Thirty years ago, a young healthcare attorney sat across from small hospital pharmacy teams and told them to get ready. 340B, the federal drug discount program many of them relied on to stay open, was going away. Everyone said so.
Three decades later, that attorney is Kim Tzoumakas, now CEO of VytlOne, and she still hears the same prediction every year. She has stopped believing it.
Kim spent her first twenty years embedded inside hospitals and health systems as a healthcare lawyer, then ran two large provider businesses before pharmacy: she was CEO of RAYUS Radiology and CEO of 21st Century Oncology. Now she runs VytlOne, the roughly 100-year-old pharmacy services company she rebranded and merged into its current form after taking the job, a business that generated $1.4 billion for its pharmacy partners in a single year. Its newest bet is VytlAIQ, an end-to-end intelligence platform built from the ground up rather than grafted onto a legacy system.
Below is her operating playbook, in her own words:
The first thing she checks to know if a business is healthy, and why it isn't the P&L
How you build software when the rules might change next quarter
Why most health-system dashboards get ignored, and what makes one get used
The one line where a hospital actually crosses from "using 340B" into "abusing it"
The uncomfortable truth for a CFO who has been burned by vendors
Where AI should stop in a pharmacy, and the legal risk she watches as tech players rush in
The first thing she checks isn't the money
Ask most operators how to read a business and they go straight to the financials. Kim goes somewhere else first. Twenty years of walking into hospitals to fix what was broken taught her that the money is downstream of a few things that come before it.
"The key things for a healthy organization: one is the type of boards you have and how constructive they are, ownership model, and then financial stability. Those are really the three things that allow you as a CEO to come in and have success."
The order matters. A constructive board and a workable ownership model are what make the financial repair possible in the first place. Get those wrong and no amount of operating skill saves you.
Why "340B is going away" has been wrong for 30 years
This is the belief everything else rests on. Kim's read, sharpened by a career of advising providers on exactly this, is that the prediction keeps failing because it misreads what the program actually is.
"When I started practicing law, aging myself, but thirty years ago, the big conversation was 340B is going away. And we spent lots of time advising small providers that they needed to be prepared, because it was going away. And here we are thirty years later, and I still hear people saying it's going away. And the reality is, I think 340B is evolving and changing more rapidly than it used to, and that's making it more complex."
Her point isn't that 340B is simple or safe. It's that it has become load-bearing for the providers who depend on it.
"Government and other officials realize that this is an absolute critical part of survival for many of these nonprofit health systems. And it's the way they put money back into patient care and back into their communities."
So who keeps predicting its death? She is blunt about where the noise originates.
"The reasons are all the same, and it almost exclusively comes from manufacturers who don't like to be able to offer the drugs at the discounted prices."
And the argument that the savings never reach patients? She has looked for the evidence.
"I have yet to find a nonprofit hospital or health system that isn't focusing their energy on trying to build new programs, trying to keep programs alive, and frankly serving a lot of uninsured and underinsured patients. I think the noise and the rhetoric that's out there, that this money is not going for what it was intended to, is just not accurate."
Building product when the rules change next quarter
VytlAIQ launched into a moving target. It came to market right as the courts threw out the 340B rebate model, the kind of shift that changes how payments flow and how fast cash arrives. Kim's instinct was speed. Her team pushed back.
"I was one that was pushing, like, how do we build this faster, and my teams, who are all in the pharmacy space, were saying it's much more important that we build it right."
That tension produced the core architectural call. Instead of stitching together tools that already existed, they built from scratch, including a module ready to handle the rebate change when it lands.
"That's the reason that we made the decision to build it from the ground up rather than trying to use pieces that might already be out there, because we do know that it's going to continue to evolve and change, and we want to be able to be on the cutting edge of that."
The lesson for anyone building in a regulated space: when the rules are the product, owning the foundation beats moving fast on borrowed parts.
The dashboard problem
Every health system already has dashboards. Most of them get built and then ignored. Kim knew that going in, so the question she set was not "what data can we show" but "what will a pharmacist actually act on."
"If we can build a platform as opposed to a bunch of different tools, and that platform can give everything that the pharmacy team, and frankly the hospital leadership, CEOs and CFOs, want to see and need to see in one centralized location..."
The difference is what the platform does with the data once it is in one place.
"It's actually going to give real-time data, real-time decision making, with the AI behind it, the ability to identify and check all 340B claims to identify: are they eligible? Has all the documentation been there, so that if you do have an audit later, you can back it up."
A dashboard reports. A system that flags an ineligible claim before it costs you money, and files the paper trail for the audit you don't yet know is coming, is a different thing.
Where a hospital actually crosses the line
Ask Kim whether hospitals abuse 340B and she won't dodge it. She draws one clean line, and it is narrower than the critics imply.
"The only place I would say there's a justification for saying 340B is being abused is if there is a hospital that is billing 340B and collecting a rebate. So you can't double dip. You cannot get rebates on your drugs and bill it as a 340B, because then you're basically getting the discounted prices and you're getting the manufacturer's rebate back."
Everything short of that double dip, she argues, is a provider doing exactly what the program intends.
"When they are treating 340B patients, billing those claims as 340B, [they're] absolutely in the right, and they're entitled to every dollar that they can maximize in that structure, as long as they're also not collecting a rebate on it."
What you can't break when you move fast
Kim rebranded and merged a company with a century of history, and she did it quickly. The interesting part is what she refused to touch.
"The biggest thing you can't break in that process is culture. There are individuals who have been with this organization for twenty-five, thirty years. And when you come along and you say, 'We need to turn a corner and we need to be a different organization,' you have to do that in a way that you're respecting the history, and you're respecting the fact that there are people that have given many, many years to patients in this organization."
Speed and respect are not opposites here. She moved fast on the structure and slow on the "why," so the people carrying the institution understood the change instead of surviving it.
The CFO conversation nobody wants to have
Bring up the CFO who has been burned by vendors and Kim describes a pattern she hits constantly. Her team shows a health system a large, real opportunity, and the pharmacy team waves it off.
"We'll come in and we'll share, 'You have a ten-million-dollar opportunity here,' and the pharmacy team in some organizations will say, 'No, we're not doing that,' or 'We're already doing that.'"
She doesn't read that as stubbornness. She reads it as scar tissue.
"Teams have been wiped out and replaced through outsourcing models. And I think that creates some of the skepticism and concern in pharmacy leaders that, hey, I don't want to bring this organization in that's going to wipe out my team."
Her answer to that fear is the positioning of the whole product. It is built to back a strong pharmacy team, not replace it.
"We are bringing something they don't have the ability to build internally. So it should create a win-win."
Where AI stops
Kim built an AI-native platform, which makes her view on AI's limits more credible, not less. She is precise about the boundary.
"It should never make a clinical care decision. It should never make a decision that's required to be made by a licensed person. What it should be able to do is be that intelligent partner."
In practice, that looks like the software doing the tedious detective work and handing the judgment back to a person. Her example: the 340B engine spots a denied claim, notices the provider's name was probably misspelled, and surfaces it for review.
"It cuts out all of those steps in between. But that final yes or no decision is still made by the pharmacy individuals."
Then she puts the lawyer's hat back on and names the risk she watches as tech companies pour into healthcare.
"A tech player coming in, and there's lots of them out there, a lot of them are very good, but they don't have the background in healthcare. They don't understand the legal and regulatory restrictions, they don't understand the patient risks."
Her warning to providers is direct: vet who you build with.
"It's incumbent on healthcare providers to make sure they're partnering with those organizations that truly understand healthcare, and not the VC startup looking to make a quick dollar in the AI tech space. ... There is a significant risk of missteps if you move too quickly on this, without making sure that you understand what the guardrails are."
The five-year test
Ask Kim what success looks like in five years and she doesn't describe technology. She describes the moment a scared person waits on a drug.
"Speed to medication, speed to treatment, taking down the barriers to prior auth. Prior authorization is the biggest pain point out there, both for patients and for providers."
She grounds it in what specialty patients actually hear.
"There's one thing you don't want to hear as a patient: 'We can't get your medication,' or 'It's going to take another week or two to get it.' They're looking at this as, 'I've got a diagnosis, I need to do something now.' And they're feeling really out of control."
That is the whole thesis in one image. The measure of the software is a patient who never thinks about it.
It tracks with something else she does. Kim mentors veterans through the Pat Tillman Foundation, many of them rebuilding a career from scratch after service, often heading to law or medical school in their thirties.
"How do you fit yourself back into a workforce you never really grew up in?"
For someone who spends her days telling hospitals to move fast without breaking their people, that is not a side project. It is the same problem.
Want to go deeper? This is drawn from Kim Tzoumakas's full conversation on episode 536 of the Slice of Healthcare podcast. Listen wherever you get your shows.
This episode is brought to you by: Sage Growth Partners — Value-focused strategy and marketing for growth-driven healthcare organizations.
