The Problem With Rebates | with Steve Ditto

“Rebates, I’ll go out on a limb and say, they’re almost inherently evil... Your sickest employees are paying for that rebate.” - Steve Ditto PBM rebates are sold as savings. Steve Ditto argues they do the opposite. Manufacturers pay for rebates by raising list prices, and members’ copays and deductibles are based on those inflated prices. The employer cashes the rebate check while its sickest members cover the cost. Steve spent 30 years as a healthcare consultant before the wrong $100,000 infu

“The idea with WellGenie is, what if we can increase access and remove the cost burden? Then we give the opportunity for people to not delay care.” - Chris Mathew, WellGenie Many employees have insurance they can’t afford to use. Every prescription, virtual visit, and specialist appointment costs them money, so they put off care until small problems become expensive ones. Chris Mathew joined me this week to explain how WellGenie makes everyday care free for each employee and up to four family

“Medical physicians are trained that [diabetes is] not reversible... Still to this day, I would say 95% of medical physicians do not know it’s reversible.” - Dr. Jeffrey Hockings, Diabetes Reversal Group Type 2 diabetes costs a self-funded employer about $15,000 a year per diabetic employee, and the standard of care is to manage it with medications for life. Dr. Jeffrey Hockings has spent almost 17 years showing it can be reversed instead. More than 10,000 people have reversed it on Diabetes Re

"He went from injury Friday night to in front of the correct surgeon on Monday afternoon." - Dr. Tom Weber, MD Ortho Most MSK spend goes to the wrong care: ER visits for back pain, $3,000 MRIs that could cost $450, weeks of waiting, and surgeries that never needed to happen. Dr. Tom Weber spent 24 years as an orthopedic and sports medicine physician before building MD Ortho to fix that. It gives every employee a physician-led team that steers them to the right care from the first call. Tom and

"[AI] absolutely is an arms race, and this is what we're dealing with on a daily basis." - Stephen Carrabba, ClaimInformatics In this episode of Last Month in Healthcare, Producer Nathaniel and I sat down with Stephen Carrabba, president and co-founder of ClaimInformatics, to break down the biggest healthcare news stories of September 2026. We started with Blue Cross Blue Shield's claim that AI-powered medical coding tools added $942 million in costs over the past two years. One example: anemi

"We pay them a $2,500 flat fee for the time that they spend with the patient and make that recommendation for no surgery. If you don't, then you've wasted their time." - Matt Eurey Most of healthcare is paid for volume, so employers end up paying for surgeries that never needed to happen. When RAND studied Carrum Health's data, about 30% of surgeries were avoided once the first step was checking whether the patient actually needed one. Matt Eurey ran benefits at Lowe's, which spent about a bil