Dr. Vipul Mankad has spent a career in the rooms where that question gets answered. In Part 1 of this two-part conversation with host Sas Mukherjee, he traces the path from a small town in India, where his father was the family practitioner who removed cataracts, delivered babies and managed an epidemic, to Cook County Hospital, NYU, Cornell, and a research career in sickle cell disease.

Then the pivot. Invited to chair a pediatrics department in Kentucky, he decided that working molecule by molecule was too small, co-founded a children's hospital, and watched managed care arrive from the West Coast. When the university realized insurers could cut it out of the network entirely, it started its own health plan. Dr. Mankad became its medical director, and got his first real look at the payer side of the equation.

Twelve years later he reinvented himself again, taking an unpaid role with the Senate Committee on Health, Education, Labor and Pensions so he could learn how health law is actually written. He was there as Kennedy and Hatch built CHIP, and as value-based purchasing, quality divided by cost, became the concept later folded into accountable care.

Part 2 covers what worries him now: Medicaid funding pressure and access, genomics-enabled personalized medicine, and remote home monitoring.

GUEST

Dr. Vipul Mankad, academic physician, pediatric hematology and oncology. Co-founder of a children's hospital in Kentucky. Board member, Catalyst Solutions.

HOST

Sas Mukherjee, President and CEO, Catalyst Solutions.

ABOUT

Catalyst Conversations brings payer executives, clinicians and policy voices into plain-spoken conversations about the systems behind American healthcare.

The One Big Beautiful Bill Act put $50 billion over five years behind rural health transformation. Spread across the states, that works out to a strikingly small number per rural resident, which means the difference between systems that transform and systems that stall will come down to how the money is used.

Host Sas Mukherjee, President and CEO of Catalyst Solutions, is joined by two people who have sat on the government side of this problem:

Lisa Hettinger, former Medicaid Director for the State of Idaho and a member of the Catalyst Solutions Advisory Board.

Adam Herbst, partner at Sheppard Mullin and former Deputy Health Commissioner for New York State, where he oversaw aging and long-term care.

They get into why tightening oversight of supplemental payments matters more than headline cuts ("unpredictability is often more dangerous than outright cuts"), why redeterminations hit rural communities hardest ("most people losing coverage aren't gaming the system, they're missing the paperwork"), and why a decade of technology fixes has failed to stick in rural communities that do not trust outsiders and cannot get broadband.

Lisa dismantles the most persistent myth in rural recruiting: that specialists would come if the town were nicer. "There are no theys out there. We just simply do not have enough cardiologists available, period."

The back half turns to what actually works: regionalizing high-acuity care without abandoning local access, designing sustainability from day one rather than after the grant sunsets, sharing resources across state lines the way telecom companies already do, and using AI as a force multiplier for thin teams rather than as a decision-maker.

"Rural health doesn't lack innovation. It lacks integration and disciplined execution. The future belongs to those willing to transform early, not those who are waiting for relief."

CHAPTERS

00:00 Show open

00:13 Sas Mukherjee on Catalyst Solutions and rural health

01:31 Meet Lisa Hettinger and Adam Herbst

01:56 OBBBA and the squeeze on supplemental payments

03:37 Redeterminations, work requirements and enrollment churn

04:33 "Most people losing coverage aren't gaming the system"

04:51 What rural leaders should redesign first

06:04 Regionalizing high-acuity care without abandoning access

06:35 Why technology keeps failing in rural communities

08:05 Can telehealth replace the rural hospital?

10:37 "There are no theys": the cardiologist misconception

14:13 How vendors earn trust in a low-trust environment

15:43 What the Rural Health Transformation Program is for

16:44 The two misunderstandings that sink applications

18:15 $50 billion over five years, per rural citizen

18:45 Don't ignore history: what past CMS funding taught us

20:16 Where AI is a force multiplier, not a buzzword

21:47 Designing sustainability from day one

23:18 "If you've seen one Medicaid, you've seen one Medicaid"

23:49 "Rural health doesn't lack innovation"

24:19 Shared resources across state lines

28:20 State borders don't define rural communities

31:20 AI, triage and the data trust catch-22

33:51 Closing thoughts

34:21 The Catalyst Solutions point of view

ABOUT THE SHOW

Catalyst Conversations brings payer executives, clinicians and policy voices into plain-spoken conversations about the systems behind American healthcare. Hosted by Sas Mukherjee, President and CEO of Catalyst Solutions.