On Episode 2 of Season 4, Vanessa Moldovan interviewed me on her podcast, For the Love Of Revenue Cycle, which I am excited to share. Since starting the Healthcare Reimagined podcast, I founded a healthcare company, Covered Health, and Vanessa interviewed me about what we're doing and why we're doing it.

At Covered, we are automating the most challenging and time consuming elements of appealing denied medical claims for providers. By streamlining access to diverse databases and inputs, Covered uses technology to helps RCM specialists identify denial root causes, and appeal them.

Vanessa and I came together because we share the same vision: preventing patients from getting stuck with bills that should be covered by their insurance, and helping to empower revenue cycle management experts to resolve those denials with greater efficiency.

We discussed my motivation for starting Covered - my brother Russell's experience with unfair insurance denials during his struggle with Ulcerative Colitis. Our family was hit with massive bills, and at a time when we wanted to focus on Russell’s health, instead we were focused on denied claims. Covered intervenes to help providers overturn denials, and prevent bills from becoming patient responsibility.

We discussed my journey through the Special Forces, Parachute Health, and running sales for healthcare companies, and eventually selling into insurance plans prior to starting Covered. We also spoke about Vanessa's career, and her choice to turn down Harvard undergraduate in pursuit of a life and career that aligned with my values of giving back and sharing what I've learned with others, which is why I started this podcast.

Vanessa and I met, funnily enough, because I was looking for a podcast on denials and found this one! We connected over a shared passion to create a denial resolution tool with the goal of harnessing the multitude of databases & sources of truth that a biller has to access in order to identify the root cause of a denial and create an appeal.

We are not only reducing the clicks required to gather the information, but creating a smart tool that will guide RCM professionals through the decisions required to compile the body of the appeal, and eventually generate it for them.

We addressed Covered’s competitive differentiation within the denial management space, and the rapid advancement of AI and LLMs, which have given an advantage to new companies. We touched on the slow moving nature of incumbents, and why they often don’t succeed in building product lines that are as innovative as their original core offering.

If Covered’s mission to fight back against incorrect denials resonates with you, we want to connect! Especially (but not exclusively) if you are an independent specialty provider group, an RCM company fighting denials, or a regional/community hospital/health system. If you are struggling to address denials as a result of staffing shortages/payer policies/behavior, or you are just passionate about denials, please reach out!

Today, Covered acts as a software enabled services company, utilizing technology and Vanessa to overturn denials (we've returned tens of thousands of dollars to physicians). If you're struggling with denials, we can immediately step in and help you, and help identify trends and root causes. In special cases, we also provide consulting services.

You can learn more about Covered on our website, CoveredHealth.ai.

On Episode 1 of Season 4 of the Healthcare Reimagined podcast, I spoke with Manav Sevak. Manav is the founder and CEO of Memora Health, which helps healthcare organizations digitize and automate care journeys, and make complex care delivery simple for patients and clinicians to navigate. Manav's journey to building Memora health began with a personal story - a close friend with a chronic diagnosis, who despite being young and tech savvy, found it difficult to navigate his care.

There are three major challenges that Memora addresses: Digitizing clinical workflows, saving providers time by utilizing automation, and allowing patients to use text messaging to get the information they need about their condition.

By looking at the things that happen for every patient, every time, in the course of a particular care episode, Memora has been able to use technology to automate and even standardize certain follow-up procedures. That has cut down on inbox messages and phone calls, and even eliminated them all together. Research out of Dartmouth suggests that people forget up to 80% of what they’ve heard from their healthcare professional. As a result, getting critical information to patients in a digestible format is crucial, and text messaging has proven itself to be a very reliable format for Memora.

The best course of care will vary based on a given patient’s condition and their response to treatment. However, according to Manav, the way patients get reminded to manage their medications, come to appointments, and the way that symptom management are done, should look very similar across clinical areas. What Memora is aiming to build is a best in class process for conveying information to patients and receiving that information back from them.

Memora is also able to leverage its digital approach to ensure adherence to ever-changing guidelines. When the protocols for screening patients for mental health conditions during the prenatal period changed, Memora was immediately able to update their postpartum care program across different care sites to reflect best practices.

Manav and I went on to discuss the challenges of EHR integration for digital health startups, and the challenge of building technology before Memora had access to data from pilot customers. We closed by exploring what percentage of the back and forth between care teams and patients it might be possible to automate in the future, and the tradeoff for early stage founders between staying at a high level and diving into the weeds.

You can learn more about Memora Health on their website.

On Episode 10 of Season 3 , I spoke with my grandmother, Sydell Aaron. Ultimately, we all become consumers of Healthcare, like it or not. On Healthcare Reimagined, I typically showcase healthcare innovation - the truth is that innovations are only interesting in so far as they are making life better for patients. Last week I spoke with my grandmother about her experience as a consumer of U.S. healthcare over the past 9 decades.

Sydell, or Meema as I call her, was born in 1932. In 1929, 3 years before she was born, the first polio patient was saved. In the 1940’s when Meema was a teenager, scientists succeeded in isolating penicillin and antibiotics became widely available for the first time. Before that, you could die from a simple infection. The first kidney transplant was done in 1952, when Meema was 20. In 1964, for the first time human blood was successfully stored. Meema was 32 years old, with 3 children.

Meema has already lived 50% longer than the average life expectancy for a woman the year she was born (it was 62 back then). We spoke about her family doctor making house calls, the awe and wonder of medicine before technology that made medical information available to all, and about the trade off between safety and independence as one gets older.

We discussed a few quotes from Atul Gawande's book Being Mortal, and the loss of independence as one ages. One of the quotes from Gawande's book really captured the essence of the challenge Meema faces in her interactions with her adult children. They want the best for her, as she knows, but at times, they infringe upon her freedom in an effort to protect her: "We want autonomy for ourselves and safety for those we love.”

We went on to discuss the framework in which death is addressed in U.S. Healthcare, and a system that selects for those who can and want to fix things (Doctors), when sometimes the best option is not to fix but to provide comfort in one's final days.

We closed with a discussion about Meema's own hopes, desires, and observations after over 9 decades on this pale blue dot we all call home.

Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content.

On Episode 9 , I spoke with Shiv Rao. Dr. Rao is the founder and CEO of Abridge, which uses ambient AI to summarize conversations into clinical documentation. He is also a practicing cardiologist, and previously led the provider-facing investment portfolio for UPMC.

“What did the doctor say?" is inevitably the first question we ask a loved one who has just been to see a clinician. But how often do we get a clear answer ? How many of our loved ones are actually knowledgeable enough to grasp the details of their condition/diagnosis/care plan? Research out of Dartmouth suggests that people forget up to 80% of what they’ve heard from their healthcare professional.

That's what makes Abridge so important, and is likely the reason that over 300,000 people are using the free version of the Abridge app (which you can download here on the app store) to help make sense of medical conversations and share information from clinical consultations with loved ones.

As Dr. Rao pointed out in our conversation, there is a public health emergency occurring in the United States - we do not have the supply of clinicians necessary to meet the demands for care delivery. Compounding a lack of clinicians is an uptick in burnout. The AMA currently estimates that physician burnout is at 63%, and an article in the Journal of Internal Medicine that said clinicians would need 27 hours per day to do all the work that’s required of them. Shiv started Abridge to reduce the documentation burden on physicians, and to provide patients with a digestible, “translated” version of their clinical encounter that they can share with family members.

The benefits are also significant for clinicians. Over 80% of the clerical work that used to be involved in documenting is now getting automated by Abridge - this solution is currently saving clinicians on the platform an average of 2 hours a day!

Ultimately, as we discussed, a clinical note has three stakeholders:

1. Other clinicians on the care team - they need to understand Dr. Rao’s medical differential, and how he was thinking about the diagnosis/care plan.
2. Health plans - Dr. Rao needs to build his note in such a way that the diagnosis and follow-up recommendations can be properly coded and billed.
3. Patients and their family members, who may need to take action based on Dr. Rao’s findings, which they thus need to understand.

A single note cannot be all of those things at once. Abridge solves this problem by summarizing and structuring the information to create different artifacts for all three sets of customers.

Abridge has raised $27 million to date from investors like Union Square Ventures, Bessemer Venture Partners, and Wittington Ventures. For more information, you can check out their website: https://www.abridge.com

Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content.

Dylan Beynon is the founder and CEO of Mindbloom, an at-home psychedelic therapy startup. Dylan has been named a top 25 consumer healthtech executive and one of the 100 most influential people in psychedelics. Mindbloom has facilitated 100,000+ psychedelic therapy sessions since launching in 2019, and is now the largest provider of ketamine therapy in the U.S.

Increasing access to Ketamine therapy was one of Dylan's main motivators for starting Mindloom. His family was among the 70% of those living paycheck to paycheck in America, for whom standard treatment would have been unaffordable. Mindbloom is now available in 35 states, accessible to 70% of the U.S. population, and has reduced the cost of treatment by as much as 72% (see linked study).

We spoke about the addiction fallacy related to Ketamine, and the comprehensive study Mindbloom published in the Journal of Affective Disorders demonstrating that their methodology delivers significantly better clinical outcomes than traditional in-person clinics, as well as SSRI’s, talk therapy, and legacy medications. This is a link to the study.

Dylan shared some surprising stats during our discussion:

• With SSRI's (prozac and lexapro), 47% of people get a greater than 50% improvement in depression symptoms. Talk therapy is closer to 40%, roughly the same as a placebo.
• In peer reviewed clinical studies across 1250 participants, Mindbloom patients saw clinically significant improvement in symptoms 60% of the time.
• Mindlboom has shown through clinical research that their patients are also getting a side effect less than 5% of the time, as compared to the 30-50% of patients who experience moderate to severe side effects from SSRI’s.

We moved from the discussion of efficacy to the topic of reimbursement. Ketamine is generally not reimbursed today for depression and anxiety, with the exception of J&J, which in 2019 got S-Ketamine approved for suicidality and treatment-resistant-depression. Unfortunately, it is still extremely expensive - approximately 13x the cost of generic ketamine.

Dylan’s personal connections to depression and SAD are extensive. He lost both his mother and sister to fentanyl overdoses, despite trying every traditional treatment available to try to help them.

While Dylan believed that his target customers would be early adopters before starting Mindbloom, he ultimately found that it was people who have struggled with anxiety or depression for a long time. Their average customer today is 41 years old, with more over the age of 57 than in their 20’s. We spoke of some of the other potential causes of the mental health crisis in the U.S. Among them, the poor metabolic health of the average American, which is getting worse. Finally, we discussed Dylan’s learnings across three companies about how to build a successful company culture. We touched on the gap between good and great talent, and the false choice between being direct and honest, and being kind. Mindbloom won the Tony Shay award for transformational company cultures, which is a testament to the work environment Dylan and his team have created.

Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content.

Additional links: Chemical imbalance of the brain theory may not be true.

Dr. Groves is the Chief Medical officer of Banner Aetna, an independently licensed insurance company with a 50/50 ownership split between Banner and Aetna. "We have taken two elite athletes, put them together and said 'who is best at what, and let's leverage their respective strengths going forward.'"

Banner Aetna has tried to be strategic about what services that are currently handled by the care delivery system or insurer should reside with the other. By pushing care management (among other things) to the delivery system, they have been able to eliminate confusion for patients and duplication of efforts.

We also spoke about prior authorization. In the eyes of Dr. Groves, prior authorization is a way to check, "Is this really necessary based on medical literature?" now that the speed at which medical information doubles has gone from 50 years in the 1950's to weeks or months today. At Banner Aetna, half of all prior authorizations are now being done by Banner, which means that Banner doctors are speaking to their peers within the health system when discussing authorizations, and that those peers have access to the patient's record in real time, and can check for missing information.

When it comes to attribution, Dr. Groves rejects the concept of "owning patients", and notes that Banner Aetna patients are often treated by physicians in the Banner Network that are aligned but not owned by Banner. Dr. Groves sees Banner Aetna's role as financing the services that a trusted physician feels his or her patients need, and helping to support the trusted relationship between a doctor and patient wherever it is occurring.

As we moved to a conversation about innovation in healthcare, Dr. Groves noted that technology should always be in service of the relationship between a clinician and patient. Trust, he noted, is what has suffered as technology has created a wall between patients and physicians. Dr. Groves is interested in technology that can streamline back office functions, make it easier for patients to find the right doctor, and assist patients in following through on commitments they have made to their physician to improve their health.

We also touched on physician incentives. It has been Dr. Groves' experience over 30 years of managing physicians that whenever you attach reward and punishment to a metric, it immediately starts being distorted. "Intrinsic motivation is dampened by external rewards."

Dr. Groves cited research by Brent James, which indicates that the ease of accomplishing a task is what drives most physician behavior. Physicians are inherently competitive, and thus sharing data with physicians so they can see where they stand in relation to their colleagues is also important. Financial reward is a distant number 3 on the list of what influences physicians. Putting excessive weight on specific metrics results in an overemphasis on a limited set of metrics instead of the relationship and an evaluation of the whole patient.

On episode 6 of season 3, I continued my conversation with Dr. Stephen Klasko, who was the president of Thomas Jefferson University and CEO of Jefferson Health from 2013-2021. Under his leadership, Jefferson expanded from 3 hospitals to 18, and saw its revenue grow from $1.8 to $9 billion. Dr. Klasko was #2 on Modern Healthcare’s “100 Most Influential Individuals”. He is also the co-author of 2020’s UnHealthcare: A Manifesto for Health Assurance with Silicon Valley investor Hemant Taneja, and is currently an executive in residence at General Catalyst.

In the second half of this two-part episode, Dr. Klasko and I discussed some of the systemic issues in U.S. Healthcare. We started with a discussion of behavioral health, and how we will need to think differently about clinician/patient interactions to get at the root of the problem, starting with acting more proactively.

The antidote to much of what ails us, in Dr. Klasko's opinion, is healthcare at any address (i.e. Jefferson sent a nursing student into the home of an asthma patient with 10 previous ED visits that resulted from asthma exacerbations. The nursing student discovered mold, and so Jefferson sent a handyman to fix it at a fraction of the cost of an inpatient admission). Nobody wakes up in the morning and says "I am going to telebank", and yet we talk about meeting people where they are (tele-health, homecare, etc.) as though it's novel. Dr. Klasko's vision was that Jefferson would one day no longer be defined as a hospital system, but as a system that provided healthcare at any address. He asks, rhetorically, "Why would you want to be defined by the place where you've in essence failed to keep people healthy?"

Despite advocating un-scaling, in order to innovate, Dr. Klasko freely admits that he grew Jefferson from 3 hospitals to 18. Yet, these mergers allowed him to obtain huge geographic proximity - nobody was more than 10 or 15 minutes from a Jefferson facility. As a result of facilities owned by the hospitals they bought, Jefferson was also able to obtain massive primary care networks, further contributing to the vision of healthcare at any address. We spoke about Tandigm's partnership with Penn and IBC, and what it will take for that partnership to bear fruits for the clinicians and patients involved. Finally, we discussed mergers and acquisitions, and the future of our healthcare system.

Dr. Klasko can be found on Twitter and Linkedin.

Please make sure to check out Society for HealthCare Innovation (SHCI) website (http://www.SHCI.org) for more information about our work.

On episode 5 of season 3, the first of this two-part episode, I spoke with Dr. Stephen Klasko about his unlikely journey from OBGYN to the president of Thomas Jefferson University and CEO of Jefferson Health from 2013-2021. Under his leadership, Jefferson expanded from 3 hospitals to 18, and saw its revenue grow from $1.8 to $9 billion. Dr. Klasko was #2 on Modern Healthcare’s “100 Most Influential Individuals”. He is also the co-author of 2020’s UnHealthcare: A Manifesto for Health Assurance with Silicon Valley investor Hemant Taneja, and is currently an executive in residence at General Catalyst.

Dr. Klasko and I began the episode discussing the creation of the Jefferson Italy Center in Rome and partnership with Gemelli Hospital. Jefferson's presence in Italy highlighted one of the ironies of U.S. Healthcare - while we claim to be on the cutting edge of innovation when it comes to healthcare, we create serious barriers to entry. The CEO of Marriott Hotels in Italy can be a CEO in the U.S., but if you are the head of cardiovascular surgery at Shanghai university and you come to the U.S., we make you retake your residency. We also shun the use of alternative medicine, which is used to treat 2/3 of the world’s population, because it doesn’t fall into the familiar categories of surgery or drugs (Jefferson created the Marcus center for Integrative Health which is taking the best of care that happens around the world that is not just drugs and surgery).

Jefferson's uniquely international presence and perspective served the health system well during COVID. Their Italian hospital served as the canary in the coal mine, and allowed Jefferson to have a clear picture of the damage that COVID would ultimately cause long before most of the U.S,. Jefferson had also invested $50 million into Telehealth in 2014 and maintained the pandemic preparedness team it had stood up when Ebola (almost) hit.

We touched on the state-level licensure requirements and how much the emergency protocols reduced tensions around credentialing. The idea that someone might need a different debit card to pull money out in every state is ridiculous, and yet in healthcare, it is the status quo in credentialing because it often aligns with the vested interests of the incumbents.

Dr. Klasko blames the system in its entirety for the fact that while predominantly underserved people died because they didn't get care during the pandemic, insurers quadrupled their net operating income because people they thought would get care died.

You can find the full episode here:
Spotify: https://spoti.fi/3D26Ayq
Apple Podcasts: https://apple.co/3eZyovm

Dr. Klasko can be found on Twitter and Linkedin.

Please make sure to check out Society for HealthCare Innovation (SHCI) website (http://www.SHCI.org) for more information about our work.