Health Tech Nerds Radio

Kevin interviews Sam, Co-Founder and CEO of Oshi Health, about the GI market and the Peterson Health Technology Institute report, which found clear savings for GI solutions focused on IBS and IBD. Sam explains the difference between wraparound programs and clinician-led models that can diagnose and prescribe, noting GI access shortages and that many counties lack gastroenterologists. He describes Oshi’s virtual, nurse-practitioner-led care team—overseen by GI physicians and supported by dietitians, gut-brain specialists, and care coordinators—and how Oshi coordinates colonoscopy and other in-person procedures through referrals and partnerships. They discuss contracting lessons in commercial value-based arrangements, immediate cost savings from avoiding repeat workups and treat-and-release ER visits, strategies to build patient trust via testimonials and direct-to-consumer awareness, and plans to deepen local GI integration and use AI to improve efficiency and outcomes.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Psychiatry still relies heavily on medication management and talk therapy, leaving many patients—especially those with treatment-resistant depression—cycling through SSRIs without response, despite FDA-approved options like TMS (approved 2008) and Spravato/esketamine (approved 2019) that show roughly twice the effectiveness versus standard treatments. Ben Kuhn, co-founder and CEO of Everbright Health, explains why these interventions haven’t become routine in independent practices: complex, frequently changing payer eligibility criteria, provider discomfort discussing specialized treatments, onerous prior auth, and the operational/compliance burden of running a new service line. Everbright Health positions itself as an AI-enabled MSO partner (not an acquirer), promising implementation in ~60 days by identifying eligible patients, managing education, prior auth/billing, and operations. The conversation also covers emerging therapies (psilocybin, PTSD treatment “Prism,” remote monitoring) and growing payer interest in outcomes/value-based models, citing data suggesting up to 50% total cost-of-care reductions when treatment resistance resolves.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this episode, Health Tech Nerds Kevin and Martin interview Thyme Care President and COO Bradford Diephuis about the U.S. oncology market, highlighting rapid therapeutic advances alongside outdated care delivery and misaligned “buy and bill” incentives that tie practice economics to drug margins. They discuss Thyme Care’s growth and care model: contracting with risk-bearing payers and entities to manage a claims-attributed oncology population, deploying a 500+ person wraparound care team to reduce avoidable acute care utilization, and partnering voluntarily with oncology practices on high-value drug interventions, waste minimization, and palliative/advanced care planning. Bradford also outlines contracting approaches using concurrent benchmarks and how Thyme Care uses AI mainly to automate back-office care workflows rather than patient-facing tools.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Opioid addiction remains a major U.S. public health crisis despite overdose deaths falling back toward 2019 levels, and Ophelia leaders Zach Gray and Dr. Arthur Robin Williams discuss expanding access to medication-assisted treatment (MAT) via a virtual-first model. Gray describes founding Ophelia after losing someone to overdose and argues MAT resembles long-term medication plus counseling but has been constrained by burdensome rehab-style requirements and limited prescribing capacity. Williams outlines his harm-reduction and research background and explains how new synthetic drugs, online access, and shipping have accelerated risk. They argue adoption lags due to fragmented care and Medicaid contracting, highlight Pennsylvania’s Center of Excellence as a workable reimbursement model, warn of SAMHSA and Medicaid funding pressures, and note how fee-for-service reimbursement limits innovation and AI adoption.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Stedi founder Zach Kanter joins fresh off a $50M raise to explain the role of clearinghouses in healthcare, why the Change Healthcare cyberattack forced the industry to pay attention, and why legacy incumbents are incompatible with where healthcare is going.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Cityblock's CEO Toyin Ajayi joins to make the case that AI should be deployed in Medicaid first, not last. With 60% of healthcare AI investment going toward revenue cycle and risk adjustment, she argues we're using the technology to deepen an inflationary spiral instead of solving the hardest problems. She breaks down how value-based care creates the right incentives to change that.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

The Grand Roundup | March 30, 2026A packed hour of health tech news: Kevin and Martin recap AHIP (the mood was grim), break down the MA final rates notice dropping any day now, and dig into the peptide/longevity boom reshaping consumer health. Plus two live guest interviews — Toyin Ajayi of Cityblock Health on why AI should be built for Medicaid first, not last, and Zach Kanter of Stedi on their $50M raise and what a billion claims a year looks like. Then a rapid-fire rundown of $581M in funding across 12 deals, including Qualified Health, Doctronic, eMed, and more.In this episode:AHIP recap: MA gamesmanship, no-network plans, and the final rates noticeCityblock Health CEO Toyin Ajayi on AI + MedicaidStedi CEO Zach Kanter on clearinghouses, Change Healthcare, and scaling to 1B+ transactions$581M in funding across 12 dealsThe peptide/longevity wave and what it means for health techReferenced this week: AHIP MMDC, CMS/CMMI, Stedi, Cityblock Health, Qualified Health, Thesis Care, Doctronic, eMed, Adonis, Blossom Health, Clasp, Dimer Health, Prax Health, Certuma, VITLFor more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Kevin is joined by HEP Managing Partner, Ezra Mehlman, and Executive Partner, Tom Cassels, to discuss findings from Health Enterprise Partner’s annual LP survey of ~150 health system and health plan executives. They highlight widespread but shallow AI adoption which has the potential to widen gaps between best-in-class organizations that redesign processes, and laggards that “slap on” tools. They also discuss the finding that nearly 90% of providers expect labor costs per discharge to rise in 2026, driven by slow human/organizational change and persistent clinical labor pressures. They also discuss virtual care’s “next wave” as operationally embedded by specialty (e.g., behavioral health, OB/GYN, orthopedics), and growing payer-provider collaboration via specialty-focused risk/shared-savings models (e.g., kidney, cardiology) and improving interoperability as a path out of adversarial “bot vs bot” dynamics.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

When it comes to the social safety net, America’s public schools are a critical hub for connecting needs with resources, regardless of whether they’re adequately staffed or resourced for this herculean task.Across the country, administrators, teachers, counselors, and perhaps if they’re lucky, a social worker or a nurse, find themselves helping students and their families navigate housing insecurity, hunger, and a healthcare system barely legible to people who do work in it for a living. Perhaps now more than ever, demand for mental health services is far outstripping supply making it harder for students and the adults who care for them to match kids with care.I’ve got some personal experience with this from my time as a Teach For America corps member, which has made me especially interested in Marble Health’s mission and vision of personalized therapy for students. Here to talk about the realities of student mental health today, and how Marble Health is working with school counselors and Medicaid to meet this profound need, I’m excited to welcome Jake Sussman, cofounder and CEO of Marble Health.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Kevin interviews Ashul Govil, Chief Medical Officer and Co-founder of Story Health by Innovaccer and a Sutter Health cardiologist, about Story Health’s evolution from virtual cardiology care powered by health coaches to an AI-forward model after joining Innovaccer. Ashul says their focus has been closing gaps in episodic, brick-and-mortar care by reaching patients at home, publishing outcomes, and now using AI to scale safely amid staffing constraints, including filtering remote monitoring data into actionable clinician decisions. They discuss Story Health by Innovaccer's partnership with Minneapolis Heart Institute/Allina to extend the CHAMP heart failure clinic model to rural and high-risk post-hospitalization patients, emphasizing workflow redesign and systemwide adoption. Ashul also covers Story’s fee-for-service and value-based economics, the CMMI ACO Access model’s promise and payment concerns, risks of fragmented care, and why AI’s cost-deflation impact will be gradual due to trust and technical limits.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Kevin O’Leary and Martin Cech discuss a proposed cross-market mega merger between Sutter Health and Allina Health, including the combined scale, planned $2B regional investment, and skepticism that such mergers improve quality or lower costs despite claimed efficiencies. They’re joined by John Zutter, CEO of Lantern, who explains Lantern’s distributed “surgeons of excellence” approach versus traditional centers of excellence, its concierge patient experience, and how it selects providers using regulatory, clinical, appropriateness, and patient-reported outcomes data; he also shares context on Lantern’s $30M round and utilization-driven differentiation.The episode also covers CMS remarks on steering beneficiaries toward accountable care relationships, early rollout challenges and backlash around Washington’s Wiser model and prior auth, a CMS timing change spurring state directed payment applications, and a funding/deal roundup including Doximity, Verily, Latent, Turquoise Health, Conduit Health, and Nadia Care, plus a stalled Qualtrics–Press Ganey deal due to debt markets.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Martin talks with Dr. Chris Cogle, author of the recently released book Public Startup and health care policy expert, about how Medicaid agencies sit at the intersection of medicine, policy, quality, data, finance, and operations to improve care for millions while managing limited taxpayer resources. They discuss Medicaid as an under appreciated innovation lab, what makes pilots succeed or fail, and how state–managed care organization relationships have evolved into partnerships focused on accountability, risk, and care coordination—especially in Florida’s large managed-care program. Chris explains where value-based care works (defined populations, actionable data, simple contracts) and where it struggles (small cohorts, heavy admin burden), and how Medicaid-born models like telehealth and community-based care can diffuse into commercial and Medicare Advantage. He also offers guidance for policymakers, agencies, and startups: treat Medicaid as a platform, invest in data, reward outcomes, create safe pilot pathways, and lean into Medicaid rather than avoiding it.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

At a very high level, the problems of the American healthcare system are:The US spends a lot more money than it takes in from tax revenue, quite a bit of which is on healthcare either through government funded programs or “tax expenditures” like the tax exclusion for employer sponsored programsLike most services oriented professions, healthcare is subject to Baumol’s cost disease: “There is no technological change which can make an orchestra take less time to play a symphony - service industries don’t have the same productivity improvements as manufacturing industries” yet healthcare provider salaries need to rise despite the lack of productivity gains.The American public isn’t inclined to pay more taxes or reduce service consumption or pay its healthcare providers less.CMMI which was created by the Affordable Care Act to try and engineer some other, more palatable solution to this trilemma: i.e. “test innovative payment and service delivery models to reduce program expenditures under the applicable titles while preserving or enhancing the quality of care furnished to individuals under such titles.”It would be charitable to call its record mixed with its portfolio netting out to cost the taxpayers much more money than it has saved. A few weeks ago, former CMMI senior adviser Ankit Patel wrote an article in Out Of Pocket called How to Fix CMMI Models which I thought was very good, and I was excited to welcome him to HTN radio to talk about it.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Tom Friedman became executive director of the North Carolina State Employee Health Plan in January 2025, covering the plan’s 775,000 active and retired members and its 55-person team managing $5.5B in spend. Friedman says the plan faced major projected deficits ($500M in 2026 and $1.4B in 2027) after years without premium or benefit changes, depleted reserves, and limited population health investment, with about 70% of members having chronic conditions. He describes ending the Clear Pricing Project, arguing it raised costs despite showing members are highly price sensitive. The plan is boosting independent/rural primary care via networks paid ~160% of Medicare with reduced administrative burdens and shared savings, and is using Lantern to offer select elective surgeries at $0 member cost by shifting to much lower negotiated rates; 400 surgeries were completed with ~1,900 in the pipeline. Financially, projections improved toward a ~$450–$460M positive stabilization rate next year, with plans to expand “preferred provider” incentives across services.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

This week’s Grand Roundup covers Devoted Health’s hiring signals and strategy, including 47 open roles (many clinical), a 700-clinician medical group, 200,000 encounters last year, and claims of 5,000 “AI agents,” sparking questions about productivity and a potential path toward a virtual, national Kaiser-like model. The discussion then shifts to torts and product liability, using McPherson v. Buick to frame emerging legal questions for AI in healthcare, including red-teaming of Doctronic and a PVO lawsuit over an allegedly missed finding, plus concerns about liability shifting onto primary care in access-style models. They also review Medicare Advantage’s cost debate (MedPAC’s 14% higher estimate), political scrutiny, possible market “creative destruction,” and rate-notice dynamics (skin substitutes, chart review delinking). Finally, they touch on Medicaid work-requirement implementation costs (Georgia), key public-market notes (Humana benefits, Agilon outliers, Surgery Partners), and private rounds (aMI Labs/Nabla, Nitra, Translucent, doula models).For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe