The Astonishing Healthcare Podcast

Judi Health
  • 5.0 (16)
  • MEDICINE
  • UPDATED WEEKLY

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

  1. FEB 6

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

    For the 100th episode of Astonishing Healthcare, we welcomed AJ Loiacono, our co-founder and CEO, back to the show for a lively discussion about the evolution of our industry and business. What started as a transparent pharmacy benefits manager (PBM) in the "age of indifference" is now a more comprehensive health benefits manager (HBM), and we've entered the "era of acceptance." It's been an incredible 8+ years of growth, fueled by innovation and an unwavering commitment to our clients and delivering on our mission: to build the infrastructure our country needs to deliver the healthcare we deserve. But we had to endure an "age of confusion" to get here! AJ explains why traditional healthcare giants are facing a "BlackBerry moment" - trying to emulate a conflict-free challenger when "it’s already too late." The balance of power is shifting away from the traditional PBMs, as the industry now demands full transparency - buyers of health benefits today are smarter than ever before. We also discuss how and why the U.S. wastes [at least] a trillion dollars annually by trying to deliver care using inefficient, fragmented systems; we built the infrastructure to stop it. This episode isn't just a retrospective; it’s a blueprint of sorts, and we've got the cultural DNA required to bring about sustainable change (vs. just daydreaming about it). Related Content Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and WellnessJudi Health’s Capital Rx Surpasses Five Million Contracted PBM Lives as America’s Largest Employers, Unions, and Leading Health Systems Evolve Their Health Benefits StrategiesAH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing HealthcareHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center Model For more information about Judi Health and this episode, please visit Judi Health - Insights.

    32 min

  2. JAN 30

    AH099 - Providing the Right Level of Guidance & Expertise in this Business is About as Hard as Driving Change, with Hannan Allen

    For Episode 99 of Astonishing Healthcare, we welcome Hannan Allen, SVP of Consultant Relations to the company and show! The discussion builds on Episodes 90 and 93, with Jim Winkler of Business Group on Health and Susana Villegas Spillman, respectively, by explaining why "pharmacy benefit consultants have a really tough job right now" and tackling some timely questions, including how has the role of the benefits broker or consultant evolved? What's making the job so complex lately? And, are plan sponsors' primary needs changing? We cover these questions and many more - including who will win Super Bowl LX. - with Hannan, so if you're working in the pharmacy and health benefits space, you won't want to miss this one. Tune in to hear about: Biosimilars - the big opportunity and challenges PBMs have createdThe push for transparency, and what it means for consultantsHow to weigh price/cost, and why drug mix is so importantPrioritizing member care and programs that benefit membersThe opportunity cost of sticking with the status quo (is astonishing) Related Content How employers can take back control of unnecessary pharmacy spendingJudi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM ReformReplay: PBM Procurement Decoded: Insights from a Pharmacist and an ActuaryHealth Benefits 101: Service Excellence & Scaling an Award-Winning Call Center Model For more information about Judi Health and this episode, please visit Judi Health - Insights.

    20 min

  3. JAN 23

    AH098 - Introducing The Judi Group: Mission-Driven Advocacy for Employers

    This episode of Astonishing Healthcare features three members of The Judi Group's leadership team: Jeff Hogan (Co-Founder & Managing Director), Chris Deacon (Director, Growth & Strategy), and Julie Selesnick (Director, Legal & Compliance). The Judi Group is a new venture - a premier advisory firm in healthcare on a mission to help companies evaluate the totality of their health vendors and contracts, deliver insights that lead to more responsible action, and ultimately improve the overall cost picture and health outcomes for their health plans and plan members, respectively. But why now? What steps can employer plan sponsors take to improve their contracting and access data? How do you set up a sustainable fiduciary process? For the answers to these and many more questions, like our guests' personal reasons for embarking on this journey, you'll have to listen in! Highlights We've reached a boiling point - everyone is tired of how the US healthcare system operates,, the misaligned incentives throughout the supply chain, and the unnecessary complexity of it all.There's a growing willingness among employers to challenge the status quo, embrace transparency, and create customized benefit plans that better serve their unique populations.Jeff is driven - in part - by his experience as a public servant, Julie tends to fight for the underdog, and Chris is inspired by the opportunity to make a tangible difference in healthcare.The RFP process must be redesigned for each employer, with their unique needs in mind.Access to claim-level data is critical if employers are to fulfill their fiduciary duties, make informed decisions, and ensure prudent use of employees' healthcare dollars. Related Content AH041 - ERISA Litigation Outlook and Meeting CAA Requirements: What Can Plan Fiduciaries Do?Health Benefits 101: The Importance of a Transparent PBM ModelReplay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and WellnessJudi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform To learn more about the Judi Group, the team, and its mission and services, please visit www.judi.group. For more information about Judi Health and this episode, please visit Judi Health - Insights. Disclaimer This podcast is for informational and entertainment purposes only. The views expressed are those of our guests, do not constitute professional advice, and may not represent Judi Health's/Capital Rx's position on any matters discussed. We make no representations or warranties regarding the accuracy or completeness of the content; information is subject to change and may not be updated.

    31 min

  4. JAN 16

    AH097 - Stories from the Next Generation of Healthcare Disruptors, From Internship to Impactful Full-Time Work

    For Episode 97 of Astonishing Healthcare, we sat down with three team members who interned with Judi Health (Capital Rx) and recently joined our mission as full-time employees! Jakob Deel, Lisa Yu, and Bryan SebaRaj discuss their respective paths to Judi Health, from why they chose healthcare and how they found their internships to why they decided to join a newer, disruptive health tech company over larger "hyperscalers." So, this episode has something for every undergrad and graduate student. That said, Episode 97 isn't just about landing an internship or transitioning from an intern to full-time employee. The trio also discusses the engineering, development, and operations/policy work they are doing to help advance our industry. Our goal is really to raise awareness of the different paths the next generation of healthcare disruptors can take, how to prepare if you're on that path, and highlight the reward at the end of this first step in what will undoubtedly be long and successful careers! To learn more about life at Judi Health, check out our Careers Page, and keep an eye out for our 2026 summer internship program openings, which will be posted there soon. For more information about Judi Health and this episode, please visit Judi Health - Insights.

    18 min

  5. JAN 9

    AH096 - A Quick Government Programs Update: The IRA & MPPP, Managing D-SNPs, and More, with Jason Barretto

    For Episode 96 of Astonishing Healthcare, Jason Barretto, our SVP of Government Programs, returns to the show for a discussion about what's happening on the health plan side of the business. As a company, we spend a lot of time talking about and showing how modern technology streamlines benefit administration workflows and overall operating efficiency, solves longstanding problems, and helps clients stay nimble to meet the intent of new regulations. Well, Jason's experience managing PBM relationships at health plans helps him - and our team - add real value when working with our clients. And, thankfully, he loves to talk about it! During this episode, we discuss: Intensifying demand for transparency (beyond just price transparency)The Inflation Reduction Act (IRA) and the implementation of Maximum Fair Prices (MFP)Slow adoption of the Medicare Prescription Payment Plan (MPPP) and how CMS is removing barriersA streamlined approach to managing Dual Special Needs Programs (D-SNPs), something Jason "wanted to solve" when he started hereA really interesting observation about the popularity of GLP-1sCMS changing its audit approach and the importance of audit readiness in 2026 Related Content How Our Favorite New Judi® Features Aid Government ProgramsJudi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM ReformJudi® is a Tech-Enabler – A Case StudyAH058 - Building Judi®, the Healthcare Infrastructure of the Future, with Liya LomsadzePartnership & Collaboration: Why PBMs and Health Plans Should Sync on Regulatory Change Management For more information about Judi Health and this episode, please visit Judi Health - Insights.

    16 min

  6. JAN 2

    AH095 - What's in Store for the New Year? A Special Round-Robin Episode of Astonishing Healthcare

    Episode 95 of Astonishing Healthcare features six previous guests on the show who share astonishing observations from 2025 and some bold predictions for the New Year! Industry veteran Jeffrey Hogan, our General Counsel and Chief Compliance Officer, Lloyd Fiorini, ERISA law expert Nick Welle, two of our clinical leaders – Sarra Izadi, PharmD, Chief Clinical Officer, and Bonnie Hui-Callahan, PharmD, CDCES, Sr. Director, Clinical Programs, and our Chief Technology Officer and Co-Founder, Ryan Kelly, joined us for this round-robin discussion that’s packed with insightful reflections and optimism about the future. We won’t ruin it in the show notes, but based on what we saw in 2025: Everyone has finally had enough of the costs and opacity of the U.S. healthcare system – a $70k family premium is truly astonishing It’s surprising that, despite the lawsuits, warnings, and reform efforts, the proverbial hammer didn’t drop on anyone for not being a good health plan fiduciary The speed and impact of AI have broadly been more positive than expected The rise of cardio-diabesity How GLP-1s helped shift the balance of power in the pharmaceutical supply chain And in 2026, we may see: Employers fight back – they take agency over their plans, and for first movers that started with transitioning to aligned PBMs, it’s “game on” for the rest of their health plans The cash price – or acquisition cost – of drugs in the U.S. becomes the baseline – i.e., we finally see a real change in how drugs are priced ICHRAs and other alternative models become more popular Employers look to new clinical programs and models that demonstrate a return on their spending AI become more important for clinical workflows (not decision-making, at least not yet) Pharmaceutical manufacturers find themselves with increasing bargaining power vs. traditional PBMs A new Stanley Cup champion, and a Super Bowl ring for… Related Content Judi Health Policy Pulse: 2025 Regulatory Roundup, the Push for PBM Reform Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness AH094 - How Unified Claims Processing Evolved from Pharmacy: Improving Member Care & Operating Efficiency Health Benefits 101: The Importance of Clinical Programs How to obtain Rx data and what to do with it For more information about Capital Rx and this episode, please visit Judi Health - Insights.

    30 min

  7. 12/26/2025

    Best of '25! AH048 - High-Cost Orphan Drugs, Securing Claims Data, and More, with Dr. Eric Bricker

    We got the ball rolling in 2025 with this episode, and it ended up at the very top of the activity list, so we'll close out the year with it as well! Thank you, Dr. Eric Bricker for joining us in the studio for Episode 48 of the Astonishing Healthcare podcast. Known for his entertaining and educational videos covering all sorts of hot topics in and around healthcare and employer/employee benefits, Dr. Bricker and host Justin Venneri discussed the issues of high-cost drugs and access to claims data - two topics he covered on AHealthcareZ - Healthcare Finance Explained - that should [still] be top of mind for plan sponsors as pharmacy costs continue to rise. Dr. Bricker shared several ways employers, depending on their size and risk tolerance, may be able to navigate the challenge of rising pharmaceutical costs for orphan and other expensive drugs - including GLP-1s. He also explains how the RFP process can be used to secure the plan's claim data, which is necessary to meet fiduciary obligations. While every plan is unique, most plan sponsors face similar challenges that the traditional PBM model isn't flexible or aligned enough to solve. Lastly, Dr. Bricker expressed astonishment by the complacency out there, but he was right! The setup was perfect for an acceleration in the pace of change in 2025, and we see the momentum carrying over into 2026 - so, tune in to hear why, if you didn't catch Episode 48 the first time around. AHealthcareZ Reference Videos High Cost Orphan Disease Drugs ExplainedDo Employers Own Their Claims Data? It's Complicated. Related Content AH030 - Plan Sponsors Need a Source of Truth; Get Your Data Now & Find It, with Jeff HoganHow to obtain Rx data and what to do with itAH093 - Health Benefits that Work for Everyone: Aligning Incentives & Focusing on Members’ Needs, with Susana Villegas SpillmanWhy Savings Don't Materialize: The Truth About Pharmacy Benefit Procurement eBook (Free) For more information about Capital Rx and this episode, please visit Judi Health - Insights.

    26 min

  8. 12/19/2025

    Best of '25! AH086 - Balancing Technology and a Human Touch in Member Service, with Lisa Ellerhorst and Sonia Pettis

    In this Best of '25! episode of the Astonishing Healthcare podcast, Lisa Ellerhorst (Sr. Director, Customer Care Operations) and Sonia Pettis (Manager, Customer Care Operations) discuss our approach to member care! Lisa and Sonia have been with Judi Health (Capital Rx) since 2020 and have helped Will Tafoya develop our unique contact center model from the ground up. Building on Episode 34 - Customer Care in Healthcare: Setting a Higher Bar, and the questions plan sponsors and benefits consultants often ask during the RFP process (Episode 84), this episode covers: Several of the most frequent reasons plan members call and how those questions are handled, including switching a prescription from retail to mail and vice versa, prior authorizations for GLP-1s, and more.How to navigate transitions and focus on quality care (over speed).What it takes to maintain a high level of customer satisfaction (99%) while handling a 50% spike in call volume year-over-year.The communication strategy used to educate members and help them navigate new offerings effectively.The role of AI and how agentic AI can support member care and free up our skilled, PTCB-certified reps to handle more complex issues.Future-proofing the service model and preparing for the 2026 welcome season. Related Content Pharmacy Benefits 101: Building an Award-Winning Call Center from ScratchAH017 - Pharmacy Benefits 101: Prior AuthorizationHow employers can take back control of unnecessary pharmacy spendingCapital Rx’s Customer Care Team Wins 5 Stevie® Awards for Customer ServiceWatch: Are Your Prior Authorizations Actually Working? For more information about Capital Rx and this episode, please visit Judi Health - Insights.

    20 min
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Ratings & Reviews

5
out of 5
16 Ratings

About

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

Information

  • Creator
    Judi Health
  • Years Active
    2024 - 2026
  • Episodes
    108
  • Rating
    Clean