Health Tech Nerds Radio

Tim Fitzpatrick, founder of Signals Group, joins to discuss innovation and value-based care (VBC) in nephrology. He outlines how CMMI kidney models have evolved from focusing on ESRD hospitalizations (CEC) to home dialysis and transplant incentives (ETC) and now earlier-stage CKD transitions (KCC), citing reported improvements like higher optimal starts, home dialysis use, and preemptive transplants, while noting open questions on cost effectiveness.The conversation covers the growing landscape of kidney VBC operators beyond DaVita and Fresenius, the levers they use to manage total cost of care (care coordination, addressing social needs, avoiding hospitalizations), and early consolidation among providers. They discuss why the US lags in home dialysis, DaVita’s investment in home care (Elara), and how the dialysis bundled payment system may stifle innovation and the key areas to watch in policy and kidney drug development. The three part series on value-based kidney from Signals FS care can be found here: - Part 1: https://media.signalsfs.com/p/the-current-landscape-of-value-based- Part 2: https://media.signalsfs.com/p/the-current-landscape-of-value-based-26d- Part 3: https://media.signalsfs.com/p/the-current-landscape-of-value-based-1d4- DaVita’s investment in Elara: https://media.signalsfs.com/p/brief-davitas-investment-in-elaraFor more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Any conversation about value-based care in pediatric populations would be incomplete without talking about children with high medical complexity.The reality of caring for children with high medical complexity and the barriers their families face is under-discussed, and so is the hard problem of financing their care– it’s 6% of the population and 40% of the spend according to this note from the Children’s Hospital Association, and of that 40%, roughly half is on skilled nursing. It’s also important to keep in mind that ~50% of children’s healthcare is paid for through Medicaid and CHIP.An interesting approach to delivering high quality care for these children is Prescribed Pediatric Extended Care, also known as PPEC. To talk about the unique challenges that high medical complexity kids face, the care they need, and his company’s approach to meeting those needs, we’re welcoming Jeffrey Soffen, CEO of Spark Pediatrics.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

The episode covers a busy Monday in healthcare and markets: Universal Health Services announced it will acquire Talkspace to expand outpatient behavioral health and virtual care, raising questions about Talkspace’s largely non‑W2 therapist model and the modest premium paid. Hims and Hers and Novo Nordisk unexpectedly reengaged after a broken partnership and lawsuit, with Hims curtailing compounded GLP‑1 advertising, Novo dropping its lawsuit, and Novo products expected on the platform, boosting Hims’ stock. Wiley’s AI-focused earnings call and partnership with OpenEvidence (including equity)CMS action against Elevance over risk-adjustment submissions via encrypted USB drivesHospital operators’ revenue growth driven mostly by price and coding intensityIdaho legislation targeting a freestanding ER’s heavy use of the No Surprises Act IDR processPrivate-market deals for FindHelp and Greater Good HealthThe collapse of New Mountain’s planned “Thoreau” spinoutOperational and financing challenges of scaling cell and gene therapies.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

A little noticed aspect of the bipartisan PBM reform bill is strengthening of the “any willing pharmacy” provisions of Medicare. To talk about what “any willing pharmacy” means in practice, why it was included in the PBM reform bill, and broader discussion on medically integrated dispensing and the policy environment, we’re joined by two pharmacist-leaders at House Rx: Denali Cahoon, Chief Pharmacy & Operations Officer, and Tamiko Yamatani, VP, Client Operations.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this episode of Health Tech Nerd Radio, Kevin speaks with Bruce Greenstein, the Secretary of the Louisiana Department of Health, and Will Shrank, the Co-Founder and CEO of Aradigm, about how state Medicaid programs are preparing for the coming wave of cell and gene therapies.The conversation covers state and federal roles, innovative payment models (including Louisiana’s earlier “Netflix model” for Hep C), operational challenges for providers and manufacturers, and the need for ecosystem-level public-private partnerships while warning against other payers shifting risk onto Medicaid.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this episode, Justin Mares, CEO of Truemed, discusses why preventative care is widely supported but hard to finance due to limited ROI data compared to pharmaceuticals. He explains TruMed’s mission and business model: infrastructure that helps qualified individuals use tax-free HSA/FSA dollars for evidence-backed lifestyle interventions—such as fitness, sleep products, and medically tailored programs—through partnerships with merchants like Eight Sleep, Peloton, Lifetime Fitness, and Garmin, plus a direct-to-consumer eligibility flow. The conversation covers how TruMed decides what qualifies (clinical evidence in reputable journals), the role of letters of medical necessity via a compliant telemedicine process, and the goal of building a more “formulary-like” system for prescribing lifestyle interventions based on biomarkers and outcomes tracking. Justin also addresses criticisms that HSAs favor higher earners, argue for prevention as a tool to reduce chronic disease costs, and compare U.S. healthcare incentives with Singapore’s Medisave approach, emphasizing that fixing lifestyle and environmental drivers of chronic disease is essential.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

After spending about as much time on the State of the Union as the President spent on health care in the speech, Kevin and Martin talked about a busy week in the health care public markets including some analyst skepticism around Humana’s 2026 margin guidance and MA MLR dynamics; Hims financial results and burgeoning investor distrust; and GoodRx’s role as a pharma channel.They touch on Option Care’s Stelara biosimilar-driven margin compression, Fresenius’s improving value-based kidney care amid regulatory headwinds, and VBC updates from Agilon, Evolent, Privia, Clover, and Alignment, focusing on recontracting and risk transfer. Plus, UHS price-driven growth, skepticism about AI ROI, an Allina–Innovaccer/Story Health cardiology partnership, and rising attention to 340B financing and HHS’s rebate pilot.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Kevin interviews John Kao, CEO of Alignment Health, after the company reported earnings that beat the high end of guidance across membership, revenue, gross profit, and EBITDA. Kao explains Alignment’s provider-alignment model: guaranteeing PCP revenue via monthly payments, stratifying members so an interdisciplinary “Care Anywhere” team manages the highest-risk 10% at home, and sharing data back to physicians to improve outcomes and reduce avoidable hospitalizations. He discusses California-specific dynamics with IPAs, shared-risk arrangements, and global capitation, and contrasts these with expansion into new markets via clinically integrated networks and hospital systems. They address oncology as a specialty risk area, health system tensions around MA payment and claim edits, and CMS’s MA advance notice, emphasizing program integrity and the potential advantage for low-cost, clinically driven plans amid V28 and policy changes.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Purva Rawal and Liz Fowler, along with their co-authors, have written a several recent forefront articles in Health Affairs that are timely given all the attention to Medicare and MA right now. The one that’s been on our mind lately is “Reengineering ACOs to Make Medicare Competitive,” and we're excited to welcome them to share their thoughts on improvements to the program and recent developments like CMS’s Long-term Enhanced ACO Model (LEAD) and CMS Administered Risk Arrangements (CARA)Additional ContextChris Klomp, the Medicare Director, made an interesting comment at the J.P. Morgan Healthcare conference earlier this year, sharing that CMS wants two types of Medicare: 1. Original Medicare in accountable care relationships; 2. Medicare Advantage, with Klomp noting that they renamed the internal team at CMS from Fee for Service Medicare to Original Medicare last month as a symbol of the focus.Medicare Advantage has been getting most of the attention in healthcare policy worlds after the jaw-dropping Advance Notice from CMS, but in Martin's opinion what’s going on with Accountable Care Organizations deserves more attention. While MedPAC and the Better Medicare Alliance argue about whether MA actually saves money, the Medicare Shared Savings Program has a consistent track-record of real, albeit modest, savings.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Oren Shatken and Romanos Fessas, co-founders of Jukebox Health, join us to discuss how home-based interventions can improve outcomes and reduce costs for long-term services and supports (LTSS) populations. They explain the economics of LTSS and dual-eligible members, why keeping people safely at home matters, and how occupational therapist–led assessments and home modifications can drive measurable ROI for health plans.The conversation covers Jukebox’s operational model — building OT and contractor networks, partnering with plans on outcomes-based contracts, and delivering interventions that improve independence while preventing costly utilization. They also share real-world examples, lessons from working with Medicaid populations, and what’s next, including proactive monitoring and AI tools for care managers.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Martin and Kevin discuss three ways the government has tried to spend less money on healthcare: the Inflation Reduction Act, The No Surprises Act, and ACCESS. They highlight what we learned from public companies this week including Grail’s stock drop after an NHS study missed its primary endpoint and reimbursement concerns; Talkspace’s shift from consumer to B2B; and Community Health Systems’ divestitures while also previewing Hims’ earnings and its acquisition of Eucalyptus. They discuss Scripps exiting Medicare Advantage after losing ~$75M and moving patients to traditional Medicare plus MedSup, contrasted with Cleveland Clinic expanding global cap lives. Looking ahead, they previewed upcoming earnings (Option Care, Fresenius, Acadia, Agilon, Teladoc, GoodRx, Privia, UHS, Clover, Alignment), flag HRSA’s renewed 340B rebate model discussions, and close with Inhabit Home Health & Hospice being acquired by Kinderhook for ~$1.1B amid MA contracting challenges and a broader theme of healthcare services companies considering going private.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

The conversation covers Omada’s views on the ACCESS program and the recently announced reimbursement rates, how they’re thinking about using technology to scale their care operations, plus the new cholesterol program they just announced. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Kevin sits down with Jacob Shiff, the Chief AI & Technology Officer at CMMI, to unpack the new ACCESS model and what it means for healthcare innovators looking to reshape care delivery for Medicare populations.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

On January 29th, CMS announced that Medicaid Technology Companies had pledged $600 million in savings to support the implementation of community engagement requirements from H.R. 1 and other improvements to the Medicaid tech stack.To discuss the current state of the Medicaid tech stack, how preparations for the January 1st 2027 implementation of community engagement requirements and twice yearly redeterminations is going, and alternatives to the Deloitte-Equifax “means-testing industrial complex” we’re joined by:Nikita Singareddy , CEO of Fortuna HealthLuke Farrell, former USDS lead for benefits during the PHE unwinding, author of The Means-Testing Industrial Complex and Fellow at the University of Michigan’s Better Government Lab.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Martin and Kevin unpack CMMI’s new Access program, focusing on reimbursement rates that landed well below digital health expectations and what that signals about CMS pushing AI-enabled, lower-labor care models. They discuss Humana’s earnings and its $1B Max acquisition, debates over Medicare Advantage costs versus traditional Medicare, healthcare job growth amid AI narratives, and an earnings roundup covering Hinge, Tenet, and Oscar’s ACA and ICHRA momentum.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this episode, meet Kelsie Brandt, Chief Clinical Officer at Nest, as she discusses the launch of Nest Origin, a new comprehensive prenatal, postpartum, and infant care program for Medicaid families. Kelsie explains her background in pediatric nursing and the critical role caregivers play in child and infant health. The conversation delves into the challenges Medicaid mothers face, the structure and benefits of the Nest Origin program, and its potential to significantly improve maternal and infant healthcare outcomes. Learn how this initiative, supported by the David and Lucille Packard Foundation and evaluated by UPenn, aims to create a positive shift in healthcare for vulnerable mothers and families.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this special report episode recorded on February 11th, the Health Tech Nerds team dives into the key takeaways from Humana's recent earnings call. The discussion covers Humana's 25% growth in their individual Medicare Advantage book. Despite their stock trading down, the team finds reasons for optimism, particularly around retention rates and profitable plan sales. They also explore larger industry implications, including the impact of CMS's 2027 rate notice and the future strategies of Humana in relation to other Medicare Advantage plans. Key points include Humana's approach to retention, profitability challenges, and the potential ripple effects on regional and smaller insurance plans. Tune in for an in-depth analysis of Humana's current standing and future trajectory in the healthcare market.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this insightful episode, we sit down with Anurati Mathur, co-founder and CEO of a Sempre Health, which is focused on improving medication affordability. The main focus of the discussion is on the complex landscape of medication affordability and how his company addresses it by creating a two-sided marketplace between pharmaceutical manufacturers and health plans. The CEO explains the company's innovative approach to distributing existing funds more effectively and aligning the interests of various stakeholders, including manufacturers, payers, PBMs, and patients. He also touches on the underutilization of financial assistance budgets, the model's expansion into different payer types, and the positive outcomes they've achieved in medication adherence and patient satisfaction. Tune in for a comprehensive look at how technology and innovative business models can transform healthcare affordability.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this episode, we delve into major developments in the healthcare industry, including the recent bankruptcy of Carbon Health and its ambitious goals, the evolving landscape of AI in primary care, and funding trends. We also discuss primary care access challenges, recent earnings reports from major companies like Molina, Centene, and DaVita, and the outlook for PACE models and vertically integrated healthcare systems. Join us for a comprehensive analysis of the shifts and trends impacting the healthcare sector.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this episode, Kevin and Martin discuss significant developments in the healthcare sector, focusing on recent changes to Medicare Advantage announced by CMS, which resulted in a $100 billion overnight loss in market cap for publicly traded insurers. They delve into the nuances of effective growth rates, risk adjustment changes, and their potential long-term impact on the industry. They also cover three notable M&A deals in the startup space – Sword Health acquiring Kaia, Spring Health acquiring Alma, and Premise Health acquiring Crossover Health. Lastly, they highlight key takeaways from recent earnings calls for UnitedHealth Group, ance, and HCA, noting the varied performance and strategies in navigating the current healthcare landscape.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

Dr. Rebekah Gee and Rebecca Kavoussi, founders of Nest, discuss their innovative approach to healthcare for Medicaid populations, emphasizing an in-home, family-centered model. They share their experiences and strategies for addressing social determinants of health, improving accessibility, and harnessing the power of data to enhance healthcare outcomes. The discussion covers Nest's business model, operational challenges, geographical expansions, and future plans to scale their impactful care model. Key highlights include operational efficiencies, radical accessibility, and the potential long-term benefits for families and communities.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this episode, the hosts are joined by Tim and Dr. Malick, the CEO and CMO of Hopscotch Primary Care, a company dedicated to transforming rural primary care through innovative models and technology. They discuss the unique challenges faced by rural healthcare providers, such as access issues, worse payer mixes, and workforce shortages. The conversation highlights Hopscotch's high-touch, high-tech model, which includes strategies like virtual specialty consults and AI implementations to improve patient outcomes and ease provider burdens. They also delve into the Rural Health Transformation Program and the importance of thoughtful investments to create sustainable health solutions. In the discussion, Dr. Malick and Tim emphasize the significance of appropriate compensation models for healthcare providers and the potential benefits of expanded scope of practice for nurse practitioners and physician assistants. The episode concludes with information on how listeners can follow Hopscotch Primary Care's journey.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

In this episode, Kevin and Adam discuss a new pilot program in Utah that uses AI to process prescription refills for a specific set of medications without human intervention. They delve into the details provided by a recent Politico article, explain the problem of medication noncompliance, and discuss how AI can improve accessibility to medication renewals, particularly in rural areas. The conversation covers the metrics for success, patient and provider acceptance, and the potential for expanding the program. They also touch on regulatory issues, the strategic importance of this pilot for their business, and the challenges of securing malpractice insurance for AI-based medical decisions.For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe