Thoughts on Healthcare Markets & Technology Podcast

Payers and providers sign one contract. Then each builds separate software to interpret it. Two codebases. Two answers. That gap is where denials live. The industry response: buy better AI. Providers use it to fight denials. Payers use it to generate them. Both sides get better weapons. The battlefield never changes. This is a coordination problem, not a tech problem. Card networks solved it for p...

CMS flagged ~$93.5B in improper payments across 5 programs. A Texas court just vacated the rule designed to claw it back. This is not a compliance story. It is a market structure story. Medicare Advantage hit 6.09% improper payment rate, within target. Sounds fine. But that measure captures documentation gaps, not systematic risk-score inflation worth tens of billions more. RADV was supposed to fi...

Anthropic launched a science research platform AND announced its own drug programs on the same day. The toolmaker opened a mine next to its customers’ mines. Claude Science connects 60-plus scientific databases, runs code on HPC clusters, and keeps data on your own infrastructure. Reproducibility is baked in, every result traces to source code. The conflict: Anthropic sells to pharma and also runs...

A scoliosis surgery. Surgeon earned $8,016. The assistant standing next to him got $196,566. That is a 24x multiple in favor of the person holding the retractor. It is not a one-off. Texas prostatectomy: surgeon $1,843, assistant $50,456. NJ breast reconstruction: surgeon $2,707, assistant $111,000. Same law, same arbitration channel, same result. The mechanism: No Surprises Act arbitration. Assis...

FDA is formally reviewing BPC-157, TB-500, MOTS-c, Semax, and 3 other gray market peptides at its July 2026 advisory committee meeting. The wellness clinic industry is watching closely. These 7 peptides have no USP monographs, no FDA-approved drug status, and no path to legal 503A compounding until FDA acts. Most were previously in a do-not-compound category. Removal from that list is NOT a green...

Pathway Labs cleared the FDA for six structural heart conditions off one ECG. The $8.5M seed round is the least interesting part of this announcement. The model trained on 700k+ ECG-echo pairs at NewYork-Presbyterian. In a 3,200-ECG head-to-head, it hit 77% accuracy vs 64% for cardiologists. That gap is real. Then it landed on OpenEvidence, used by 750k+ verified clinicians. That distribution solv...

Hospitals pay vendors 6-7 figures yearly for software a frustrated clinician could have built over a weekend. The clinician usually spec’d it out anyway. Agentic coding tools just flipped the constraint. The gap was never clinical expertise - it was engineering bandwidth. Now that gap is mostly gone. Academic medicine already has the perfect learning model: tumor boards, M&M conferences, grand rou...

Every provider org, RCM vendor, and clearinghouse rebuilds the same prior auth logic from the same payer PDFs. In isolation. Every time. That is the infrastructure problem hiding in plain sight. Payer coverage policy is conditional logic: inputs are codes, diagnoses, durations, site of care. Outputs are auth required, document these things first. It behaves like software maintained with no version...

Children learn without labels, without feedback, and on almost no data. Healthcare AI still struggles with all three. Here is why the gap is a product opportunity. In 1996, eight-month-olds extracted word boundaries from a two-minute speech stream with no cues except raw statistics. Same machinery works on shapes and tones. It is self-supervised learning on a banana-sized power budget. Clinical la...

Midjourney’s scanner went viral. The most-shared posts claimed its AI rebuilds your scan in real time. The company said there is no AI in the scanner at all. The feed inverted the most important fact. The imaging runs on Butterfly Network’s chip, 40 modules per prototype, under a deal worth up to $74M over 5 years. BFLY jumped 52-56% in a day. The headline said Midjourney. The business story is Bu...

A self-funded employer spending $50M/yr on health claims often cannot produce its own claims data. The TPA holds it and charges for access. The employer is the fiduciary. This is the baseline absurdity. The contracts make it worse. TPA shared-savings fees run 20-30% of repricing. Audit rights are written to find nothing. Data ownership clauses say the TPA owns data the employer paid to generate. T...

SpaceX at $1.77T. Anthropic near $965B. OpenAI targeting $1T. Three filings just warped the entire listing market, including for healthcare. 80% of global VC went to AI in Q1 2026. Four names took $188B of a record $300B quarter. Every healthcare company was fighting over the scraps. A trillion-dollar IPO does not compete with a $1B health tech float. It makes a $1B float invisible to generalist i...

Tampa General cut early sepsis deaths 68% and saved 886 lives using Palantir. The algorithm is not the reason why. The system pulls Epic data, lab feeds, and device telemetry into one patient object model and scores every patient every 15 minutes. But the model just flags. The rapid response team and the antibiotic clock do the saving. Every failed sepsis alert tool died the same way: fires to a b...

Healthcare employs 1 in 9 Americans. Anthropic just named it as both the biggest AI automation target AND the designated landing zone for everyone else’s displaced workers. Same industry. Opposite fates. The back office is the kill zone. Autonomous coding vendors report 85-95% of charts processed without human touch. Ambient documentation went from demo to procurement line item in 30 months. This...

CMS just mandated that 43 states verify Medicaid work requirements by Jan 1, 2027. Almost none of them have built the software to do it. Georgia spent $92M on its work requirement pilot. More than $2 in administration for every $1 in actual medical care. 4,300 enrollees against 246,000 eligible. This is not a workforce policy. Most Medicaid adults already work or qualify for an exemption. The mand...

The administration is building a regulatory pathway for AI systems that diagnose and prescribe with no physician in the loop. Utah already has a pilot running. The Medical Licensing Board asked for an immediate suspension. A Nature Medicine study gave chatbots 1,200 real patient simulations. Correct diagnosis rate: 34%. They were worse than Google at guiding people to the right decision. These sam...

Mayo Clinic will OWN the frontier healthcare AI model it is building with Microsoft. Microsoft will distribute it through Azure. That ownership split is the entire story. Mayo brings 54M+ de-identified patient records, 5.8B+ images, and years of longitudinal linkage infrastructure. Microsoft brings compute, engineers, and Azure distribution. Neither could do this alone. The benchmark driving the s...

A YC company grew 17x and hit seven figures in ARR in under a year by not selling software. It does the fax, referral, scheduling, and collections work instead. 15-25% of specialty referrals never get scheduled at all. Not lost to competition. Lost to intake paperwork. One client had 4,800 referrals sitting in Epic for 4 months. Payers denied more claims in 2025 than 2024. Up to 65% of denials are...

Smart Therapy LLC billed $14M in phantom autism therapy over 5 years. The state had all the data to catch it. Nobody ran the queries. How it worked: teenage relatives billed as clinicians, parents paid $300-$1,500/mo per kid to enroll, forged supervisor sign-offs, billing maximums every single day, transport vendors on the same payroll. EIDBI claims in Minnesota went from $600K in 2018 to $400M by...

VERVE-102 just published Phase 1b data in NEJM. Single IV infusion. 88% PCSK9 reduction. 62% LDL-C reduction. 18-month durability. No serious adverse events in 35 patients. But the core problem being solved is not efficacy. Statins work. PCSK9 inhibitors work. The problem: roughly half of patients prescribed lipid-lowering therapy stop taking it within a year. Every year. Consistently. Adenine bas...

The real hospital AI regulator is not the FDA. It is the Joint Commission, which accredits 80% of US hospitals and controls access to 60% of their revenue. In September 2025 the Joint Commission plus CHAI released AI governance guidance. Once it enters accreditation standards, hospitals operationalize it the same way they operationalize infection control. Mandatory committees, audits, evidence bin...

HHS shipped an LLM workflow for federal audits without an RFP. No vendor circus. No multi-year authorization. That is the actual story from May 21. Single audits from every entity spending over $1M in federal funds sit in the Federal Audit Clearinghouse. Most were never read. HHS is now reading them with ChatGPT and threatening funding cuts for chronic deficiencies. Three months earlier, CMS dropp...

Forus raised $160M at a $1B valuation on ~$50M in annualized revenue. That is a 20x multiple at Series B. Here is why Thrive and General Catalyst wrote that check. Healthcare is a transaction routing economy, not a care delivery industry. Every prior auth, every benefits check, every specialty pharmacy assignment is a transaction. The intermediary stack exists entirely because of that fragmentatio...

California pays RNs $148K nominally. After cost-of-living adjustment it drops to third. Oregon wins. Minnesota is second. Hawaii, nominally second, falls dead last. Adjusted NP pay: Oklahoma is first at roughly $148K annualized. Iowa second. Kansas third. California does not crack the top ten. The coastal sweep inverts completely. Indiana has the highest cost-adjusted PA wage of any state for any...

Q1 2026 produced four hardware-driven digital health mega-rounds in one quarter. Whoop at $10.1B. Neuralink at $9.7B. BrainCo at $1.3B unicorn birth. eMed at $2B. Either hardware is back or this is the top. Context: Peloton went from $171 to under $4. Lululemon wrote off Mirror entirely. Fitbit got swallowed by Google. The consensus by late 2024 was that consumer health hardware without a regulato...