In this inaugural Healthcare 101 segment, Dr. Randy Vogenberg breaks down the fundamentals of the American health insurance system. From the evolution of employer-sponsored coverage to the rise of managed care and vertical integration, this episode explores why healthcare feels so complex and where the money actually flows.

Listeners will gain clarity on the role of middlemen, cost shifting, site of care decisions, and what individuals can do to better navigate the system. Whether you are an employer, industry leader, or consumer, this episode offers foundational insights to help you make more informed healthcare decisions.

Key Topics

• The historical evolution of the American health insurance system
• Cost, access, and quality as the core healthcare triangle
• Employer-sponsored coverage and government programs
• The rise of managed care and third-party intermediaries
• Vertical integration and consolidation in healthcare
• Who the “middlemen” are and how they influence costs
• Transparency challenges in healthcare pricing
• Cash pay options vs. traditional insurance pathways
• How consumers and employers can become more engaged
  
  
  

Episode Chapters with Timestamps

00:00 – Introduction to Healthcare 101
00:34 – What is the American health insurance system?
01:04 – How cost, access, and quality shape healthcare
03:55 – Why the system is so complicated
05:20 – Who are the key players in healthcare?
07:15 – The role of middlemen and consolidation
09:16 – Vertical integration explained
09:59 – What individuals can do to navigate the system
11:51 – Cash pricing vs. traditional insurance models
13:00 – Why understanding the system matters

Michael's LinkedIn

Randy's LinkedIn

Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.

In this episode of the Only Healthcare Podcast, Michael Navin and Randy Vogenberg welcome Lynn Hanessian, founder of Engager, for a wide-ranging discussion on why healthcare engagement has become a critical challenge for employers, providers, and consumers. Drawing on her background in economics, healthcare communications, and strategy, Lynn explains how rising costs, shifting information sources, and complex benefit designs are placing new demands on patients who are not equipped to navigate them.

The conversation explores transparency, trust, technology, AI, employer responsibility, and the growing need to teach consumers how to engage with healthcare decisions in real time.

Key Topics Discussed
• Why healthcare engagement has become a missing skill
• The shift of cost and decision-making to patients
• How employers have become the most trusted healthcare messenger
• Transparency gaps in pricing and plan design
• Changing information behaviors and the rise of generative search
• AI, technology, and their limits in improving care today
• Consumer confusion around access, urgency, and cost
• Public trust, misinformation, and the burden on providers
• What engagement must look like for the future of care

Episode Chapters with Time-Stamps
00:05 – Welcome and introduction
01:05 – Lynn Hannessian’s background and focus on engagement
03:32 – Defining engagement and identifying critical audiences
05:06 – Employers, patients, and the information gap
06:12 – Shifts in how people seek healthcare information
09:22 – Care management, stakeholders, and alignment challenges
12:13 – Transparency tools and pricing visibility
15:06 – Empowering consumers to question costs
16:07 – Building healthcare literacy and decision skills
18:02 – Trust, misinformation, and public health messaging
21:10 – AI, post-COVID acceleration, and system strain
24:58 – Access challenges in rural and underserved areas
26:37 – Expectations of consumers and providers
29:41 – Policy, JPMorgan conference insights, and what is coming
34:25 – Specialty care growth and employer readiness
36:11 – Multi-generational care complexity
37:51 – Closing thoughts and where engagement goes next

Michael's LinkedIn

Randy's LinkedIn

Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.

In this episode of the Only Healthcare Podcast, Michael Navin and Randy Vogenberg welcome healthcare attorney, policy advocate, and author Chris Deacon for an in-depth conversation on how structural incentives, middlemen, and lack of transparency have reshaped the U.S. healthcare system.

Drawing from her experience overseeing New Jersey’s state health benefits program and her book The Great American Healthcare Heist, Chris explains how employers and public sector plans are increasingly squeezed by rising costs, opaque pharmacy benefit structures, hospital consolidation, and technology deployed to optimize revenue rather than reduce spend. The episode explores why understanding contracts, data, and incentives is critical and where real opportunities for reform may still exist.

Key Topics Discussed
• How healthcare incentives became misaligned across the system
• Why transparency is essential to restoring affordability
• The evolving role and impact of pharmacy benefit managers
• FDA approval, drug marketing, and assumptions about efficacy
• Vertical integration and the corporatization of medicine
• Public sector healthcare insolvency and budget crowd-out
• How AI is being used to optimize billing rather than reduce costs
• Practical levers employers can use to regain control

Episode Chapters with Time-Stamps
00:04 – Welcome and introduction to Chris Deacon
01:01 – Chris’s background in public service and healthcare oversight
03:12 – Why state healthcare plans mirror the commercial market
04:16 – The motivation behind The Great American Healthcare Heist
07:28 – Training gaps and healthcare literacy challenges
09:07 – Pharmacy benefits, PBMs, and middlemen dynamics
12:21 – FDA approval, drug marketing, and flawed assumptions
14:49 – Healthcare spending surpasses $5 trillion
16:04 – Public sector insolvency and budget crowd-out
18:54 – AI, revenue optimization, and unintended consequences
20:17 – Hospital consolidation and vertical integration
23:20 – Transparency, direct contracting, and paths forward
26:22 – Practical levers employers can pull today
29:19 – Early signs of market change
31:27 – Closing reflections and call to action

Michael's LinkedIn

Randy's LinkedIn

Sponsored by:
Peek: A game-changing prescription shopping solution that allows its members to view all their prescription cost options across cash discount programs and their insurance in one easy-to-use platform. Peek is currently being offered to organizations to help both employees and plan sponsors save money on their prescription spend. https://peekmeds.com/.

Institute for Integrated Health (IIH): Health care benefits, insurance coverage regulations, and doing business in the healthcare industry can be complicated. At IIH, Dr. Randy Vogenberg and his team understand these unique challenges and provides strategic guidance customized to every client. To help overcome your unique challenges, IIH delivers education, planning and advisory on market trends, and U.S. health care market intelligence. The firm’s decades of proven success are due to strategic collaboration with associates from the business, clinical, and scientific communities. https://iih-online.com/.