:01:52 Stuff: 0:01:52 – 0:17:37 Tetris Effect: 0:17:37 – 0:30:10 Red Dead Redemption 2 Chat: 0:30:10 – 0:52:06 News: 0:52:06 – 1:07:42 Doctor Who S11E06: 1:07:42 – 1:57:36 Subscribe to our YouTube Channel! Subscribe for free to 'The Weekly Stuff' in iTunes! Follow Jonathan Lack on Twitter! Follow Sean Chapman on Twitter!

On the 100th anniversary of the Armistice being signed, it seemed fitting on the day of Remembrance that the tone of this week’s Doctor Who struck a more sombre tone, and that’s exactly what we got in “Demons of the Punjab”, written by Vinay Patel. The Three Who Rule give their thoughts on the episode, as well as all the news of the week that was, including an expanded stats section! Links: – Support Radio Free Skaro on Patreon! – Episode 6 review, Demons of the Punjab – The Tsuranga Conundrum BBC One overnight viewing figures – Arachnids in the UK final BBC One viewing figures – BBC America Series 11 Ratings – Series 12 in preproduction – Gallifrey One 2019 guest update – Chicago TARDIS – Doctor Who supports Children in Need – Wheel in Space animation sample at Missing Believed Wiped – Big Finish brings back the Paternoster Gang – Bandai Namco canceling Doctor Who Battle of Time – Thirteenth Doctor 5.5″ action dollie – Doctor Who Christmas apparell

En su última aportación como guionista hasta el final de temporada, Chris Chibnall nos trae la primera aproximación de su era. ¿Qué le ha parecido a Dylan esta aventurilla de nuestro equipo TARDIS contra el temible y adorable Pting?El programa volverá en una semana con el comentario de Demons of the Punjab, por Vinay Patel.Podéis escuchar el programa a través de Ivoox: También podéis escuchar el programa directamente a través de este enlace.Los temas musicales usados en este programa se distribuyen a través de whomix:2014 Redux - DalekiumDelia Derbyshire Restoration - Joel Schelfhout

Glenn catches up with AAHOA Secretary Vinay Patel who shares what's happening in the political landscape regarded the lodging industry. They cover the recent AAHOA & AHLA Legislative Action Summit, Tax Cuts and Jobs Act and Tax Reform 2.0, JOLT Act, Joint Employer, tariffs and more. First, Bruce Ford, SVP of Lodging Econometrics gives a report from The Lodging Conference and event Glenn missed and is very sad about. Subscribe to our weekly newsletter. Text hotel to 66866. Visit www.novacancynews.com Send us your thoughts and comments to Glenn@rouse.media, or via Twitter and Instagram @TravelingGlenn. Visit our sponsors: Duetto, Red Roof Subscribe on iTunes: No Vacancy with Glenn Haussman Subscribe on Android: https://play.google.com/music/listen#/ps/Ifu34iwhrh7fishlnhiuyv7xlsm Send your comments and questions to Glenn@rouse.media.  Support the show: https://www.patreon.com/novacancy Follow Glenn @TravelingGlenn Find Bruce Ford on Twitter @BFinNH, and learn more at www.lodgingeconometrics.com Learn more at www.novacancynews.com Produced by Jeff Polly: http://www.endpointmultimedia.com/  

I met up and chatted to Madani Younis, the out-going Artistic Director of The Bush Theatre. We chatted about what it means to be an artistic director, renovating The Bush Theatre, supporting new writers and the play An Adventure written by Vinay Patel and directed by himself. Madani Younis took over as Artistic Director of The Bush Theatre in 2012, a theatre is all about new writing. He has gone on to most recently directed Leave Taking by Winsome Pinnock and An Adventure. He has changed the shape of the building and made a place that reflects the Uxbridge Road. Socials: @bushtheatre @Mumba_Jasmine @OrdArtists www.bushtheatre.co.uk mumbadodwell@outlook.com

I met up and chatted to Vinay Patel about writing for stage and screen, being commissioned by The Bush Theatre and about his play An Adventure, which is currently on at The Bush Theatre till 20th October. Vinay, is a writer for both Stage and Screen who was commissioned by the The Bush and wrote an epic based on the adventures of his grandparents. The play is about a particular family who move from India to Kenya and then to London. The story explores how we fit into different societies that may not want us and how home can be far from where we are born. Vinay other's works being, Sticks and & Stones, Murder By My Father and Doctor Who. Socials: @VinayPatel @Mumba_Jasmine @OrdArtists www.bushtheatre.co.uk www.vinaypatel.co.uk mumbadodwell@outlook.com

Christian Marclay's acclaimed 24 hour video installation The Clock at Tate Modern is a montage of thousands of film and television clips that depict clocks or reference time and operates as a journey both through cinematic history as well as a functioning timepiece. The installation is synchronised to local time wherever it is on display, transforming artificial cinematic time into a sensation of real time inside the gallery. John Carroll Lynch's debut feature Lucky stars Harry Dean Stanton in his last major screen role in a career which included films such as Repo Man, Wild at Heart, Paris, Texas and Wise Blood. Lucky co-stars David Lynch, Stanton's long time friend and collaborator. The Letters of Sylvia Plath Volume II: 1956 - 1963 edited by Peter K Steinberg and Karen V Kukil document - unabridged and without revision - Plath's literary development and private life. It includes 14 letters Plath wrote to her psychiatrist, Dr Ruth Beuscher, between 1960 and 1963. Trust is a ten part series starring Donald Sutherland as J Paul Getty and Hilary Swank as Gail Getty, the mother of John Paul Getty III, heir to the Getty oil fortune who was kidnapped in 1973 by the Italian mafia in Rome. It was written by Simon Beaufoy and directed (first three episodes) by Danny Boyle who previously worked together on Oscar winning Slumdog Millionaire. An Adventure by Vinay Patel at the Bush Theatre in London follows young couple Jyoti and Rasik as they leave India for Kenya in hope of a better life, only to find themselves entangled in the Mau Mau rebellion, from which they leave for England. It is based on the life story of Vinay Patel's grandparents and is directed by Madani Younis, the Artistic Director of the Bush Theatre.

Episode 5 HOLY ROAD by Vinay Patel Directed by Andy Goddard Performed by Ian Houghton A man goes for a run, attempting to work through his grief, to put together a ‘repair kit' for himself. But as he searches in his past for comfort, darker forgotten truths are uncovered. Produced by Will Bourdillon and James Huntrods. Audio produced and edited by Andy Goddard. The Miniaturists Podcast is supported by Nick Hern Books. www.miniaturists.co.uk

I enjoy all my guests on Barefoot Innovation, but if someone forced me to choose my favorite episodes, this one would be on the list. It’s partly because my guests, the co-founders of Bee, were so fun to talk with, and so thoughtful. And it’s also because they are addressing one of the objections people raise to fintech – the notion that it’s only for millennials. Bee was founded in June of 2015 by Vinay Patel and brothers Max and Alex Grasner as an outgrowth of One Financial Holdings, a 'venture-backed laboratory for innovation in retail financial services'. In pioneering an innovative capital-light model using pop-up kiosks and street teams to sign up customers in-person, Bee is able to offer top quality financial services at a significantly lower cost than traditional brick-and-mortar bank branches. Bee is specifically targeting the lack of quality services for low-and moderate-income underserved people (although my guests point out that 'underserved' and 'underbanked' are not words people use to describe themselves). The product is intended to function as an alternative to checking accounts, structured as a prepaid card paired with a mobile app. Bee partners with Community Federal Savings Bank to offer alternatives to checking and savings accounts to its customers in New York and California.  Part of what makes this interesting is Bee’s specific hybrid model of personal touch and high tech. They’re trying to put the human beings where customers need them the most – in explaining and opening the account. And then they’re trying to drive down costs overall by not providing branches and tellers for routine functions. Bee’s team goes in person into underserved neighborhoods in New York and San Francisco, and they set up eye-catching mobile kiosks, which they compare to food trucks. They get people interested and then help them through a thorough process of thinking through their needs; opening an account; setting up and learning to use the app; and then, often, letting the new customer stay on to take advantage of the Bee wifi hotspot. The in-person signup process also helps guard against money laundering, since people are seen face-to-face.  I think you’ll be fascinated by Max and Vinay’s insights into these consumers, including their huge financial savvy -- how thoroughly they know their money situations, and how they optimize their spending on their phones (and the challenges of working with such a wide array of phones that may be old or broken). Vinay and Max talk about their customers’ worries about both pricing uncertainties and payment delays (issues that are being tackled by other innovators as well).    One repeated theme is the company’s commitment to treating these customers with respect by providing a product that is obviously high-quality, right down to the thickness of the card, and providing a truly fantastic user experience on the app. They say customers often take selfies with the Bee team, at the end of setting up an account.  Bee’s CEO, Vinay Patel, has a joint law degree and MBA from NYU. He spent 5 years teaching at NYU Business school and at Columbia Public Policy Business School. He then moved on to McKinsey and Co. as a consultant to banks and government.  Max Gasner has a background as an investment stock broker on Wall street from 2007 – part of what motivated this work. He has also worked in the Bay area at an AI company  - Prior Knowledge, and then moved on to a tech company which eventually morphed into Salesforce.  We recorded this episode several months ago. Since then the company has grown. It also won national recognition in New Orleans in June at the Emerge Conference, as one of the winners of the Financial Solutions Lab competition run by the Center for Financial Services Innovation and funded by JPMorgan Chase. Max and Vinay are eloquent on the need for regulators to allow space for robust innovation – just one startup might create the 10X breakthrough that can change people’s lives. They’re also thoughtful on their commitment to earning compelling returns for their investors, including Blumberg Capital, Fenway Summer Ventures and AXA Strategy Ventures.  They aim to do this with their unique formula of delivering personal attention and high value to a huge, largely untapped market, at very low cost.  Enjoy my conversation with Bee. More Links and Information One Financial Holdings Blog Bee card website and access to kiosk locator CFSI CFSI research on consumer financial health and the financial situations of underserved families Blumberg Capital Fenway Summer Ventures AXA Strategy Ventures My blog post on CFSI’s research on underserved consumers, “Underserved and Underestimated”  More about Vinay Prior to Bee, Vinay spent five years at McKinsey & Company, where he advised leaders of US banks and public sector organizations on executing large-scale IT modernization programs. Vinay is a faculty member at both NYU Stern School of Business and Columbia School of International and Public Affairs, where he has taught courses on Enterprise Strategy, Game Theory, and Data Visualization. Vinay holds a J.D. and an M.B.A from NYU, and a B.A. with honors in Economics from the University of Chicago. He is happily married and lives in Brooklyn. LinkedIn Twitter: @patelpost More about Max Prior to Bee, Max built and sold a machine learning company to Salesforce.com and traded equities in NY and London. Max holds a B.A. in South Asian Languages and Civilizations from the University of Chicago, where he graduated after spending two years at Deep Springs College. He lives in West Oakland. LinkedIn Twitter: @gasnerpants More about Bee Bee is a financial technology startup built on the principle that all Americans deserve convenient, high quality retail financial services. Bee has pioneered an innovative capital-light model using pop-up street teams and kiosks to sign up customers in-person for financial services at significantly lower cost than with traditional brick-and-mortar bank branches. Bee partners with Community Federal Savings Bank to offer alternatives to checking and savings accounts to its customers in New York and California. Bee has ambitious plans to expand its product offering and geographic footprint over the coming years. Its major investors are Blumberg Capital, AXA Strategic Ventures, T5 Capital, Fenway Summer Ventures, and Western Technology Investment Websites: www.onefinancialholdings.com and www.beecard.us Support the podcasts - A buck a show! I've decided to distill a lesson from the popular podcast series Hardcore History, by emulating their habit of asking everyone to send them "a buck a show." Some years ago, the show's host Dan Carlin realized the podcast was taking over his life - much as Barefoot Innovation has been doing with mine! He hit on the idea of asking listeners for "a buck a show," and eventually reached the point where he can devote himself to producing the series. Barefoot Innovation is produced part-time by me and two young, very talented helpers. One of them has a day job and the other is a full-time graduate student. If all our listeners will chip in a buck a show, we'll be able to expand our interviews, accelerate our pace (believe it or not, we currently run at a four- to five-month backlog from recording date to posting!), and be able to do some fun new things we have in mind for you. We'll appreciate any and all help to keep the show going, and growing! And remember to post a review on iTunes. Support the Podcast Subscribe to our Mailing List Sign up with your email address to receive news and updates. Email Address Sign Up We respect your privacy. Thank you!

Barefoot Innovation has been in hiatus in recent weeks because my father passed away. I was in San Francisco and got a call saying he was suddenly ill and might not live through the day. I rushed for a redeye and flew all night home to Boston, where my son Matt met me and we drove to Harford in the wee hours. My brother and sister had rushed to our Dad too, and he had held on. In fact he began to do better, regaling us with stories in the ICU, bringing his sharp engineering mind to analyzing his medical situation, and enjoying us singing to him (we’re a singing family). We had hopes he would recover, but a few days later, he worsened and ultimately did not pull through. He was 95 years old. His name was Glidden Sweet Doman. And he was a remarkable innovator. He’s being widely remembered as the last of the great helicopter pioneers, and he was also an important inventor in wind energy. Those two industries share the same technology – the wickedly complex science of rotor dynamics. This very special episode of Barefoot Innovation is a conversation I recorded with him last Thanksgiving but had not yet posted. I got the idea of doing this podcast after watching a video of a talk he’d recently given at the New England Air Museum, which has two of his Doman Helicopters on permanent display. Listening to his lecture, I kept noticing parallels with the themes we discuss on Barefoot Innovation. It occurred to me that it would be fun to do a show inviting insights from someone who, nearly a century ago, began innovating in a field that’s very different from finance, but that was being similarly transformed by new, fast-changing technology. Glid Doman was born in the village of Elbridge, New York, in 1921. His father, Albert Doman, brought electricity to that part of the state in 1890 (you can still see historic sites related to it), and was an inventor of the electric starter and electric windshield wiper. My Dad’s uncle, Lewis Doman, invented the player piano. His half-brother Carl Doman pioneered both aircraft and automobile engines and became a senior executive at Ford. His half-sister Ruth Chamberlain was the first woman architect in the region. My family is loaded with the genes for invention and entrepreneurship. For my Dad as a boy, the most exciting field of invention was aviation. Airplanes were barnstorming farm fields. Airlines did not yet exist. And my Dad, who avidly read Popular Mechanics, built an airplane in his back yard (you’ll hear in the podcast whether he ever made it fly). Aviation was the new technology then, the way digitization and mobile phones and blockchains are the tech frontiers today -- or genetics or robotics or 3D printing. Aviation was full of novel engineering challenges that were not yet understood. Flight was also inspiring bold predictions about how our lives were going to change, some of which were hilariously wrong – a good lesson for people like me who like to try to forecast tech impacts. For instance, in clearing out our parents’ attic in recent days, my siblings and I found a magazine cover story advising on women’s fashion for the coming trend of traveling by helicopter. This little podcast touches only a tiny fragment of what made my Dad fascinating, and has nothing on his great life partner, our late mother, Joan Hamilton Doman. They met because she was the only woman in the 50-person University of Michigan flying club in World War II – and she was its top pilot. They had an amazing six decades or so, built around family and his work. He knew all the aviation greats from Igor Sikorsky to Charles Lindberg. He was featured on aviation magazine covers and traveled throughout the world. He was enlisted by NASA’s Jet Propulsion Lab to help design a “space sail” to rendezvous with Haley’s Comet (ultimately not deployed). He’s been honored by his alma mater, the University of Michigan aeronautical engineering school. And when his helicopter company didn’t reach scale, he pivoted to wind energy and invented a superior rotor design for wind turbines, using the same insights he’d developed working with helicopters. He led the design of two colossal experimental turbines funded by the Departments of Energy and Interior and installed in Wyoming. When he “retired” at age 65, he and my mother moved to Rome where he led international engineering teams in designing huge turbines in Europe. And then, in his 80’s, he started a new wind energy venture of his own.  Right up to his death, he continued to be engaged with an affiliated firm, Seawind Technology, which is actively working to deploy his “Gamma” rotor designs on offshore wind turbines in Europe and other parts of the world. Decades before computers could model the movements of rotor blades, my Dad used a combination of intuition, math, physics and relentless measurement to understand, correctly, the movement of spinning blades. For both helicopters and wind turbines, my Dad created massively simplified rotor designs and drastically reduced the stress on the blades as they rotate. This captures huge efficiency gains and virtually eliminates blade failure, the bane of most rotor systems. As he explains in our talk, one key to this was to realize that the commonly-used three-bladed rotor design is inherently unstable.  Wind turbines, he argued, should have two blades and helicopters – because they have to fly forward – need four. Our conversation elicited a lot of my Dad’s thoughts about how to work with young, little-understood technology, as both an engineer and entrepreneur. While we didn’t cover all the ground I’d hoped to, you’ll hear him imparting Lean Startup-type wisdom. As a young engineer, for instance, he used a jackknife to cut open the balsa wood of a Sikorsky rotor blade to install measurement gauges on it and figure out what it was doing. He bought a postwar helicopter body for a dollar. He got hold of a Chevrolet clutch to use in his helicopter engine. His team invented do-it-yourself wind tunnels. It’s an MVP approach – a minimum viable product – in which they methodically identified, isolated, and intensively tested issues and reaped what today we call “rapid learning” and “fail-fast” lessons. As they figured out answers, they quickly pivoted, trying to succeed in an industry where, unlike today’s fintech, entrepreneurs needed huge amounts of capital. (In our recording, he talks about how easily his enterprise raised money, but that pattern did not hold over the decades.) Our conversation only touches on a few of these lessons (and nothing about the wind business), but shining through it is his defining trait, the one that made him most successful, which was unbounded and insatiable curiosity. Mainly, this episode shares his secret to being an innovator – and to having a wonderful career. His advice:  find organizations that have a lot of interesting problems, and go there and figure out how to solve them. For those intrigued with the technology history of the twentieth century, I’m attaching early chapters of a biography that my brother, Steve Doman – also an aeronautical engineer -- is writing about our father’s journey. Here, also, is an overview and short video on Doman Helicopters created by my sister, Terry Gibbon (she too is an entrepreneur, with her own video company).  And here is a short video of one of the wind turbines. To prepare this episode, I re-listened to the recording just a few weeks after his passing. One thing I notice is that, as we had this conversation after our Thanksgiving dinner last fall, my Dad’s comments kept making me laugh. Whenever he said goodbye to people, he always added the advice, “keep smiling.”  Words to live by. Let me share two updates about me and the show. First, I’ve become involved in a very significant project aimed at helping prepare our U.S. financial regulatory framework for the challenges raised by innovation. I’m going to stay in my Harvard fellowship for a second year, still writing my book on innovation and regulation, but will also be devoting much of my time to this initiative, which I’ll tell you more about as it develops. One result of the new project is that I’ve decided to suspend the Regulation Innovation video series we launched earlier this year. I expect to reactivate it when I have time to create the videos.  Meanwhile, they are still available, still for free, at www.RegulationInnovation.com. Please do check them out. As I said when we started the series, I think the articles that accompany these videos might be the most important writing I’ve ever done. Second, we will soon be back from the Barefoot Innovation hiatus, and what a line up we have!  We’ll have CFPB Director Richard Cordray; Digital Asset Holdings’ Blythe Masters; National Consumer Law Center’s Lauren Saunders; the prize-winning founders of Bee, Vinay Patel and Max Gasner; Harvard professor and behavioral economics scholar Brigitte Madrian; Funding Circle’s U.S. CEO Sam Hodges; QED Investors co-founder and venture capital wise man Caribou Honig, and the chief compliance officers of both Citi and Wells Fargo, Kathryn Reimann and Yvette Hollingsworth Clark, together.  And those are the ones we’ve already recorded! We have many more exciting people in the scheduling queue. This is why we ask you to send in “a buck a show” – the show has turned into a major enterprise, just because we have so many fascinating people to talk with. We’ll try to speed up production as best we can, I’ll look forward to your continued feedback. Meanwhile, keep smiling.  Jo Ann Click below to donate your "buck a show" to keep Barefoot Innovation going and growing. Support the Podcast Subscribe to Our Mailing LIst Sign up with your email address to receive news and updates. Email Address Sign Up We respect your privacy. Thank you!