Replay - Unifying Medical and Pharmacy Benefits: The Blueprint for Better Employee Health and Wellness

The trajectory of healthcare costs in the US, which currently resembles a rocket ship in flight, is unsustainable. Business Group on Health’s 2026 Employer Health Care Strategy Survey shows employers are preparing for an 9% increase in costs, while waste within the healthcare system reportedly approaches $1 trillion annually. So what is the solution that solves the cost dynamic for employers while enabling quality care delivery for members? The answer: a unified claims processing approach.

Dr. Sunil Budhrani, MD, MPH, MBA (Chief Innovation & Medical Officer, Judi Health) and Josh Golden (Chief Strategy Officer, Capital Rx) joined Dan Schawbel from Workplace Intelligence on November 18 to discuss how streamlining core claim administrative functions and workflows can address the root causes of inefficiency and waste in traditional benefit structures. The goal? To achieve the lowest net cost without sacrificing service levels.

Check out the replay and highlights below!

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Highlights

Employers are focused on healthcare costs (10:45)

What we really are dealing with is an entire ecosystem, an entire supply chain, that is architected to profit off of the increases in cost that you're describing. And that's the tectonic force that these employers and patients are up against when it comes to the misaligned incentives that exist here. I think it's great to start with pharmacy because I call pharmacy right now the tail that's wagging the dog from a health care finance standpoint." - Josh Golden

The need for modern enterprise health technology (17:38)

"And the irony in that is why where we see so much wasting of expenditure in health care because all of these old, old systems that cannot connect with each other in each step result in delay of payments, poor patient care, and et cetera that happens outside the hospital, which is why there's a renewed interest now and modernizing infrastructure outside of that place." - Dr. Sunil Budhrani

The time to adopt transparent PBM and health benefit models is now (41:01)

"It's a perfect storm right now that's driving employers to take more accountability for the administration of their benefit. Sunil mentioned the financial pressure, but there's also frankly regulatory and legal pressure that they're seeing on the horizon. You got class action lawsuits filed against ERISA plan sponsors, against the employers alleging that they're not fulfilling their fiduciary responsibility with prudence because they're selecting these old world vendors that have old world profit models that are misaligned with the interest of the plan or the interest of the patients." - Josh Golden

"There's a breaking point not just in commercial... but also in the federal program space, because ACA subsidies are going down or away. We also have Medicaid going down or away. And guess who's gonna get hit? The hospitals are going to start. If you just look at the news, the market is speaking for itself. The hospitals are operating on narrow margins. I predict you're going to see dozens, if not hundreds of hospitals closing over the next two to five years, because they just cannot operate uncompensated or under compensated care." - Dr. Sunil Budhrani

Unified claims processing improves health benefit administration (49:03)

"To me, we call it unified claims processing as a single place where you can bring together medical and pharmacy claims under one roof. If you create a single unified place where medical, pharmacy, vision, and dental claims are processed, what I call an enterprise health platform, you can start getting a connected view of the patient, a holistic view of the patient." - Dr. Sunil Budhrani

Advice for HR leaders (56:19)

"If you're not a deep expert in this field, find one that you can trust, but find one that is... objective, because there's also conflicts that extend up into the consultant and broker community that buyers, employers need to be aware of." - Josh Golden

"You have a responsibility to ask questions, so you educate yourself. It's always good to know if you stay with your current vendor by asking questions of everyone else and your vendor, because then you know you're making the right decision." - Dr. Sunil Budhrani

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Curious how Unified Claims Processing™ and Judi Health™ can help reduce costs while enabling better member health outcomes? Get in touch with our team today!

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