Diabetech - Diabetes Tech, Research, News Why US Healthcare is Broken - Today’s Issues & AI Solutions Ahead
Dec 23, 2024
Jeff Delverne, Director of Payer Relations at Beta Bionics and author of The Healthcare Economy, breaks down U.S. healthcare finance in plain terms. He talks consolidation, PBMs and rebate incentives. He unpacks insurer strategies steering patients to owned services and why pricing is opaque. He also explores how structured data and AI — including big tech-EHR moves — could change workflows and costs.
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Two Distinct Businesses Explain Insurer Profit Motives
- Large insurers run two businesses: low-margin traditional insurance and high-margin health services (Optum-style) that grow 8–30% annually.
- Delverne says the services arm (clinical staffing, PBM, tech) produces much higher margins and fuels corporate growth.
From Pump Sales To Payer Relations At Beta Bionics
- Jeff recounts his path from Tandem Diabetes rep to Beta Bionics market access director to understand payer flows.
- He describes calling on regional and national plans and shifting focus to pharmacy to lower out-of-pocket pump costs.
PBMs Use Scale To Control Drug Flows And Squeeze Local Pharmacies
- PBMs (like OptumRx) centralize drug contracting, adjudication, and pharmacy networks to deliver scale and pricing.
- Delverne details how PBMs contract 66,000 pharmacies and push mail-order to capture volume and margins, squeezing local pharmacies.