Ep. 109 - Downcodes, Takebacks and Timely Filing: How Payers Really Win (ft. Chris Acevedo)

Ep. 112 - Justin Hand Unveils Insights on Healthcare's Private Equity Landscape - Re-release

Physician burnout rises, administrative burdens pile up and private equity money floods into healthcare, but most doctors still ask one urgent question: “What are my real options?” In this re-release of a foundational episode of Working Healthcare, Meredith Hirsh sits down with Justin Hand, founder and managing director of Westcove Partners, to map those options with clear, pragmatic detail and a sharp eye for legacy. Justin opens with the staggering scale of global healthcare private equity and explains why low- and middle-market practices draw such intense investor interest. He breaks down platform practices, bolt-ons and strategic acquirers, then shows how each path reshapes a physician’s autonomy, income and succession plan. Meredith pushes on the real-world pressure points, from ASC decisions and hospital affiliations to growing physician and administrator burnout, and Justin responds with candid stories from more than 90 healthcare transactions. Together they explore “income repair,” MSO structures and equity rollover, translating finance jargon into concrete examples that matter to clinic owners who juggle payroll and patient care every day. Justin contrasts physician-owned success stories with groups that seek private equity partners to resolve friction, expand recruiting or survive in markets dominated by MA plans and hospital systems. The conversation returns again to legacy, as Meredith and Justin weigh the value of independence against the reality of shrinking margins and the responsibility to keep practices open for patients and staff. If you lead a medical practice or advise one and you want a clear, narrative guide through private equity, MSOs and succession planning in today’s healthcare economy, listen in to this episode of Working Healthcare and share it with a colleague who wrestles with the same decisions. Contact Justin: LinkedIn: @justinhand [https://www.linkedin.com/in/justin-hand-560a331/] Contact Meredith: Website: meredithhirsh.com [https://www.meredithhirsh.com/] Instagram: @workinghealthcare [https://www.instagram.com/workinghealthcare/] Facebook: WorkingHealthcare [https://www.facebook.com/workinghealthcarepodcast] LinkedIn: @meredithfhirsh [https://www.linkedin.com/in/meredithfhirsh/] YouTube: @WorkingHealthcare [https://www.youtube.com/@WorkingHealthcare]

Ep. 111 - Chuck Melendi Unveils the Truth Behind Big Pharma - Re-release

Drug prices soar, patient bills spike and everyone blames Big Pharma, but what if the real power players sit in the shadows behind your pharmacy counter? In the re-release of this foundational episode of Working Healthcare, Meredith Hirsh invites Chuck Melendi, founder of the Disruptive Dialogue podcast and veteran Johnson & Johnson insider, to walk straight into the fire and unpack the truth behind the industry’s most polarizing debates. Chuck uses clear, punchy stories and hard numbers to show how “Big Pharma” no longer stands as the biggest giant in healthcare, then compares drug manufacturer revenue to the colossal income of insurers and PBMs that quietly control formularies, rebates and patient access. He explains how direct-to-consumer advertising evolves, why TV spots drive sales and why he still argues for unbranded education that keeps the conversation between physician and patient. Meredith presses him on drug pricing, and Chuck responds with an insider’s view of transparency reports, R&D budgets and the delicate balance between profit, innovation and public responsibility. The episode then dives into the rebate game, formulary battles and the brutal leverage PBMs hold over both manufacturers and clinics, all in language that clinicians, patients and advocates can follow. Chuck shares vivid moments from decades of account management, including the tug-of-war between safety data, patient services and the raw economics that dictate which medications stay on a plan. He tells the personal story behind his decision to leave J&J, describes himself as “too knowledgeable to stay silent” and why he launched a mission-driven effort to disrupt the system through consulting, speaking and podcasting. Meredith and Chuck close with a bold wish: break up publicly traded insurers and PBMs and restore a healthcare landscape that serves patients instead of quarterly earnings. If you want a candid, experienced voice to guide you through the real forces behind drug prices, PBMs and Big Pharma’s reputation, listen in to this episode of Working Healthcare and share it with someone who navigates those pressures every day. Contact Chuck: LinkedIn: @chuckmelendi [https://www.linkedin.com/in/chuckmelendi/] Website: disruptivedialogue.org/meet-chuck [https://www.disruptivedialogue.org/meet-chuck] Discruptive Dialogue podcast: Disruptive Dialogue with Chuck Melendi [https://podcasts.apple.com/us/podcast/disruptive-dialogue-with-chuck-melendi/id1809415150] Instagram: @chuckmelendi [https://www.instagram.com/chuckmelendi/] Facebook: facebook.com/cmelendijr [https://www.facebook.com/cmelendijr/] YouTube: @DisruptiveDialoguePodcast [https://www.youtube.com/@DisruptiveDialoguePodcast] Contact Meredith: Website: meredithhirsh.com [https://www.meredithhirsh.com/] Instagram: @workinghealthcare [https://www.instagram.com/workinghealthcare/] Facebook: WorkingHealthcare [https://www.facebook.com/workinghealthcarepodcast] LinkedIn: @meredithfhirsh [https://www.linkedin.com/in/meredithfhirsh/] YouTube: @WorkingHealthcare [https://www.youtube.com/@WorkingHealthcare]

Ep. 110 - Demystifying Pharmacy Benefit Managers (ft. Alerie Stiles) - Re-release

Pharmacy benefit managers sit between your doctor and your drug, yet almost no one understands how they really operate. In this re-release of Episode 5, Meredith Hirsh and guest Alerie Stiles strip away the jargon and expose the vivid, real-world impact of PBMs on patients, physicians and independent practices. Alerie shares her unconventional path from cold-calling EHR demos to shadowing more than a thousand physicians, then harnesses that frontline insight to build technology that frees doctors from clunky software and restores genuine face time with patients. Meredith and Alerie walk through the “vertically integrated” world where one parent company can own the insurer, the PBM, the pharmacy and even the clearinghouse, and they unpack what that structure means for coverage decisions and drug access. The episode turns deeply personal with the story of a breast cancer prescription that takes three weeks to reach a patient, landing her in the hospital, and then contrasts that devastation with a medically integrated dispensing model that delivers specialty medications in just three days. They decode rebates and DIR fees in clear, concrete language and explain why independent clinics and hospitals fight so hard to keep dispensing power inside the care team. Alerie closes with a bold vision for immunology and rheumatology, where payers approve transformative biologics but only community practices can dispense them, not PBM-owned specialty pharmacies. If you want sharper insight into who truly controls your prescriptions and how independent practices fight back for faster, safer access to life-changing drugs, listen in to this episode of Working Healthcare and share it with someone who navigates the PBM maze every day. Contact Meredith: Website: meredithhirsh.com [https://www.meredithhirsh.com/] Instagram: @workinghealthcare [https://www.instagram.com/workinghealthcare/] Facebook: WorkingHealthcare [https://www.facebook.com/workinghealthcarepodcast] LinkedIn: @meredithfhirsh [https://www.linkedin.com/in/meredithfhirsh/] YouTube: @WorkingHealthcare [https://www.youtube.com/@WorkingHealthcare]

Ep. 109 - Downcodes, Takebacks and Timely Filing: How Payers Really Win (ft. Chris Acevedo)

Most people think a doctor’s visit ends when they walk out of the exam room. It doesn’t. That visit triggers a maze of prior authorizations, coverage rules, coding decisions and payer tactics that can make or break a medical practice months or even years later. On this episode of Working Healthcare, host Meredith Hirsh sits down with Chris Acevedo, CEO of Acevedo Consulting, who grew up watching his mom run practices and now helps physicians across the country navigate the business side of medicine. Chris walks through what really happens before and after a visit—from front-desk data entry and benefit checks to denials, timely filing traps and surprise takebacks on claims that payers already processed and paid. He explains why one technical error can cost a practice both the drug it infused and the reimbursement it thought was safe, creating what he calls a double whammy. They dig into downcoding policies, constantly shifting Medicare rules, ABN changes, and why “just because you got paid doesn’t mean you get to keep the money.” Chris shares how good doctors get pulled into fraud and abuse nets designed for true bad actors, and why practices who never intend to cut corners still wind up at risk when they ignore incident-to rules or skip basic reconciliation of fee schedules and payments. Throughout the conversation, Chris argues that practices must treat compliance and revenue integrity like any other core expense—alongside cleaning crews, accountants and legal counsel—because no one else will protect the dollars that keep their doors open. He also makes the case for patients owning more responsibility for their care in a system where payers carry outsized leverage and physicians burn out under constant whack-a-mole regulation. If you work in a practice, lead one or just wonder why your “paid” claim still looks shaky 18 months later, this episode gives you a clear, practical look at the rules behind the medicine. Contact Chris: Website: www.acevedoconsultinginc.com [https://www.acevedoconsultinginc.com] LinkedIn: www.linkedin.com/in/christopher-acevedo-34b3579 [https://www.linkedin.com/in/christopher-acevedo-34b3579] Contact Meredith: Website: meredithhirsh.com [https://www.meredithhirsh.com/] Instagram: @workinghealthcare [https://www.instagram.com/workinghealthcare/] Facebook: WorkingHealthcare [https://www.facebook.com/workinghealthcarepodcast] LinkedIn: @meredithfhirsh [https://www.linkedin.com/in/meredithfhirsh/] YouTube: @WorkingHealthcare [https://www.youtube.com/@WorkingHealthcare]

Ep. 108 - Where Did All the Doctors Go? A Surgeon and Medical School Dean on What We’re Losing (ft. Dr. Chad Perlyn)

When Chad Perlyn was four, his parents drove through the night to say goodbye to a baby who was not expected to live. A young pediatric surgeon walked into the waiting room, laid out an impossible choice then walked back out hours later with a smile that meant one thing: the baby survived. That moment set Chad’s life in motion. On this episode of Working Healthcare, host Meredith Hirsh sits down with Dr. Chad Perlyn, a pediatric plastic surgeon, Oxford-trained scientist, MBA and dean of Nova Southeastern University’s allopathic medical school. Chad traces his path from a waiting room in Miami to Oxford labs and, after the earthquake in Haiti, to a children’s hospital where a pilot on the tarmac asked, “Who’s in charge?” Everyone turned to him. From there, the conversation turns to the crisis hiding behind titles and credentials. Fewer physicians run their own practices. More young doctors enter a world of EMRs, system jobs, private equity rollups and patients who no longer automatically trust the white coat. Chad explains why hanging a shingle is getting harder every year, why more physicians now work for someone else and what that means for access, autonomy and the future of independent medicine. He worries less about AI than about what medicine could lose if machines manage too much of the work: the human voice in a crisis and the hand on a parent’s shoulder when there is no cure, only presence. If you wonder where all the independent doctors went or what kind of physician will be waiting on the other side of the exam room door 10 years from now, this episode asks the question medicine cannot afford to ignore. Contact Chad: LinkedIn [https://www.linkedin.com/in/chad-perlyn-md-phd-mba-facs-1102a019a/] Contact Meredith: Website: meredithhirsh.com [https://www.meredithhirsh.com/] Instagram: @workinghealthcare [https://www.instagram.com/workinghealthcare/] Facebook: WorkingHealthcare [https://www.facebook.com/workinghealthcarepodcast] LinkedIn: @meredithfhirsh [https://www.linkedin.com/in/meredithfhirsh/] YouTube: @WorkingHealthcare [https://www.youtube.com/@WorkingHealthcare]