Dirty Little Secrets
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Healthcare's financial incentives are broken — and most people have no idea. We're pulling back the curtain on who gets paid for what, why your premiums keep rising, and the forces conspiring to keep it that way.
Telling the Truth on Healthcare
About the Show
The healthcare system has secrets. We're telling them.
Every year, employers and individuals pay more for healthcare — and get less in return. The reasons aren't mysterious. They're structural, financial, and deliberately obscured by the parties that benefit from the confusion.
Who Gets Paid — and Why
Healthcare is a business. We break down the financial relationships between insurers, hospitals, drug companies, and middlemen — and what they mean for what you pay.
Why Premiums Keep Rising
Premiums go up every year. Deductibles go up every year. We explain the underlying economic forces — and who profits from the cycle.
The Diagnostic Gap
Diagnostics guide 70%+ of clinical decisions but represent less than 5% of healthcare spending. The result: treatments administered without the information needed to know if they'll work.
The PBM Problem
Pharmacy Benefit Managers were supposed to lower drug costs. Instead, they've become one of the most powerful — and least understood — forces driving them up. We explain how.
through insurance premiums, pharmacy benefit managers, drug pricing, diagnostic gaps, and the incentive structures that keep costs rising no matter what anyone does. No jargon. No agenda. Just honest answers to the questions you're asking.
Dirty Little Secrets is the podcast that follows the money —
Hosted by the founders of Alva10, whose careers have been spent inside the system trying to change it — this is the show for anyone who writes a healthcare check and wonders where the money actually goes.
Who It's For
This show is for anyone who uses or pays for healthcare
Whether you're managing a benefits budget, navigating coverage decisions, or just trying to understand why your EOB looks the way it does — Dirty Little Secrets was made for you.
EMPLOYERS & BENEFITS LEADERS
You're signing off on a healthcare spend that keeps growing with limited visibility into why. We give you the economic literacy to ask better questions — of your carriers, your PBMs, and your benefits consultants.
HEALTHCARE PURCHASERS & PAYERS
The people making coverage decisions deserve to understand the full picture of the financial incentives shaping the market — including the ones working against their members' interests.
PATIENTS & INFORMED CITIZENS
You don't need to be in healthcare to want to understand it. If you've ever been surprised by a bill, denied a claim, or wondered why a drug costs what it costs — this show is for you.
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If your company has more than about 500 employees, the card in your wallet probably says Aetna or United or another insurance company- but none of them are actually paying for your care. Your employer is, with your premium dollars. 67% of workers are in self-funded plans, which means the money from your paycheck and […]
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Hannah Mamuszka and Lena Chaihorsky bring on Russell DuBose, VP of Human Resources at Phifer, a family-owned manufacturer in West Alabama, to tell an unforgettable story. In 2017 DuBose — a retired Army colonel with no healthcare background — took over benefits, and two months later stood in front of a CEO-chaired committee holding numbers […]
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Hannah Mamuszka and Lena Chaihorsky interview entrepreneur Mark Cuban about why U.S. drug and healthcare prices are so high — and what he’s building to counter them. Cuban walks through the drug supply chain: brand manufacturers sell to three dominant distributors, then pharmacy benefit managers (PBMs) — the three largest of which are owned by […]
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Hannah Mamuszka and Lena Chaihorsky interview Greg Baker, founder and CEO of AffirmedRx, a pharmacy benefit manager structured as a public benefit corporation. Baker, a pharmacist who spent years running on-site pharmacies for large employers, argues the drug-pricing system isn’t broken but “working as designed” to maximize shareholder profit. He explains how the dominant PBMs […]
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Hannah Mamuszka
Founder & CEO, Alva10
20+ years in diagnostics, pharma & healthcare economics
Hannah founded Alva10 after spending two decades watching technically excellent diagnostics fail to reach patients — not because of bad science, but because of misaligned financial incentives. She has worked on the lab side, the business side, and the payer side of healthcare, giving her a full-system view of where the money flows and why. A frequent writer and speaker on healthcare economics, Hannah brings the rare ability to translate both the science behind the curtain and the financial architecture of healthcare into something anyone can understand — and get appropriately angry about.
Lena Chaihorsky
Co-Founder & SVP Payer Innovation, Alva10
Precision medicine, payer strategy & employer health benefits
Lena is a nationally recognized expert on precision medicine in the employer space — translating its clinical and financial implications for the benefits leaders who decide how employers invest in their workforce's health. She has spent her career designing the economic cases that move healthcare innovation from promising to covered. As the leader of the National Association of Brokers' precision medicine certification effort, Lena works daily at the intersection of what the system could be and what it currently is — and she has plenty to say about the gap between the two.
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