MHE June 2025

Giving small-molecule drugs the same 13-year exemption from price negotiation as biologics would cost the federal government billions of dollars, argue three Harvard researchers

National director of midwifery, Ob Hospitalist Group. Ob Hospitalist Group (OBHG) provides hospitals with obstetric services.

Amanda M. Shafton, CNM, DNP, FACNM, advocates for more midwives in the U.S. healthcare system, arguing that many other countries already see their value.

Ben Scharfe, CPA, shares how his career-changing advice came from an unlikely person.

Executive vice president of artificial intelligence, Altera Digital Health. Altera Digital Health provides digital services to healthcare clients.

Patrick Roberts, Pharm.D., said his career changed when he listened to a mentor encouraging him to go back to school.

Manager of formulary operations and strategy, Yale Health. Yale Health is a not-for-profit, physician-led health maintenance organization that provides integrated, patient-centered care to the university community.

Kate Masino, MBA, says her career path was changed while watching her chronically ill, aging parents try to navigate the U.S. healthcare system.

Vice president and market executive at Highmark Health. Highmark Health is a national health and wellness organization serving nearly 50 million Americans.

Justin Jasniewski, MBA, shared a story about his career turning point and how it involved a rejected proposal and a Big Three PBM seven-figure check.

CEO at Serve You Rx. Serve You Rx is a midmarket pharmacy benefit manager (PBM) for self-funded employers.

Bonnie Hui-Callahan, Pharm.D., says her career took off after not matching for a pharmacy residency—a setback that taught her resilience and led her to a better fit the second time around.

Senior director of clinical programs at Capital Rx Capital Rx is an enterprise health technology company and public benefit Capital Rx is an enterprise health technology company and public benefit corporationbthat provides various healthcare benefit administration solutions for commercial, Medicare and Medicaid plans.

Vice president of postacute care solutions at OneHome. OneHome is a postacute services business for Medicare Advantage members offering engaged, at-risk network oversight for home healthcare, skilled nursing facilities, durable medical equipment and infusion services.

Cassie Houff, MBA, says the most impactful change for U.S. healthcare would be “an overhaul to the fee-for-service payment system,” arguing that it doesn’t incentivize timely or necessary care.

Matthew Helbling says the turning point in his pharmacy career came when he took on a pilot program for medication therapy management—and discovered the power of connecting more deeply with patients.

Director of clinical effectiveness and operations at Prime Therapeutics LLC. Prime Therapeutics is a pharmacy benefits manager owned by 19 Blue Cross and Blue Shield plans.

Esteban Gallardo, Pharm.D., said his career path changed after early mentorship showed him how managed care pharmacists could make a broader impact on a larger scale.

Chief of pharmacy at CareAllies. CareAllies is a population health company that supports physician practices and health plans.

Kathryn Boger, Ph.D., said leaving academic medicine to co-found InStride Health was both terrifying and transformative. Boger reflected on advice she received early and said, “If you’re feeling scared, it’s a sign that you’re growing.” This wisdom continues to shape her path today.

Co-founder and chief clinical officer, InStride Health. InStride Health provides evidence-based care for children, teens and young adults with anxiety and obsessive-compulsive disorder (OCD) and their families.

Medicare Advantage plans have drawn the ire of lawmakers for aggressive coding. Investigations are underway. Some hope artificial intelligence (AI) can be part of the remedy.

Oren Mechanic, M.D., M.P.H., was one of Managed Healthcare Executive’s Emerging Leaders in Healthcare in 2022. We caught up with him as part of our “Where Are They Now?” series spotlighting the career paths of past emerging leaders.

Nancy Hoyt Taff, M.P.H., is the senior product manager of Medicaid at UCare, an independent, nonprofit health plan providing healthcare and administrative services to more than 600,000 members throughout Minnesota and parts of western Wisconsin.