Health Tech Nerds Radio

Jeremy Friese spent a decade as a physician at Mayo Clinic navigating prior auth from the provider side. Now he runs Humata Health, which helps large health systems submit better prior auths to every plan in the country. Humata is a participant in CMMI's WISeR program, handling Oklahoma's fee-for-service Medicare prior auth, and six months in, providers are submitting almost exclusively through Hu...

Kevin and Martin start with a discussion about a crowded week in healthcare AI funding. Prosper AI and Assort Health’s fundraising announcements were released on back-to-back days, with nearly identical customer quotes claiming each was "the only true platform." Kevin and Martin work through what that signals about the agentic voice AI space. They also cover Alan's €480M raise at a $6.3B valuation...

JD Friedland is the executive director for ventures at Cleveland Clinic, where he evaluates and deploys emerging health technology across one of the country's largest and most research-intensive health systems. He walks through what Cleveland Clinic has actually built — some examples include: sepsis detection with Bayesian, clinical trial recruitment via Dyania, and surgical note generation throug...

Kevin and Martin by discussing the OhioHealth DOJ settlement and what banning anti-tiering, anti-steering clauses in hospital contracts could mean for employer plan design, narrow networks, and upstart insurance models. They talk about the $12B Ensemble Health Partners deal: what it says about the RCM market's appetite for holistic versus point-solution approaches, and where it might fit into Matt...

Hashem Zikry is a practicing emergency physician at UCLA, a researcher focused on unnecessary ED utilization, and the medical director for clinical research and policy at Counsel Health — which, this week, began integrating Oura biometric data into clinical decision-making for the first time. That combination of roles gives him an unusual perspective on the question everyone is asking: what should...

Thirty-five years into Medicare Advantage, John Kao sees the V28 correction as a pricing reset, not a structural rupture. Plans that invested in clinical care delivery are emerging from it better positioned than those that leaned on coding and prior auth. He expects MA to capture 65–70% of the senior market within the next decade — and argues the current administration's push on program integrity...

Kevin and Martin chat about Matt Holt's return with a reported $12 billion bid for Ensemble Healthcare Partners. They unpack what it means that Thoreau, Holt’s AI-forward play, is interested in a business whose CEO explicitly pitched a more human-centric approach to RCM. From there, they do a deep dive into what’s going on in Hawaii: HMSA's decade-long VBC experiment is unraveling, providers have...

Seth Cohen runs Cedar, which sits inside the bill-pay workflow for health systems across the country, meaning he sees the patient collections reality that most hospitals are still processing. Most providers still sort patients into commercial, government, and self-pay, a taxonomy that made sense 15 years ago and doesn't anymore. ACA premium churn is quietly flipping commercial AR to self-pay retro...

Ezekiel Emanuel helped write the ACA, and now he's thinking about what comes next. To those saying America needs to spend more on healthcare, he points to countries like Germany, Switzerland, Norway—all have universal coverage, their systems provide comparable care quality to the U.S., yet they spend considerably less. The issue isn't money—it's how the system is organized. On the reform timeline,...

Kevin and Martin open with an unusual question: how much fraud should we actually tolerate in healthcare? News from Minnesota prompted the question, where the state just disenrolled 3,400 Medicaid providers, most not for fraud, but for incomplete paperwork. Kevin's argument is that zero-tolerance consolidates the market around whoever's best at compliance, not care. Martin mentions that we're unde...

Prior to the wave of GLP-1s, Amit Shah has spent a decade working on reversing metabolic disease through nutrition. As a leader at Virta Health, he's experienced the impact that changing what people eat can have on type 2 diabetes, cardiovascular events, and outcomes across a surprising range of conditions. In this episode, he talks about the reality that 93% of American adults have some form of m...

Michelle Turner spent years as a foster parent watching the healthcare system fail the kids in her home because the existing system wasn't built for them. She founded Here Now Health to fix that, creating a virtual mental health platform purpose-built for foster-connected youth, controlling for the many barriers they face in seeking care. She walks through the little-known world of foster specialt...

News & Analysis from Health Tech Nerds Kevin and Martin open with Elevance's "thumb drive gate" CMS update, a $935 million accrual, and questions about what they ultimately owed. They debate how many $100 billion healthcare AI companies the market can support, using Commure's $7B valuation and Rockefeller-esque platform ambitions as a case study. In health law: the Clover Stars ruling and post...

Will Johnson, CEO and Co-Founder of Gyde, joins on the day Gyde announces the acquisition of We Know Medicare to discuss the MA brokerage market and where it's headed. Will walks through Gyde's acquisition model: buying quality MA brokerages and equipping them with a platform and support to drive organic growth post-acquisition. He contrasts this what agencies historically experienced in M&A:...

Loren Adler, Fellow and Associate Director at the Brookings Institution, joins to assess the No Surprises Act four years in after recent coverage in NYT sparked discussion. The good news: patients have largely been removed from balance billing. The harder news: the IDR arbitration process that replaced rate-setting has pushed prices to nearly 4x historical in-network rates in radiology, with those...

News & Analysis from Health Tech Nerds Mass General Brigham faced pushback from two directions in two weeks — the state flagging the MinuteClinic partnership for increasing costs, and its own primary care docs criticizing the K Health AI partnership. Kevin's take: MGB has the highest primary care rates in Massachusetts with PCPs talking about unionizing, raising the question of whether an acad...

Otto Sipe, founder and CEO of Photon Health, joins following the company’s $16M Series A to discuss why prescribing infrastructure remains surprisingly antiquated, and why Photon believes the real opportunity is not transmitting prescriptions, but helping patients obtain them. Otto explains how Photon evolved from an e-prescribing network into a consumer-oriented prescribing marketplace focused on...

Sean Doolan and Emre Karatas from Virtue VC join to discuss their thesis that a new actuarial infrastructure layer is emerging in healthcare and why they're investing behind it. The starting point is a simple observation: most healthcare risk is either mispriced or unpriced, and the incumbents who could theoretically fix it are structurally prevented from doing so because their business models dep...

Patrick Foley, CEO of Belong Health, joins to discuss the growing opportunity in Medicare Advantage special needs plans and how Belong is helping community health plans compete in a market increasingly dominated by nationals. Patrick walks through the three types of special needs plans — D-SNP for dually eligible members, C-SNP for chronic conditions, and I-SNP for institutional settings — and why...

Dan Ferris, Chief Growth Officer at LifeStance Health, joins following the company's Q1 earnings to discuss how the largest outpatient mental health provider in the country is thinking about growth, operations, and the road ahead. LifeStance serves over a million patients annually across 600 clinics and 33 states, with 8,300 employed clinicians. Dan walks through the growth algorithm: a confident...

News & Analysis from Health Tech Nerds Q1 earnings broadly reinforced a shift away from hype narratives and toward operational execution across value-based care and healthcare services companies. Agilon : Stock jumped after a "turn the corner" quarter. The standout data point: new heart failure diagnoses occurring after hospital admissions reduced from 40-50% industry-wide to roughly 5%, refle...

The North Carolina State Health Plan turnaround offers a compelling case study for what happens when a state leverages the full set of managed care and benefit design tools available to them. Vice Chairman Brian Miller joins to share his perspective on the philosophy behind the plan's member-first approach and what it suggests for healthcare affordability more broadly. Brian walks through the prin...

Natalie Davis, CEO of United States of Care joins to discuss the organization’s latest polling on healthcare affordability and what it reveals about voter sentiment heading into the next election cycle.  Drawing from research across more than 30,000 Americans, Natalie explains why affordability consistently emerges as the public’s top healthcare concern—not just because of medical bills, but becau...

Bryan Roberts from Venrock joins to discuss Eli Lilly's acquisition of Kelonia, a gene therapy company Venrock seeded in 2020, for up to $7 billion. Bryan walks through the original investment thesis: autologous ex vivo CAR-T therapy was producing remarkable efficacy in late-stage multiple myeloma, but everything else about the model was broken: six to seven week processing times, $220,000 cost of...

Eliana Berger, CEO and co-founder of Joyful Health, joins Kevin and Martin following the company's recent $17M Series A. Eliana walks through what she observed spending two years inside provider practices as a fractional CFO, the data fragmentation that sits underneath revenue cycle, and how she thinks about the distinction between AI services and AI agents in denials work. Topics discussed: What...