Join host Patty Fahy, MD as she shares the evidence for why physicians must lead healthcare and lead us out of the current healthcare system morass. Patty has twenty years of experience working with leaders in healthcare—as a member of an executive team, founder of a successful coaching and consulting firm, and as a committed physician advocate. This podcast is for you if you want expert physician leaders at the helm of U.S. healthcare systems and if you want practical advice and critical conversations about honing the leadership skills of physicians.
The Licensed to Lead Podcast offers new angles on the neuroscience of leadership, challenges a “burnout industry” that is profiting from physician burnout, and offers a no-holds-barred investigation into the business school mindset that puts profits over patients. Patty and her guests provide provocative and clear recommendations for changing the business of medicine so that it fulfills the professional obligations of medicine.
The physician identity is deeply rooted in doing the right thing for patients. It is time for the financial preoccupation that arises from a business school mindset to be subordinated to the professional obligations we have to patients. Find out more about Patty and Fahy Consulting at LicensedtoLeadPodcast.com.
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Join host Patty Fahy, MD as she shares the evidence for why physicians must lead healthcare and lead us out of the current healthcare system morass. Patty has twenty years of experience working with leaders in healthcare—as a member of an executive team, founder of a successful coaching and consulting firm, and as a committed physician advocate. This podcast is for you if you want expert physician leaders at the helm of U.S. healthcare systems and if you want practical advice and critical conversations about honing the leadership skills of physicians.
The Licensed to Lead Podcast offers new angles on the neuroscience of leadership, challenges a “burnout industry” that is profiting from physician burnout, and offers a no-holds-barred investigation into the business school mindset that puts profits over patients. Patty and her guests provide provocative and clear recommendations for changing the business of medicine so that it fulfills the professional obligations of medicine.
The physician identity is deeply rooted in doing the right thing for patients. It is time for the financial preoccupation that arises from a business school mindset to be subordinated to the professional obligations we have to patients. Find out more about Patty and Fahy Consulting at LicensedtoLeadPodcast.com.
027 - 13 Ways PBMs Profit Mightily and Hurt People
Licensed to Lead
39 minutes
4 years ago
027 - 13 Ways PBMs Profit Mightily and Hurt People
Pharmacy benefit managers, or PBMs, are companies that manage prescription drug benefits for payers like insurance companies, government programs such as Medicare and Medicaid, and self-insured employers. They are the middlemen and money handlers who negotiate with pharmaceutical manufacturers to determine drug prices and drug placement on formularies. Considering the costly and far-reaching impact of their negotiations, they have been allowed an inexplicable level of unchallenged secrecy in all of their transactions. Their work determines the total cost the payer will spend on prescription medications, the patients’ access to medications, and how much pharmacies are paid. While their role, ostensibly, is to help control waste and rein in spending on pharmaceuticals, it doesn’t appear those goals made it onto most PBM to-do lists. Abject lack of oversight in a for-profit environment has turbocharged the opportunism among PBMs. The three largest PBMs control over 75% of the business, all three are ensconced in the Fortune 50, and all three are facing racketeering charges. There are a slew of investigations and state and federal legislation focused on curtailing predatory behavior by PBMs.
In this episode, I'm tapping the expertise of Dr. Barbara McAneny, an oncologist, CEO and founding partner of the New Mexico Cancer Center, and former AMA president. Dr. McAneny helps me walk through the myriad ways PBMs increase their own profits while causing harm to patients, pharmacists, and doctors.
In this podcast, you will find 13 problems with PBMs including these five moneymaking machinations:
--Discount and Rebate Strategies—that INCREASE drug prices --Spread Pricing – a kissing cousin of skimming --Administrative Fees—until the cows come home --Mail Order Waste—a money-making scheme --Direct and Indirect Remuneration—surprise billing PBM-style
Meet Barbara L. McAneny, MD: Dr. Barbara McAneny is nationally recognized as an advocate, an innovator, a business leader, and a doctor’s doctor. She is a board-certified medical oncologist and hematologist from Albuquerque, New Mexico where she is the CEO and co-founder of the multi-specialty, multi-site New Mexico Cancer Center. She also founded the New Mexico Cancer Center Foundation, which provides grants to help patients with nonmedical expenses. In 2012 she received a $19.8 million grant to create an oncology medical home, demonstrating that triage pathways would improve outcomes and also lower costs. The Come Home medical home has been recognized and adopted as a recommended model by CMS. Her leadership roles reach well-beyond New Mexico, including nearly two decades with the American Medical Association leading up to her role as the president of the AMA in 2018.
Join host Patty Fahy, MD as she shares the evidence for why physicians must lead healthcare and lead us out of the current healthcare system morass. Patty has twenty years of experience working with leaders in healthcare—as a member of an executive team, founder of a successful coaching and consulting firm, and as a committed physician advocate. This podcast is for you if you want expert physician leaders at the helm of U.S. healthcare systems and if you want practical advice and critical conversations about honing the leadership skills of physicians.
The Licensed to Lead Podcast offers new angles on the neuroscience of leadership, challenges a “burnout industry” that is profiting from physician burnout, and offers a no-holds-barred investigation into the business school mindset that puts profits over patients. Patty and her guests provide provocative and clear recommendations for changing the business of medicine so that it fulfills the professional obligations of medicine.
The physician identity is deeply rooted in doing the right thing for patients. It is time for the financial preoccupation that arises from a business school mindset to be subordinated to the professional obligations we have to patients. Find out more about Patty and Fahy Consulting at LicensedtoLeadPodcast.com.
