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

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]

Ep. 107 - From War Zones to Break Rooms: What Healthcare Leaders Miss About Change (ft. Dr. Loubna Noureddin)

At 10 years old, Loubna Noureddin runs from her home in Sierra Leone as gunfire explodes, clutching fear and leaving her teddy bear behind. In the jungle, hungry and exhausted, she follows the smell of barbecue and realizes the feast might be her. Cannibals wait. A stranger who should be the enemy steps in instead and saves her life.  That is where her story of leadership starts. Not in a boardroom. In survival. On this episode of Working Healthcare, host Meredith Hirsh sits down with Loubna, a refugee kid who grows into a leadership scholar, healthcare executive and author of Determined to Change. She moves from war in West Africa to civil war in Lebanon to the quiet safety of Montreal, where she begins to understand why some people break under constant threat and others grow braver. Loubna now looks at American healthcare and sees the same nervous system on overload. Change initiatives fail. Employees shut down. Leaders rush from one transformation to the next while nurses cry in break rooms and managers feel more like therapists than bosses. She argues the problem is not that people resist change. They resist confusion. No one turns off the air in the “bounce house,” so everyone keeps jumping harder until they burn out. In this conversation, Loubna shares small, specific practices that shift cultures: 10 intentional minutes of connection a day, an empty chair in every meeting that holds the fears no one wants to say out loud and clear priorities that do not change with every email. She calls leaders back to something simple and radical in a tech-obsessed system: humanity matters. If you feel overwhelmed by change or responsible for people who are, this episode grounds you and gives you language for what your team already feels. Tune in and learn what a girl in a jungle teaches today’s C-suite about surviving change. Contact Loubna: LinkedIn: https://www.linkedin.com/in/loubnan/  Facebook handle: Mind Market Consultants  Instagram handle: https://www.instagram.com/mindmarketconsultants  YouTube handle: https://www.youtube.com/@mindmarketconsultants3092 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. 106 - Why Healthcare Keeps Saying No to Better Solutions (ft. Holley Miller)

What happens when an industry built on science and data refuses to act on its own evidence? Host Meredith Hirsh sits down with Holley Miller, a veteran health tech strategist whose 40-plus years navigating medical device adoption, robotic surgery and emerging technology has given her a clear-eyed view of why healthcare is structurally designed to protect the status quo even when it underperforms. Holley reframes clinical resistance not as stubbornness but as rational risk management and makes the case that what looks like innovation failure is really a change management crisis hiding in plain sight. From laparoscopic surgery to AI adoption, she breaks down what it actually takes to move stakeholders, why incremental change rarely sticks and what leaders get wrong when they lead with solutions instead of problems. If you have ever walked out of a conference fired up and watched the momentum die in your next team meeting, this one is for you. Pull up a chair and tune in. This conversation will change how you think about change. Contact Holley: LinkedIn [https://www.linkedin.com/in/holleypmiller/] YouTube [https://www.youtube.com/@GMMDoWhatMatters] 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]