Dasha: Welcome to the Biomedical Frontiers Podcast, where we explore pivotal research projects and disruptive innovations aimed at translating scientific advancements into tangible healthcare solutions. I'm your host, Dasha Tyshlek.
Personal healthcare spending in the US averages over $11,000 per person annually. This is a 2022 statistic. In 2025, private healthcare insurance, premiums averaged $7,450 per year, which is approximately $620 per month per person. Over $70 billion of medical debt is borrowed by Americans in 2024. At least on the employer sponsored healthcare side,
40% of all healthcare costs now is going to drugs. 40% of all healthcare is just the drugs? Yeah, that's right. This is just boggling my mind so much. And what that clause specifically stated was, pharmacists are prohibited from telling patients about lower cost treatment options at the pharmacy. So that the, those, the specific medication that the doctor wrote would be the one that's processed through the insurance.
It, it was very difficult for pharmacists to have those conversations with patients. Welcome back to the show. Our guest is Vinay Patel. He has a distinctive perspective on the nuances of drug pricing and accessibility. His home delivery pharmacy has served over 15,000 patients. As a pharmacist, he has personally seen the impact of cost on patient care. Today,
his company, MakoRx, is innovating subscription based healthcare services with a focus on reducing drug prices for those with chronic conditions.
Vinay: In today's episode, you will learn why healthcare has become so expensive for everyone.
How technology is making prescription medications more accessible. Revitalizing, struggling independent pharmacies and the role and value of the pharmacist and how to partner with them in patient care. 
Dasha: Vinay I am so excited to have you on the show because when we put this poll out to our audience on LinkedIn, we had a lot of people really interested in hearing more about healthcare costs, and you had actually reached out specifically because you write on the topic of healthcare costs.
This is an area in which you specialize and in which you're making a difference. And so, I was very intrigued. We, we got a lot of questions that came in from our audience and we're gonna be actually asking them throughout the show. I wanna start off with just a few interesting facts: personal healthcare spending in the US averages over $11,000 per person annually. The average cost of employer sponsored health coverage is expected to surpass $16,000 this year.
Over $70 billion of medical debt is borrowed by Americans in 2024. This is like overwhelming amount of cost. And it, this is not the kind of debt that you get excited about because you're gonna, you know, build a company with it.
This is, this is very devastating. What's causing this, why?
Vinay: We could probably spend all week talking about why it is the way it is. There's various factors that are contributing to the debt. A lot of it. Some of it has to do how we pay for healthcare in this country. It's different than other countries do.
It's very siloed or segmented. And the burden of who pays for that has been shifting over the last, let's just say 25 years, 15 to 25 years. A lot more of the burden in who pays for these costs, have shifted to the patient away from, you know, insurance companies paying for a lot of the medical care upfront.
It's patients having to pay for that and that's contributing to personal debt that they've accumulated because, it's really difficult when a majority of the country, that can't afford, you know, when you hear statistics about who, what can, what kind of expenses can you afford? If you were to get hit with, you know, a hundred dollars or $500 expense that came out of the blue, would you be able to afford it?
And you have a big majority of the country saying, no, I couldn't even afford that. And now we have, deductibles, which is essentially the portion that patients have to pay before their health insurance kicks in as at, you know, $2,000, $5,000, $7,000. It's that's a lot of money for people to have to pay.
And so it's getting, it's contributing to, to this national debt, personal debt that people have in medical.
Dasha: And, and I you said there's a shift, so there's a, a real trajectory in terms of cost shifting to the patient. Can you share a little bit of like what, what that looks like? What was happening 20 years ago?
What, what's happening now? What's making the difference? 
Vinay: Healthcare has gotten more expensive and we've seen that. Let's, we'll go back to when I was growing up and my parents had health insurance through their employer. It was really straightforward.
You paid a couple hundred dollars a month, you got really good healthcare that, you know, you just sort of paid for the doctor visit when you went to go see them. And it was just a flat copay and there were drugs that you needed, and it was just sort of a flat copay to get the drugs, and there were no deductibles.
Then what happened was healthcare premiums started to go up and become more expensive. And as those premiums started to go up to cover more people, a big inflection point that we had was probably when the Affordable Care Act went into place. When when that law took effect, it required insurance companies to cover some minimum set of coverage coverages for everyone in the, in the country.
And because the required to have certain coverage for your insurance, the cost of that insurance, rose. And then they also on the, on the other end, capped how much an insurance company could make in profit. Now it's called the medical loss ratio. So that accelerated and they covered a lot more folks through the Affordable Care Act, which is the main purpose of that, of legislation was to make sure more people had access and coverage to healthcare.
And on the flip side, there was no, essentially cost containment on how much premiums could go up. So if a company's, sort of capped at making a profit of 15% every year. The only way you can get more profit is by making the price of that go up. And so health insurance premiums started going up to counteract, you know, the, the cap they put on the profit.
And as those premiums started going up and up. And it became more and more unaffordable, the cost of care, the services that we all consume for healthcare or for anywhere. From going to see your primary care doctor to getting medications, to going to the hospital, surgery, so on and so forth. As all of those became more and more expensive. 
We now have, how do we, how, how, who pays for this and how do we pay for it? And so a lot of that cost shifting became higher deductibles. Healthcare plans that had higher and higher deductibles in them to shift the cost, the upfront cost to consumers, to patients, essentially on the up on the front end.
And it became essentially a catastrophic policy. Essentially, you paid out until the five, $7,000 until insurance actually kicked in, if you had some major catastrophic life event: an accident, cancer, god forbid or some major event that you would need healthcare for. But now it disproportionately affects people with chronic conditions as well.
Dasha: What about other things you hear kind of people referencing in terms of cost, like transparency of pricing? I hear a lot, it's a big discussion point right now. How does that play into the costs of care? 
Vinay: So the transparency discussion has to go what, what the concept was is if we all know the prices of something and we know the, the,
true prices of some of, of healthcare services that we all consume, we can make informed choices. Unfortunately, its not that simple.
Consumers don't make direct healthcare choices. We go through the advice of a trusted advisor, like a nurse or our provider saying, hey, you should go, you know, get this scan done here and that's where I recommend you do and just go down the hall. Or health systems owning providers in the community owning primary care providers and specialist providers, and they're referring into the health system that owns it's sort of the most expensive place to get some of these scans done because of just how they bill insurance when you get a scan done in a health system versus independent.
And so it was supposed to this transparency and there, there, there isn't a, a lot of clarity on the transparency either. You know, there was a report of somewhere around 60 to 70% of health systems haven't reported into machine readable format all of the costs that are in the health system and what are those costs?
Those are costs that no one really pays in the charge master, so on so forth. And so, yes, you know, the concept was there to help lower, lower costs, but I don't think that it works that way in healthcare. Healthcare is unlike anything else in the, in, in the world, in the economy. 
Dasha: Well, let's get into what are the costs of healthcare?
So what is what is the expensive items? Is it the lifesaving, like advanced cancer treatments? Is it just regular care? What, what's kind of the big items that, that make up these large costs, kind of a, a population level? 
Vinay: What's contributing more and more to the cost of healthcare are expensive medications.
Some of these medications are cancer drugs that you take, you know, to help cure or treat cancer to get into remission. Some of these drugs are chronic drugs that you need to take on a monthly basis. I'm sure if you've seen any sort of live sports event recently, every other ad on TV is for a medication that.
Patients can administer themselves, so their self-administered medications and therefore chronic conditions, chronic conditions like psoriasis or arthritis or, or rheumatoid arthritis, so and so forth. These are medications that are specialty medications that cost a lot of money that you have to take every month to control your chronic condition. And those are now contributing upwards of,
at least on the e employer sponsored healthcare side, 40% of all healthcare costs now is going to drugs. 40% of all healthcare is just the drugs. Yeah, that's right.
 
Dasha: So it seems like that's a really big lever right there that you found in your practice for reducing costs. How does reducing costs through the cost of chronic care management and drugs, how does that work?
Vinay: So it starts with assessing every single patient and medication. You have to understand what they're taking the medication for, what they've tried previously. Have a consult, you know, as a pharmacist, we consult with specialty providers and understand their background, their their medical history, and the thinking of the provider to need a specific therapy.
Once we have some context and some background, we can actually go into here's some alternatives, and it's not abundantly clear to providers what other alternatives that may be lower cost, because of the way the healthcare system, especially on the pharmacy side, is structured. Every single insurance company has several different plans, healthcare plans, that you as an individual can enroll into, or as an employer, they can opt to offer their employees. And every single plan, there's hundreds of these healthcare plans across all of the insurance companies, have their own specific set of drugs that they cover. So it's different.
So now you have hundreds of different formularies or lists of drugs that are covered by the health insurance company and it gets very confusing and overwhelming for providers to, to have to figure out. Are you on plan A, B, C, D, F, from insurance company Z? And they cover this drug. But when I see someone that's on the same insurance company but on a different plan, they don't cover this drug.
And it's, it's gets very frustrating. And so providers stick to what they know that they've used and that works. And so sort of, they sort of default to that. And then we come in and say, okay, wait, let's take, let's put a pause here. The reason why we're, or intervening on this patient is because of the cost of the medication, or either the cost of the employer or the cost of the patient is just too much.
It's overwhelming. There's ways to mitigate that. You know, if that's the drug that they need to be on, there's no other alternatives that they can try, or that they've tried and they failed and this is the best one, then we have to go find how to save on that drug. How to save the employer from spending. Most of the drug costs today,
if you have employer sponsored healthcare, the employer spending most of that drug costs. And, how can we help the member save? And there's different, various, different tools and options we have that go into this collaboration that we have with the providers in the community. 
Dasha: Yeah, that's very, very interesting.
What I, so I had a somebody I worked with who came up with this term "complification". And what it was is there's things that are naturally complex. Then there are things that you "complificate" to make them more complex. And what you described to me in terms of what the physician is facing when they're trying to figure out a treatment and prescribe something where not only is it their knowledge, that's just the complex,
what the patient tolerates, what the doctor knows about has tried trusts. But then there's the "complification" part, which is this: everybody's got different plans and then some people can or can't get certain things. That just adds this layer of complexity that's not necessarily helpful and creates like risks for doctors and, and the patient.
To me. Wouldn't the solution be that, can we advocate for that? How can we change that? 
Vinay: Yes, I need, I've started to say this term, anything's possible when with enough time, energy, and money, we can change anything. And I think it's gotten to a tipping point now more than ever before where people are realizing that we need to change what exists at a federal level.
There's definitely efforts being made but there's also a lot of money on the other side to keep the system the way it is, the status quo. What you mentioned, the "complification," that's by design. It's because the insurance companies and the vertical integration within the insurance companies are,
at their core, publicly traded for-profit companies. And they have to find a way for new revenue every single year to maintain the stock price, to maintain the shareholder investor returns. Otherwise it just, they, they wouldn't be serving their fiduciary responsibility to the company if they weren't finding new ways.
And I think that it's gotten to the point where they've started to extract rents or extract revenue outta the system without necessarily adding value back into healthcare. They've just found it, found pockets of money that they can extract, either extracting from pharmacies that are paying in the form of clawbacks or or extracting from patients who are overpaying for drugs certain times.
And all that money goes back to the insurance companies and the middlemen. Extracting money from government plans through Medicaid and Medicare, extracting money from employers through commercial insurance. And, and the spread pricing, which is overcharging them for certain drugs and, and paying the pharmacies a different price.
And there's so many areas now that, that we've gotten into. Now there's Med Pharma, which is the medical administration of drugs and how there is, a certain extraction of revenues from that bucket of money or that, that sort of new healthcare revenue stream for insurance companies. And so we've gotten to the point now where we can change it.
It's going to take a lot of effort, a lot of concerted effort from people just like you and me and your listeners to really change the system that, that, that we have today.
Dasha: So how did you like, get so passionate and get into trying to help everybody save money on on the drugs part of healthcare, and then start a company around that?
How, how did you get into that?
Vinay: It started when I was practicing. So I practice in various different areas of pharmacy. Before we started MakoRx and I worked in retail pharmacy, worked in independent pharmacy, as you mentioned at the beginning of the show. I was part of the leadership team at a home delivery pharmacy and worked in health systems.
I worked for the state and worked for community health centers. In all of this sort of practice areas that I've been involved in, the invisible hand of the insurance companies and what we call in pharmacy, pharmacy benefit companies was always there. Didn't matter where you practice, they were always there and they dictated essentially how much money pharmacies made, how much they could charge for medications, how much they would get paid for those medicines, what they what you could say to patients in terms of, you know, how you consulted with patients and, and advised lower cost treatments and there's certain restrictions there. 
Dasha: And can you explain what were the restrictions from insurance companies on pharmacists in how they advised patients?
Vinay: Great question.
So, and this was before 2018, there in the contracts, pharmacies would sign to get, to be able to take someone's insurance. So UnitedHealthcare or Blue Cross Blue Shield or CVS Caremark. There would be a clause in the contract that would be known as the gag clause. And what that clause specifically stated was, pharmacists are prohibited from telling patients about lower cost treatment options at the pharmacy. So that the tho the specific medication that the doctor wrote would be the one that's processed through the insurance. Essentially, patients, you know, having to pay, locking in the system to make sure that that drug made it to the insurance company system and got paid for.
And until there was a, a law that repealed that in the first Trump administration, it was very difficult for pharmacists to have those conversations with patients. 
Dasha: This is just boggling my mind so much. So it's the insurance. Like I can understand if the drug manufacturer wants to make sure everybody stays on brand and you don't like, but this is the insurance company.
They were, making pharmacies sign a contract that they would not advise patients on lower cost alternatives than the one prescribed, what would be the incentive for them? Why would they do that?
Vinay: If it's for a very expensive medication, they want that expensive drug to go through the plant, go through the insurance company so that they can, you know, there's, there's multiple revenue streams on a drug that the middlemen are making, and so they want to make sure that that expensive drug that's on formulary goes through the, the, the insurance company so that they can,
make, make the, the revenue off of it essentially. 
Dasha: Now, I'm, I'm honestly, I don't wanna sound offensive in any way, but this is my personal, like growing up, this is how I saw the pharmacy and the pharmacist. You, you see your doctor, you have conversations, they write you a note, and then you go to CVS or Costco, you hand the note,
somebody who you don't know, they wear a lab coat. They just get, they get some bottles outta the back and they, they tell you to wait 20 minutes or two hours. I don't know why. Is it not ready? Are they making it themselves? Is it getting shipped? I don't know. Then they hand it over to you in the counter with this giant piece of paper and they say, do what the doctor told you in terms of taking this.
What I'm hearing you say on the backside of it, if, if pharmacists are being hamstrung from advising, that means they have a lot of advice to give. Can you talk about the role of the pharmacist in and what, what should it ideally be? When they're not, their hands are not tied and they're able to participate.
Vinay: Wonderful, wonderful, question about the role of the pharmacist Dasha and, and there's, there's different, areas of pharmacy. So there's two when you, when it comes to patients interacting directly with pharmacies in the community, there's the big box, you know, chain stores Walmart, CVS Walgreens, Rite Aid, so on and so forth.
And then there's the independent pharmacies that are mom and pop owned. Your, your small businesses that are just, again, running a service. Their, their service for the community to make sure their community's healthy and well taken care of and so on, so forth. And both, both pharmacies have excellent pharmacists that work in there, but some pharmacies, like the big box change stores and the corporate environments have, not given enough time for the pharmacist to do the type of care that ideally a pharmacist that is a small business can take the time to educate you and educate patients and, and sort of inform them. So in your example, with a prescription and, and today there's no paper that's running around with a lot of it's electronic.
And so your doctor, when you see them, will just send an electronic prescription to the pharmacy. You'll walk over to the pharmacy and say, Hey, is this medication ready? And the pharmacist will then, you know, first and foremost if they're reviewing the medication and they're saying, oh, it looks like this medication.
You know, the, the insurance co company charges you this for this antibiotic, let's just say that you needed, you know 50, $60 for this medication. But in actuality, the medication could be much cheaper without your insurance as a cash price for the medicine, it would be $15 for your medication.
That's one thing that the pharmacist could then have a conversation with you about and say without, if you didn't use your insurance, if you used, some special program that we have, or if you just bought it directly from me without the insurance, it would be much cheaper. And that's another sort of mind-boggling thing is that
medical services and drugs are sometimes or oftentimes more expensive with insurance than without insurance. And that's a whole nother topic we can, we can chat about, but then they can also talk to you about do you know how to take the medicine? Do you know about the side effects of the medication?
Do you know there's interactions with other medicines you may be taking and how to avoid those interactions or what you should do, or it looks like you have an allergy to this medication the doctor didn't know about. It's my responsibility as a pharmacist to call your doctor's office and see if there's an alternative you should be taking so that I can keep you safe.
And that's a lot of what goes into when you process the medication outside of just making sure that it's the right medicine, the right dose, and the the directions are correct for what you're taking it for, and so on, so forth. And that's conversations we have on the back end with the prescriber if we notice anything that's off or funny.
And and then in addition to that, you know, also addressing the cost and the affordability side, telling you about alternatives, making sure if there's any over the counter options to help you with your illness or sickness that you know about those, and you can take those to help your symptoms. And so on so forth.
You know, that that's sort of the, the whole clinical conversation, just like you had a, a, a visit with the doctor and they had their visit and their clinical conversation. The pharmacist has, as well. That involves collaborating not only with the provider, but with the patient as well and educating and informing them.
Dasha: So, first of all, I am learning a lot here about the role of the pharmacist on the backend. It seems like something they, that's done quietly and you don't even see as a patient. I'm also really intrigued by this neighborhood pharmacy concept because, to me that's something that was like in the 1920s, you know, you see those old buildings and now they've become coffee shops or something.
So what is the small business pharmacy landscape and what, how are they different from the big box stores? Other than that they're usually more locally owned. 
Vinay: The, the difference between, the mom and pop pharmacies and the big box pharmacies is
a differentiated level of service, so customer service, and quality of care as well. When you go into these local, 'cause they have more time to, to see you and to, you know, take care of you and know your family and know the medications that you're on. It's sort of a personal level of care that you wouldn't get from necessarily from a big box pharmacy.
But the challenges that they face are, are equal in terms of all pharmacies have pressures from insurance companies and the pharmacy benefit companies in terms of reimbursement. All the and all of these pharmacies are facing the same pressures. It's a, it's harder for a local mom and pop pharmacy to weather the storm as,
a big corporate pharmacy store. We just saw this year with Walgreens in the fallout of Walgreens and how they've had to find a buyer and find a private equity purchaser to help that pharmacy continue to survive because everyone's facing the same thing and everyone's having to figure out. And we saw, in fact, if you look at the the quarterly statements or reports that come out from Walgreens every quarter for the last,
probably 10 years, they've stated, we're facing headwinds with pharmacy benefit reimbursement. We're facing headwinds with, with lower reimbursements. The, the, the, the landscape is challenging to run a pharmacy. And, and you don't see just like you said, you know, with, with pharmacists quietly doing their work and behind the counter, these pharmacies are not really well known and seen.
When you're going to and from work, you see the big, you know, corner drug stores, which are the big name stores that you see and you don't really see these, pharmacies that are mom and pop stores in the community, but they exist. A third of all pharmacies, today, about 20,000 pharmacies in the country are still owned by mom and pop or locally owned small businesses, and everyone's trying to figure out how we're going to survive.
It's just getting worse and worse every year in terms of, the, the pharmacy doesn't control what they get paid for a drug, how much they get reimbursed for that medication. The only thing they really can control is how much they're purchasing that medication for. But if the insurance company, when you as a patient come into the pharmacy and that insurance company that you have to get your,
pharmacy that your drug pays the pharmacy less than what they bought the drug for. It's, it's a never ending death spiral. It's like, you know, 30 to 40% of medications that are dispensed out of pharmacies are paid below, cost below what the pharmacy bought the medication for even at its best price. So.
And so, so that's really what we're facing now is finding ways for all pharmacies, not just mom and pop pharmacies, but we're particularly focused on helping them, you know, get a lifeline to survive.
Dasha: That's very interesting. You know, it's reminding me something somewhat similar also related to the Affordable Care Act, which is, the kind of elimination, I would say, of a physician owned hospitals because there's actually restrictions through the Affordable Care Act on what kind of practices doctors can and can't own. And the fact that physicians, you know, I can't think of somebody more qualified than a physician to run a hospital or a care center of any type.
But they, you know. Some arguments made at the time, but the results have been, you know, anything rural has been under siege because the only people really, who have been able to, through passion and grit and without significant profits, run rural hospitals where the actual physicians themselves. So it's a different kind of thing. But also the, the disappearance of the smaller the smaller doctor's office, the primary care office and the hospital run by the physician is, is paralleled. So what, what are you doing about it? What is MakoRx doing?
Vinay: So we work with, so there's many different ways as a as a citizen, as a, you know, someone who lives in this country can access healthcare and, you know, one way is to go through the marketplace and get a healthcare plan through the marketplace. Another way is to get healthcare through your employer that you work for, that a spouse works for.
And you know, Medicare is another way people access healthcare in this country, particularly if you are, above a certain age, 65 or if you are disabled or have certain special needs that you can access, Medicare. And then Medicaid, for low income individuals who can't afford any other type of healthcare can usually qualify for Medicaid.
So there's all these different ways that you can access healthcare. We're focused on one very specific silo, and that's, those that access healthcare through their employer. About 155 million or 55% of the population get their healthcare through employers sponsored health plans. Those folks get their the, the companies that provide this healthcare are what's known as self-funded.
So the company is essentially paying for all the healthcare costs up to a certain limit, and they're responsible for those healthcare costs. So they have an incentive to keep those healthcare costs as low as possible so that they can keep the costs low for their employees as well. And so we go to those companies, those employers and that self-fund their healthcare plans and tell them that we have a new way to understand pharmacy.
Not only do we educate them about all of the details and complexities that exist in healthcare, but that our model is cost plus. And what that means is we're showing, for, we're showing employers how much these drugs actually cost. We're talking about the purchase price of the medication at the pharmacy.
So there's a there's a, data set that's publicly available. The government actually collects this data on a monthly basis from pharmacies all over the country, and they average out the purchase price for each medication that's available. That's not specialty. So we're talking about brand and generic medicines.
Some of the most commonly used drugs that people take in the country. And they come up with this average price. So when one of those, so we'll, so we'll tell you the cost basis, whether it's a penny, $5, $10, a hundred dollars, or a thousand dollars. That's how much the drug costs. And then we're paying the pharmacy a flat dispensing fee to dispen that medication.
So. We, your audience has likely heard about this model through a very famous person that has a huge megaphone in the country, Mark Cuban, starting Mark Cuban's cost plus drug company. Yes, I just heard about that. And so his, his model is, there's a pharmacy that dispenses the medications out of Texas, I believe, to anywhere, to wherever people live are all over the country.
Our model is. We want you to go into a network of pharmacies that can also give you the same, it's the pricing's very similar. And we pay the pharmacy a fair fee to be able to dispense that drug. So we'll always reimburse them what it costs 'em to buy the drug. Plus a fair fee to dispense the medication, and that's the cost plus model.
And now we're able to showcase to all these employers, here's how much drugs cost that, that your members are taking. And now we're going to incentivize them by, by creating a plan design that says if a generic's available on the market, we want them to get the generic medicine. It'll help make the lowest cost for the employer and help lower the cost for the member at the pharmacy,
not having to pay the higher, higher brand cost for the drug. And when there's alternatives to drugs, we're going to reach out to those members and reach out to those providers and tell them, Hey, there's these alternatives that are lower costs. Have you thought about this? Has, is it an option for these patients?
And we're having conversations. Both patients are having conversations with providers, we're having conversations with providers to see if we can get them to on this lower cost drug. All in a sense, to do the opposite of what exists today. The status quo exists to incentivize members to utilize the most expensive drugs because it helps the insurance companies and the middlemen, the pharmacy benefit companies, generate more revenue. Whereas our model is,
we wanna lower the cost for the employer 'cause we wanna add value and showcase that we're responsible in helping to lower the cost of drugs on the healthcare plan to help them save money and find opportunities to save money just by switching. We've had a, a great story where we had an employer switch from, big three insurance company plan you know, like Cigna, Aetna or United Healthcare, to our pharmacy benefit option. And just by switching without doing anything else, just by switching and not even putting into play some really big savings programs that we have, the group saved 30% on the cost of their drugs year over year savings.
That was, you know, apparent and, and clear that the model works and that we need to, you know, help employers educate them and help them understand because of the complexities on but you know, there's a lot of barriers that exist as well. 
Dasha: And I just wanna put a point on that figure. You mentioned 30% savings on the drugs.
And the drugs are 40% of the costs you mentioned on a typical employer plan. So that's a very meaningful amount of savings to the overall healthcare plan as well. That is very, very interesting. So what, what would be like the big picture thing that could be done, whether at a policy level or, at a societal sort of mindset level, what would be like the really big win that would significantly change the cost of healthcare for Americans?
Vinay: I'll, I'll tackle this as a two part response. You mentioned policy. So at the federal level, there's two big camps in trying to address healthcare costs. One is we need to regulate these companies even more. And we saw the effects of that. We talked about this example earlier about the Affordable Care Act capping,
how much an insurance company can make in profits. And then we also saw the secondary second order effects of that, which is these companies will find a way, they have to, it's their responsibility to find a way to generate more revenue year after year. So I do, I personally don't think that more regulation will help to lower healthcare costs, make anything more affordable.
The system set up to generate, to generate more revenue out of the system than, than any regulation could, could mm-hmm, change. And they're usually, the insurance companies are usually two or three steps ahead, anyway. The second camp is to, break, break down the vertical integration. So to essentially break up the insurance companies right now and, and a health insurance company owns a pharmacy benefit company and they own, in the case of UnitedHealthcare, physician practices, where the insurance companies owning, the last statistic I read, 36% of physicians are employed by an insurance company or health system.
Nonetheless. If we, if we can disassociate the vertical integration so that health insurance companies have their, you know, are just health insurance, pharmacy benefit companies are just pharmacy benefit companies, and to help help that compete against dozens of other players in the pharmacy benefit space would be,
my personal opinion would be, you know, a much more greater competitive landscape to help lower the costs of healthcare than just trying to regulate them. And that's at a policy level and, you know, we'll see who wins how, who, you know, what will happen there. But it may take a long time given how much money's involved and how many jobs are involved in healthcare. From a, from a more general population effect in terms of changing things,
I really believe that it's the decisions that companies and people are making, people really that have employer sponsored healthcare need to go talk to their company and explain to them how unaffordable it is, what problems they're having, so that they understand, they're made aware and say, look, we need to look at other options.
And then hopefully that will engage the employers to look at different options than just sticking with the status quo. And that'll help to really change the system, and that's a lot of what Mark Cuban's advocating for is employers you need to make different decisions if you want to change the system.
They have a lot of control and a lot of leverage. If they would just, come together and utilize it.
Dasha: So I'm writing have been writing a paper on applications of AI in healthcare. And through that work I've been talking to a lot of people who are developing these companies, trying to really understand what kind of solutions they're coming up with, as well as talking to doctors and patients and understanding their perspectives.
But one thing that's really struck me in the research I've been doing. Is that, I can't say that the problem in our healthcare system is that we don't have AI in it. Like that's not the problem statement. But the problems are so systemic and deeply seeded that to really fix the root causes is, probably somewhat impractical.
It would create massive upheaval and any massive upheaval creates a lot of chaos before it creates order. And so it, it would not be a good time either way, but that some of the solutions that I'm seeing people developing, are really sort of bypassing, you could say, the root causes and creating almost like an alternative system.
Sp specifically I've been seeing the most interesting and promising technologies I think are, are the ones that are really patient facing that give you the patient a lot more control, responsibility, knowledge, access to your own records, things like that, that if you are so inclined, obviously it takes time and effort, but if it's a problem for you that it gives, you know, it takes you out of feeling like everybody but you is in control and puts you in a seat of being able to,
get a diagnostic even before you see a doctor. Get access to a care coordinator from your phone, wherever, get you know all your records in one place and ask questions of AI to, to tell you what exactly your records say, all that kind of stuff. Is there something that is, I'm, I'm, I have my own business, so I don't have, I have an employer sponsored plan.
I'm the employer of, of, you know, of me. And so for, for me, there's. Kind of, I've seen kind of two options like the the standard healthcare plan on the marketplace, and then these kind of subscription based services. Plus maybe like an accident focused plan specifically. But what are, what are some things for either the people who aren't in the employer sponsored plan class, or just generally for the individual, the patient and the person who is suffering the cost and complexity and "complification" as well.
What's, what can we do that empowers us?
Vinay: Empowers you to get healthcare coverage or to navigate the system once you have some sort of option. 
Dasha: To reduce our own costs in the healthcare system regardless of what our employer has as a plan or what we have to have as an insurance plan? 
Vinay: That's a great question.
A couple of ideas come to mind. One is having, the time and mo many people don't have the time to, with your doctor, with your provider, having a good relationship with your provider not just seeing them when you're sick or once in a while if something goes wrong, but making the time to go see your doctor once a year or maybe twice a year just to check in and say, just need to check up.
And that way your doctor can keep records, that can show a trend or can show a pattern, you know? We think we, we believe, oftentimes we see patients that believe the doctor is magic. I'm just gonna tell them what's wrong with me and they'll be able to tell me exactly what's going on with me. But more often than not, just like with great detectives, the diagnostician needs to see a pattern, needs to see a trend, needs to see something that goes on with lots of data and information.
To really diagnose and accurately a problem. And so having that relationship is key. And then having at every visit, having the time, hopefully it's more than seven and a half minutes that everyone has with their doctor to really explain and go through what's going on with you, what's going on with your life, how, you know, how are things.
And so that they can document these things to really then recognize a pattern and you have a good relationship with the provider so that when you need something, you can then ask the right questions. When you have the time to really say, okay, the doctor's saying I need this. Is this the best? You know, what are the alternatives?
 A good question that patients ask, that we tell patients to ask every time they go see the doctor is, how much would this visit cost if I didn't use my insurance? Can I just pay you directly for this visit or can I like direct primary care,
there's just a monthly fee you pay to see the doctor and you get a lot more time with them. That's sort of one way to go around the system. Yes, it's sometimes more expensive than using insurance because it's a monthly fee. But there's trade-offs and at least when you can understand the comparison, can sometimes save money.
And that applies to medications as well. Have a relationship with your pharmacist. Talk to them about what are some alternatives, understand the risks. What will this treatment do for me? What am I taking it for? Understanding that's really key. And then, also asking the question, how much can I, can I pay cash for this without using my insurance?
And what would that price be? And, and just asking those questions can really reveal a lot. And then if you do have a a, a navigator, a Care navigator through your healthcare plan, you can ask them if there's any sort of lower cost options to treatments or services that you may need.
Dasha: Those are great, great tips and, you're right, there are these subscription plans with doctor's offices. I have that for my dental. Instead of a dental insurance, I just have a, a commitment to, to have a single dentist and, and it actually gives me a lot of savings and, and I get to spend more time with my dentist, which I'm okay with.
Vinay, is there any kind of call to action that you would have at the end of this? Anything that our audience should go read or learn more about as we wrap up the episode?
Vinay: I think a good book I've been reading that I found super fascinating is called Bottle of Lies by Katherine Eban. And it talks about the generics, medica marketplace and the generic drug industry and how a lot of it's moved offshore and the supply chain issues that we're experiencing in terms of drug shortages. They're more than ever more drugs and more are lasting longer than we ever had before. Due to some of these factors that have happened over the last 15 or so years in the generic markets industry.
There's some great books by Marty Makary to explain the healthcare system, he's yeah, a great author that's written about healthcare before. And I would say that, you know, the call to action is educate and inform yourselves because of the complexities we talked about today.
Read as much as you can to understand healthcare. 'Cause the more you understand it, the more you will have your mind blown about what's wrong with it. And then you can go out and sort of have. Advocacy to either state level legislators, federal level legislators, or your own business, your own companies if you will, to advocate for change.
And it's really gonna start with a well-informed population to just understand the details and reach out if you don't have a, a good understanding because it is so complex to someone that you know has some expertise or someone that you trust that can help un explain some of these questions that you'll run across inevitably in healthcare.
Dasha: We're gonna link the books mentioned, the authors mentioned in the description, and also Vinay, we're gonna link some of your writing because you spent a lot of time explaining costs, explaining the system from various perspectives, including for doctors and pharmacists and employers.
And it's really great content and it's freely available as well. For anybody who wants a shorter form reading. I feel like you're probably digesting a lot of those books as well. So thank you so much for your time and for sharing all this knowledge with our audience. Dasha, it is an absolute honor to be on your podcast.
Thank you so much for having me. Excellent.
Thank you for listening to Biomedical Frontiers Stories with Innovators in Healthcare. My name is David Chen and I'm the managing director of the Walls H Culture Center For. Translational research at the University of Virginia. Our mission is to help bring promising new biomedical research and technology into the hands of the provider and the patient.
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