How to Spot PBM Markups Hiding in Plain Sight (feat. James Murray)

How to Spot PBM Markups Hiding in Plain Sight (feat. James Murray)

What if a generic medication retailing for $15 was billed to your company’s health plan for over $6,000? James Murray, Founder and Managing Director of Murray Strategic Healthcare Ventures, spotlights these massive markups happening every day in corporate healthcare. With 35 years of Wall Street capital markets experience, Murray brings an institutional risk manager’s lens to the opaque world of Pharmacy Benefit Managers (PBMs). He identifies the middleman fees draining employer budgets and employee retirement assets, and shares how self-insured plan sponsors can use public Form 5500 filings and new CAA disclosure mandates to demand fee transparency at the renewal table. Tired of accepting healthcare spending as an uncontrollable expense? This episode is a roadmap to reclaiming control. ________ Sign up for our email list. [https://www.movingtovalue.org/subscribe] Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members [http://movingtovalue.org/members].

Insurance Giants are Running Out of Time (feat. François de Brantes)

The legacy insurance machine is running out of time, and the pendulum is swinging back toward employers. Healthcare innovation pioneer François de Brantes lays out a ruthless, no-compromise blueprint for self-insured employers to reclaim control of their healthcare spend. Currently the Executive Vice President of Payment Innovation and Network Performance at XO Health, de Brantes pulls zero punches in discussing how the industry has crossed the line into unabashed stealing from corporate pockets. He breaks down a 25-year industry regression, as corporate giants which once demanded 100% unredacted claims data ceded that power to carriers. He exposes the opaque consultant commission schemes serving as the carriers' last line of defense, and he outlines how employers can use new transparency mandates to fulfill their legal fiduciary duties and protect themselves from liability. Stop playing defense and stop settling for point-solution pennies. Tune in for an unfiltered masterclass on how to finally force transparency and real value from the healthcare system. Find a transcript of this episode at movingtovalue.org/transcript/debrantes [https://www.movingtovalue.org/transcript/debrantes] ________ Sign up for our email list. [https://www.movingtovalue.org/subscribe] Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members [http://movingtovalue.org/members].

Treating the 'Madness' of Healthcare's Status Quo (feat. William Bestermann)

The American healthcare system is financially engineered to wait for expensive medical disasters rather than preventing them. Perhaps no one has a clearer view of how to dismantle this "rescue medicine" trap than Dr. Bill Bestermann. A preventive cardiologist and former President of the South Carolina affiliate of the American Heart Association, Bestermann has spent decades fighting the "medical-industrial complex" from the inside—as an ICU director, health plan advisor, and chief medical officer. As the author of the Slow Aging and Delayed Chronic Disease Development newsletter, Bestermann exposes how Wall Street insurance companies and obsolete, 50-year-old billing models actively protect highly profitable specialty silos at the expense of patient health. He is a fierce champion of optimal medical therapy, a low-cost, protocol-driven approach that arrests chronic disease at the root cellular level. He joins us to unpack the staggering economic disparity between standard procedure-driven care and molecular prevention, explaining how self-insured employers and communities can bypass bloated hospital networks to buy actual, measurable value. Find a transcript of this episode at movingtovalue.org/transcript/bestermann ________ Sign up for our email list. [https://www.movingtovalue.org/subscribe] Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members [http://movingtovalue.org/members].

Scaling Up Self-Funded Employer-Led Healthcare (feat. Ashley Bacot)

Picture a healthcare plan with free primary care visits, physicals and health screenings, $0 copays for most services and prescriptions and negotiated direct contracts for most major procedures, as well as on-site fitness, flu shots, vaccines, family planning, nutritional services and more. This is the reality for thousands of employees of Rosen Hotels & Resorts in Orlando, Florida, leading to high primary care compliance and huge savings — $500 million to date. As most employers brace for double-digit premium increases, Rosen's costs remain roughly half the national averages. Ashley Bacot, the architect of Rosen's world-renowned healthcare plan, joins us to discuss how this model can serve as a blueprint for scaling up sustainable, value-based healthcare across the country. Find the transcript of this episode at movingtovalue.org/transcript/bacot [https://www.movingtovalue.org/transcript/bacot] ________ Sign up for our email list. [https://www.movingtovalue.org/subscribe] Thank you to our members who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/members [http://movingtovalue.org/members].

How to Build Community Owned Health Plans (feat. Bryce Heinbaugh)

In Ohio's rural Ashtabula County, employers and patients struggled with rising costs and accessing services until a community coalition built a localized healthcare ecosystem. The results? A transparent financial structure that cuts out middlemen, direct primary care and community contracting, zero-dollar copays for many services and improved trust, satisfaction and population health outcomes. Bryce Heinbaugh, the man behind this coalition, joins us to discuss the transformative power of community owned health plans, and how his work in Ashtabula provides a roadmap for communities around the country to reclaim control from national insurance giants. Find the transcript of this episode at movingtovalue.org/transcript/heinbaugh [https://www.movingtovalue.org/transcript/heinbaugh] Mentioned in this episode: our May 2024 episode with Dr. Scott Conard [https://www.movingtovalue.org/podcast/episode/27bf54be/transforming-healthcare-the-impact-of-purpose-driven-approaches-a-conversation-with-dr-scott-conard-md], our June 2025 episode with Darrell Moon [https://www.movingtovalue.org/podcast/episode/20463a89/you-are-the-customer-fixing-healthcare-from-the-ceos-desk-with-darrell-moon], our November 2025 episode with April Kyle and Dr. Doug Eby of Southcentral Foundation's Nuka system [https://www.movingtovalue.org/podcast/episode/1e6e5aac/part-1-the-nuka-blueprint-with-april-kyle-and-dr-doug-eby]. ________ Sign up for our email list. [https://www.movingtovalue.org/subscribe] Thank you to our members [https://www.movingtovalue.org/supporters] who make our work possible! As a 501(c)(3) nonprofit, the Moving to Value Alliance relies on generous supporters to advance our mission of creating a value-based healthcare ecosystem with high-quality health outcomes at a reasonable cost for plan sponsors and their members. Get involved at movingtovalue.org/membership [http://movingtovalue.org/membership].