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

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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

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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

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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, hosts Michael Navin and Randy Vogenberg are joined by Luke Prettol, benefits strategy leader at AT&T, for a deep dive into how employers are preparing for the growing impact of cell and gene therapies. The conversation focuses less on headline costs and more on the real risk employers face as utilization increases, therapies evolve, and benefit design struggles to keep pace.

Luke explains how AT&T defines success in benefits strategy, prioritizing patient outcomes while staying ahead of market trend. He walks through how large employers think about claim size, long-term value, and the growing complexity tied to treatment risk, provider selection, and fair pricing. The episode explores why rare disease therapies will no longer be one-off events, how proactive patient identification and centers of excellence can reduce risk, and why employers must plan several years ahead instead of reacting year to year.

Key Topics Discussed
• How employers define success beyond lowest cost
• Why cell and gene therapies create new risk challenges
• Treatment risk, provider risk, and financial risk explained
• Why rare diseases are becoming more common at scale
• Planning for 3–7 year benefit strategy horizons
• Proactive patient identification and care navigation
• Centers of excellence and site-of-care decisions
• Managing pricing certainty and outcome accountability
• Budget volatility, stop-loss pressure, and financial risk
• Structural challenges including ERISA erosion and data gaps

Episode Chapters & Timestamps
00:04 Welcome and episode overview
01:36 Luke Prettol background and role at AT&T
02:21 How employers define winning in benefits strategy
03:30 Claim size versus outcomes and long-term value
06:45 The three core risks employers must manage
08:30 Why cell and gene therapies change the risk equation
10:34 Rare disease growth and planning for 2030
13:19 Lessons from specialty drug adoption
15:24 Proactive patient identification and early intervention
19:50 Centers of excellence and treatment accuracy
22:03 Predictability, data, and risk reduction
23:26 ROI, retention, and member experience
26:22 The employer “triple pain” framework
32:35 Defining success and planning beyond today
36:06 Closing remarks

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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/.

Employers are no longer waiting for healthcare costs to stabilize. In this episode, Randy Vogenberg and Michael Navin are joined by Murray Harbour to break down why advanced primary care, direct contracting, and value-based benefit design are moving from pilot ideas to core employer strategies.

The conversation examines how employers are shifting away from traditional networks, why prevention and engagement continue to struggle at scale, and what is finally changing in 2025 and beyond. From GLP-1 program missteps to bundled care models and local primary care solutions, this episode offers real-world examples of how employers can regain control of cost while improving access and outcomes.

Key Topics Discussed

• Why employer healthcare renewals are driving new benefit strategies
• The difference between direct primary care and advanced primary care models
• Evidence behind primary care investment and long-term cost control
• Why ROI is giving way to the value of investment in benefits planning
• Employer frustration with access, billing complexity, and care delays
• How self-funded employers are bypassing traditional networks
• What GLP-1s revealed about program design and wraparound care
• PBM contract limitations and emerging workarounds
• The growing role of local, high-touch primary care models
• What benefit planning for 2026 and 2027 is starting to look like

Episode Chapters and Timestamps

00:00 Welcome and guest introduction
01:40 What is changing for employers post-pandemic
02:40 Does primary care investment actually lower costs
03:45 ROI versus value of investment in benefits
04:40 Prevention, wellness, and engagement challenges
05:55 Direct vs advanced primary care explained
06:55 Why employers are bypassing traditional networks
08:10 Provider systems adopting advanced primary care
09:50 Why benefits moved down and back up the priority list
11:05 Legislative incentives and misalignment
13:20 What employers are planning for 2026
14:55 PBM contracts and pharmacy control
16:50 Multi-generational benefits and engagement
18:00 How younger workers are reshaping benefit expectations
21:05 Why change happens slowly and strategically
24:15 The future of advanced primary care and local models
27:45 Primary care as the quarterback of care
28:40 Closing thoughts and wrap-up

Michael's LinkedIn

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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, hosts Michael Navin and Dr. Randy Vogenberg welcome back Jayson Slotnick for a fast-moving year-in-review of 2025 and a grounded outlook for 2026. The conversation breaks down what changed through the Inflation Reduction Act implementation, why Most Favored Nation pricing keeps resurfacing, and how these policy forces could ripple across Medicare, Medicaid, and employer-sponsored coverage.

Jayson also explores how direct purchasing, transparent pricing models, and the shifting PBM landscape may affect affordability, access, and benefit design. From Part D redesign and underused smoothing to biosimilars, 340B dynamics, and the role of the FDA in driving competition, this episode connects the policy headlines to what employers, manufacturers, and plans should realistically watch next.

Key Topics
• 2025 recap: IRA implementation and Part D redesign
• Drug negotiation timelines and spillover effects
• Most Favored Nation pricing: what is voluntary vs mandatory
• Patient affordability: premiums, deductibles, out-of-pocket pressure
• Employer direct purchasing, net pricing, and PBM disruption
• Biosimilars, patent cliffs, and what 2027 could change
• 340B, hospital economics, and who really benefits from drug money
• FDA’s role: faster approvals, competition, and innovation
• 2026 watchlist: Part B negotiation list, CMS rules, ACA dynamics, CMMI models

Chapters
00:04 Welcome and intro to Jayson Slotnick
02:04 2025 recap: IRA, CMS, affordability pressures
02:45 Predictable vs unpredictable: Part D redesign, MFN momentum
06:22 IRA vs MFN: separate lanes, real-world collisions
09:12 Voluntary MFN models, IRA is not voluntary
12:24 Employer net pricing and direct purchasing trends
16:30 Affordability, hospital costs, and 340B dynamics
18:57 FDA’s role: competition, generics, biosimilars, faster approvals
23:22 2026 predictions: what we know is coming
29:06 Stay current, stay calm, stay focused
31:51 Commercial market changes and employer leverage
39:33 Wrap and where to follow OHP

Michael's LinkedIn

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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, hosts Michael Navin and Randy Vogenberg welcome back healthcare policy veteran Deborah Williams for a candid conversation on why 2025 became such a difficult year for employers, patients, and policymakers alike.

Coming off the tensions of the government shutdown and escalating healthcare costs, the discussion breaks down what is actually driving premium increases, prescription drug spending, hospital consolidation, and benefit design changes. Deborah draws on decades of Washington experience to explain why many policy ideas keep resurfacing, why they continue to fall short, and what risks lie ahead as the system moves into 2026.

From direct-to-consumer drug pricing and PBM reform to political gridlock and consumer backlash, this episode explores where healthcare policy may realistically land next and why affordability remains the unanswered question.

Key Topics Discussed

• Why employer healthcare costs outpaced exchange inflation in 2025
• Hospital consolidation and cost-shifting pressures
• Prescription drug spending trends and policy spillover effects
• Direct-to-consumer drug pricing and deductible portability
• PBM reform debates and unintended consequences
• Political gridlock, populism, and healthcare affordability
• What employers, plans, and consumers may face in 2026

Chapters with Time Stamps

00:04 Welcome and episode framing
00:44 Deborah Williams' background and policy perspective
01:44 Why 2025 was a brutal year for employers
03:34 Hospital consolidation and cost shifting
04:35 Prescription drug costs and market pressure
07:15 Consumer behavior, adherence, and affordability
09:00 Political realities and exchange subsidies
12:08 Insurers, public sentiment, and misinformation
14:03 Drug pricing models and global comparisons
16:41 Employer leverage and failed market solutions
17:49 Emerging therapies and future cost risk
20:24 What could improve in 2026
24:26 Populism and the next policy inflection point

Michael's LinkedIn

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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/.

Recorded live at the Nicholas Hall North American Conference, this special episode of the Only Healthcare Podcast dives into the FDA’s new Additional Conditions for Nonprescription Use (ACNU) pathway and what it means for access, compliance, and the future of consumer healthcare.

Host Randy Vogenberg is joined by industry veterans Bob Stirling and Bob Barron, with questions moderated by Mary Alice Lawless. Together, they break down how ACNU differs from telepharmacy and direct to consumer models, why scale matters, and how built-in safeguards could enable safer nonprescription access to certain therapies, including acne treatments.

The conversation explores compliance challenges, payer dynamics, employer sponsored accounts like FSAs and MSAs, and why ACNU represents a fundamentally different approach to access that could benefit consumers, manufacturers, and plans alike. This episode provides essential context for anyone tracking FDA policy, OTC switches, market access strategy, or healthcare affordability.

Key Topics Discussed

• What ACNU is and how it differs from telepharmacy and DTC
• FDA safeguards and consumer level decision support
• Scale, retail access, and why shelf access matters
• Simultaneous Rx and nonprescription marketing considerations
• Compliance challenges in traditional Rx models
• Implications for payers, coverage, and benefit design
• The role of FSAs, HRAs, and MSAs in supporting access
• Why ACNU represents a new paradigm for consumer healthcare

Chapters with Time Stamps

00:04 Episode overview and ACNU context
01:27 ACNU vs telepharmacy and DTC models
02:48 Simultaneous marketing and provider oversight
03:33 Introduction to compliance and consumer engagement
04:18 Why traditional Rx compliance programs fall short
05:46 Payer and manufacturer cost dynamics
07:05 ACNU as a leadership opportunity for consumer health
07:51 Coverage, payers, and outcomes expectations
08:34 FSAs, HRAs, and MSAs in the ACNU ecosystem
09:57 Pricing stability and consumer affordability
10:45 Key takeaways from Nicholas Hall Conference

Michael's LinkedIn

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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/.