Podcast Summary: From Back Office to Bottom Line: Driving Revenue & Access in Specialty Pharmacy

Becker’s Healthcare Podcast
Host: Erica Spicer Mason
Guest: Will Yin, CEO of Mandolin
Date: December 15, 2025

Episode Overview

This episode centers on the evolving financial models, operational challenges, and technological opportunities within specialty pharmacy—especially for health systems navigating tighter margins and increasing payer complexity. Will Yin, CEO of Mandolin, shares strategic insights on leveraging process automation and AI to boost pharmacy revenue and patient access, while offering actionable guidance for leaders adopting these innovations.

Key Discussion Points & Insights

1. The Changing Landscape of Payer Contracting and Reimbursement

Timestamp: 00:53 – 03:50

• Increased Complexity:
  • Payer requirements are evolving rapidly, adding layers of complexity for health systems already contending with narrowing margins.
  • Recent and upcoming regulatory changes (e.g., 2026 CMS reimbursement alignment, IRA 340B rebates) threaten traditional site-of-care revenue streams, particularly for hospital outpatient (HOPD) settings.
• Opportunity within Challenge:
  • Despite the pressure, specialty remains a significant revenue opportunity—if health systems can adapt.
• Will Yin’s Three Critical Needs:
  • Clarity into SOPs:
    • “Every time payers update policies, the rate of diffusion of that knowledge...is heterogeneous, leading to wildly different performance and practices across teams.” – Will Yin [01:35]
  • Consistent Quality of Labor:
    • Automation is key, but even manual teams need ‘assembly-line’ consistency to avoid costly errors.
  • Sophisticated Data:
    • Real-time telemetry enables both operational visibility and strategic decision-making, extending to reimbursement trends and patient financial outcomes.

2. Leveraging Automation to Improve Access & Prevent Revenue Leakage

Timestamp: 04:27 – 07:06

• Accelerating Time to Therapy:
  • Automation reduces manual intake and referral times from hours to minutes.
  • “Our customers are seeing referral automation drop from several hours to around 30 minutes in most cases...with E-scripts, an average complete intake time of around three minutes.” – Will Yin [04:36]
  • Automated benefits verification expedites processes previously delayed by staffing bottlenecks.
• Preventing Revenue Leakage:
  • Automated workflows help retain prescriptions within the health system, optimize site-of-care decisions, and ensure accurate, timely reimbursement.
  • Agentic AI offers a ‘command center’ view, allowing leaders to route scripts strategically and minimize leakage.
  • “AI can determine rules for how these scripts get routed to optimize for margin, patient financial clarity, and for keeping scripts within the system...” – Will Yin [06:45]

3. Build, Buy, or Partner: Infrastructure Decisions in Specialty Access

Timestamp: 07:38 – 10:07

• Honest Self-Appraisal First:
  • Leaders should assess their ability to develop, implement, and maintain the underlying technology and manage significant change.
• Industry Trends Around AI:
  • “95% of all implementations of AI at the enterprise are failing to deliver value.” – Will Yin [08:08] (citing an MIT study)
  • Organizations that buy AI solutions from vendors are 3x more likely to succeed than those building in-house.
• Vendor Differentiators:
  • Success hinges on deep domain expertise, robust change management, understanding payer nuance, and delivering operational analytics—not just on polished demos or UI.
  • “Health systems are going to go with technology providers rather than trying to run this in-house...” – Will Yin [09:47]

4. Using Data for Strategy, Forecasting, and Contract Negotiation

Timestamp: 10:43 – 11:55

• Leveling the Data Playing Field:
  • Agentic AI rebalances power and insight previously held by payers, empowering health systems.
  • Mandolin’s approach: track and record every process detail for robust analysis (e.g., denials, reimbursement rates by therapy/payer/region).
  • These insights fuel data-driven contract negotiations and compliance with stricter upcoming regulations (e.g., 340B rebate audits).
  • “What you’re getting at here is a very fundamental shifting of the data and power asymmetry, frankly back towards health systems and away from payers...” – Will Yin [10:46]

5. Actionable Advice for Pharmacy Leaders Exploring Automation

Timestamp: 11:55 – 13:54

• Balanced Perspective:

  • Leaders should be cautious—acknowledging both the hype and promise of early-stage AI—while also recognizing the escalating costs of inaction (e.g., rising write-offs and bad debt).
  • “We have this sort of a frog in the pot situation where the water is just going to keep getting hotter.” – Will Yin [12:42]

• First Steps:

  1. Clarify Goals: Know what outcomes you want.
  2. Self-Appraisal: Evaluate your system’s strengths and limitations.
  3. Find the Right Vendor: Prioritize domain expertise in specialty pharmacy.
  4. Vigorously Evaluate Solutions: Separate signal from noise by scrutinizing capabilities and fit.
  • Will Yin offers: “I’m happy to chat through overall strategy with any of our listeners... please hit me up on LinkedIn if you want some frank talk about this stuff.” – Will Yin [12:46]

Notable Quotes

• “Every time payers update policies, the rate of diffusion of that knowledge...is heterogeneous, leading to wildly different performance and practices across teams.” – Will Yin [01:35]
• “Our customers are seeing referral automation drop from several hours to around 30 minutes...with E-scripts, an average complete intake time of around three minutes.” – Will Yin [04:36]
• “AI can determine rules for how these scripts get routed to optimize for margin, patient financial clarity, and for keeping scripts within the system...” – Will Yin [06:45]
• “95% of all implementations of AI at the enterprise are failing to deliver value.” – Will Yin (citing MIT) [08:08]
• “We have this sort of a frog in the pot situation where the water is just going to keep getting hotter.” – Will Yin [12:42]

Memorable Moments

• Will Yin’s pointed observation about the MIT study on AI failures reframed the vendor-build debate and furthered the case for choosing experienced specialty partners over DIY approaches [08:08].
• The “frog in the pot” analogy [12:42] effectively conveyed the risk of inaction amidst mounting industry financial pressure.

Conclusion

Will Yin’s conversation with Erica Spicer Mason offers a thorough, pragmatic view of operational and technological transformation in specialty pharmacy. Health systems must embrace clarity, consistency, and data-driven practices—and are wise to seek out experienced partners—to thrive amid regulatory change and market challenges. This episode delivers both strategic guidance and practical first steps for leaders embarking on specialty pharmacy automation journeys.