In this episode of the Pharmacy View Podcast’s Rx to Riches stream, international host Michael Alexander, a Pharmacist, entrepreneur, digital health enthusiast, Co-Founder of Audrie, and the Regional Vice-President of Health Plans at Omada Health, interviews Dr. Drew Oliveira, Executive Director, Washington Health Alliance and Clinical Associate Professor, University of Washington; and Denise Giambalvo, Director, Member Engagement & Business Strategy, Washington Health Alliance. Together, they unravel the complexities of the U.S. healthcare system, exploring solutions and challenges in enhancing quality and affordability.

Denise discusses their journey from the retail industry to their current role, focusing on enhancing healthcare quality and reducing costs. They emphasize the importance of employer-led coalitions and their commitment to improving employee care delivery, particularly in Seattle, where they are engaged in their third coalition endeavor.

Dr. Drew Oliveira shares their diverse background, transitioning from family physician to the insurance industry, gaining insights into U.S. healthcare practices. They highlight the employer's role in creating self-insured health plans and their current focus on improving quality, access, and affordability in healthcare. They are dedicated to addressing health disparities, especially within the employer community. Dr. Oliveira delves into the evolution of the U.S. healthcare system, from apothecary-driven care to the establishment of Medicare and Medicaid, while addressing persistent challenges like the uninsured population and rising healthcare costs.

Further, Dr. Oliveira explores historical attempts to implement national healthcare programs, highlighting resistance from various stakeholders and discussing proposed solutions like Medicare for All. They emphasize the importance of aligning physician workforce distribution with population needs to enhance healthcare quality and cost-effectiveness. Denise reflects on the cultural challenges associated with implementing a single-payer or government-led healthcare system in the United States, expressing concerns about government intervention potentially limiting individual freedom in healthcare decisions.

Additionally, Denise and Dr. Oliveira delve into the multifaceted role of Pharmacy Benefit Managers (PBMs), discussing their functions in claims adjudication, formulary development, and rebate negotiations. They highlight the complexities of formularies and rebate negotiations, shedding light on how these processes impact healthcare costs and patient access to medications. Overall, the episode provides insightful discussions on healthcare challenges and strategies for improvement.

Note: Stay tuned for Part 2 as we explore the American healthcare system with Dr. Drew and Denise next week.