Claims Denied: A Hospitalogy Podcast

Blake sits down with Steve Mackin, CEO of Mercy — one of the top 15 health systems in the country with 55+ hospitals across Missouri, Oklahoma, Arkansas, and Kansas — to talk about how Mercy is quietly building one of the most interesting care model playbooks in the industry. Steve and Blake get into everything: why Mercy deliberately conceded on price to win on care model, how they cut CHF ED admissions in half, a 1,300 point solution purge, the Mayo data partnership, AI deployment at scale, and why Steve thinks there will be clear winners and losers among health systems over the next few years. This one's packed! --- Mercy: https://www.mercy.com/ Follow Steve Mackin on LinkedIn: https://www.linkedin.com/in/steve-mackin-18771021/ Follow Blake Madden on LinkedIn: https://www.linkedin.com/in/blakecmadden/  --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our podcast? Listen to previous episodes here: https://hospitalogy.com/podcast/  Be sure to leave us a review, and share our podcast with colleagues.

In this episode, Hospitalogy's Blake Madden talks with two operators who actually walk the walk in oncology: Ben Freeberg, founder of Oncology Ventures (recently announced Fund II) and Dan Nardi, CEO of Reimagine Care.  They deep-dive on why 1,000 of the 1,700 Americans who die of cancer every day don't have to, why 97% of the cancer journey happens outside the clinic (and almost nobody is building for it), and how Remy, Reimagine's AI-based virtual cancer center, is resolving half of all patient interactions autonomously while cutting ED visits by 67%. Blake also pushes Dan on the drug-distributor vertical integration question (the one nobody wants to answer on the record), and Ben goes into the Fund II thesis: life insurance as a new buyer, outpatient CAR-T, and the coming consolidation wave in digital oncology. If you care about where oncology care delivery is actually headed over the next 3-5 years, this one's for you! --- 00:00:00 - Introduction to Oncology Ventures and Reimagine Care 00:04:40 - Current State of Oncology and Investment Opportunities 00:09:43 - The Value Proposition of Reimagine Care 00:14:43 - The Role of Technology in Cancer Care 00:19:45 - Personalized Patient Engagement and Data Utilization 00:30:19 - Understanding Stakeholder Value in Oncology 00:32:41 - Fee-for-Service vs. Value-Based Care Dynamics 00:34:22 - Rethinking Incentives in Cancer Care 00:39:06 - The Role of Orchestration in Patient Care 00:42:10 - Convergence of Care Models and Patient Experience 00:45:19 - The Importance of Ambulatory Strategies 00:47:17 - Future Directions for Reimagine Care 00:52:06 - Exploring Partnerships and Growth Opportunities Oncology Ventures: https://www.oncology.ventures/ Reimagine Care: https://reimaginecare.com/ Follow Ben Freeberg on LinkedIn: https://www.linkedin.com/in/ben-freeberg/  Follow Dan Nardi on LinkedIn: https://www.linkedin.com/in/danjnardi/  Subscribe to Ben Freeberg’s newsletter: https://oncologyventures.substack.com/ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our podcast? Listen to previous episodes here: https://hospitalogy.com/podcast/  Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠https://www.linkedin.com/in/blakecmadden/⁠

What does it actually look like to run clinical strategy inside a vertically integrated giant when payor-provider trust is at a historic low? Blake Madden sits down with Dr. Ali Khan, Chief Medical Officer for Aetna Medicare, to get the answer to this question and more.  Dr. Khan has been employee 34 at Iora Health, a hospitalist/UM and CM medical director at CareMore, a division leader who scaled Oak Street Health from 23 to 75 clinics through the pandemic, and now he's trying to make CVS's vertical integration thesis actually work at the last mile. Key Topics: The real state of value-based care (spoiler: it's not as far along as anyone claims), Why Aetna is bringing nurses back to hospital bedsides, How behavioral economics is driving member engagement, and What AI should actually be used for in MA Amazing learnings in healthcare operations from someone who's practiced medicine and run P&Ls across every care model that matters. --- 00:00:00 - Introduction to Dr. Ali Khan and His Background 00:09:48 - The Evolution of Value-Based Care 00:18:45 - High Value Care vs. Value-Based Care 00:22:31 - Aetna's Transformation and Integrated Care Models 00:32:20 - Behavioral Economics in Healthcare 00:35:16 - Creating a Connected Ecosystem 00:38:54 - Navigating Structural Challenges in Healthcare 00:45:20 - Building Trust Between Payers and Providers 00:49:13 - Collaborative Care Models for Better Outcomes 00:55:11 - Triage of Current Healthcare Challenges 01:00:21 - Lessons from Healthcare Acquisitions --- Aetna Medicare: https://www.aetna.com/medicare.html  Follow Dr. Ali Khan on LinkedIn: https://www.linkedin.com/in/alikhan28/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 67K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

I sat down with Otto Sipe, co-founder of Photon Health, for what turned into one of the most wide-ranging Claims Denied conversations we've had. We riffed on the Medvi debacle, why the NYT whiffed on due diligence, the entire arc from Hims to Cerebral to vibe-coded pill mills, and Otto's vision for AI prescribing modeled after self-driving cars. Otto's April Fool's satire about AI-powered peptide prescriptions literally came true the next day. You can't make this stuff up. For anyone thinking about DTC telehealth, pharmacy economics, PBM reform, or where AI meets clinical care, this one's a must-listen! --- To learn more about Photon Health, check them out at https://photonhealth.com/  Follow Otto Sipe on LinkedIn: https://www.linkedin.com/in/ottosipe/  --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 67K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe at https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, subscribe, and share our podcast with colleagues.

I went into this conversation expecting a consumer wearables story. I came out thinking Oura might be quietly building one of the more compelling engagement platforms in healthcare. In this episode, I sit down with Dorothy Kilroy, Chief Commercial Officer at Oura. Dorothy breaks down how a ring originally built around sleep and women's health is now generating 6x engagement vs. prior programs in Medicare Advantage, driving a Cigna partnership built on redesigning chronic care around continuous biometric data, and heading toward FDA submission on hypertension detection. The consumer wedge was never the end game. It was the proof point. --- Listen to hear why: 77% of Oura's MA members are active 5+ days a week, and why that number matters more than any wellness benefit stat you've seen. Oura built a custom women's health LLM, designed and vetted by in-house clinicians, specifically tuned to not be dismissive. (A low bar in healthcare. Somehow still rare.) The Cigna partnership isn't a wellness perk. It's a bet that chronic care management gets rebuilt around continuous biometric data, not episodic claims. Why Dorothy thinks clinicians don't need more data. They need filtered intelligence that fits real workflows. Awareness beats perfection, and why that mindset shapes both Oura's product philosophy and Dorothy's own approach to executive parenthood and imposter syndrome. --- Oura Ring: https://www.ouraring.com Follow Dorothy Kilroy on LinkedIn: https://www.linkedin.com/in/dorothy-kilroy-31671a21/ Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 67K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

In this episode, we’re going DEEP on what’s broken in primary care and what it actually takes to fix it - not with another point solution, but with an AI-first care delivery platform. Dr. David Carmouche, Chief Medical and Commercial Officer at Lumeris, has a resume that reads like a masterclass in healthcare transformation: practicing PCP → Blue Cross Louisiana CMO → Ochsner VP of Primary Care & VBC → Head of Walmart Health → now Lumeris. He's seen every angle of the primary care crisis firsthand, and he's not sugarcoating it. We got into the real reason Walmart Health shut down, why Ochsner just went all-in on Lumeris's AI agent "Tom," and David's provocative white paper arguing a single PCP could manage 5,000 patients with the right AI stack.  Listen to hear why: -The ROI case for AI-enabled primary care is almost embarrassingly simple once you model it as a front door strategy, not a cost center. -Health systems face two internal sales: a fast one with the C-suite and a slow one with clinicians. Confusing the two kills deals. -The in-office primary care visit is the exception, not the rule, in 10 years. David lays out what replaces it. -First movers who crack AI-enabled primary care access don't just improve outcomes; they structurally take market share from competitors who don't. Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads. Tom serves as the AI member of a patient’s primary care team. Lumeris: https://www.lumeris.com Follow Dr. David Carmouche on LinkedIn: https://www.linkedin.com/in/david-carmouche-md/  Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 51K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

Blake sits down with Ian Koons, CEO and co-founder of Karoo Health, to unpack why cardiology is having its “VBC moment” and why most attempts to “do value” in specialty care fail the second they collide with real-world provider incentives. Ian breaks down how Karoo went from planning de novo cardiac clinics to becoming a single source of truth for cardiology VBC.  They also get into Karoo's Humana partnership, rumors of a newly signed term sheet with a top-tier investor, why V28 is reshaping the payor landscape, and the death of siloed specialty models.  Listen to hear why: -Payers are under real performance pressure (hello, MA economics), and cardiology spend is now too big to ignore. -“One-size-fits-all” specialty VBC is fantasy. Karoo partners with payers to architect market-specific cardiology contracts, then wraps physicians with the services, tech, and operational muscle to actually deliver savings without breaking the clinician experience. -The next wave isn’t 70 point solutions; it’s collaborative specialty models with fewer contracts, clearer accountability, and a single source of truth. Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads. Tom serves as the AI member of a patient’s primary care team . Learn more at ⁠⁠⁠⁠⁠⁠⁠Lumeris.com/platform⁠⁠⁠⁠⁠ ⁠ Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 51K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

On just Day 4 of his new role as Chief Clinical Product Officer at Nabla, Matt Sakumoto, MD, sat down with me for this live recording at the Nabla Summit in late January. Matt, who was still practicing as a virtual primary care physician, hadn't even finished onboarding, but he was already dropping takes on the future of agentic AI, physician independence, and why your health system's AI readiness problem is actually a people problem. Listen to hear why: Ambient scribes may be table stacks, but the next frontier is agentic AI that executes clinical workflows, not just documents them. AI may enable something healthcare hasn’t seen in decades: the return of independent primary care practices, powered by automated back offices and AI-driven operations. The success of AI adoption is about leadership buy-in, training infrastructure, governance, communication cadence, and an organization’s appetite for speed of change. Healthcare consumerism may create a new industry entirely: an “H&R Block for health insurance” to help people navigate coverage decisions. True value-based care still hinges on one unsolved challenge: how do you measure prevention when success is something that never happens? Building tools with nurses, front desks, and back offices in mind is just as important as helping doctors. --- Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads. Tom serves as the AI member of a patient’s primary care team. Learn more at ⁠⁠⁠⁠⁠⁠Lumeris.com/platform⁠⁠⁠⁠ ⁠ Nabla: https://www.nabla.com/ --- Follow Matt Sakumoto on LinkedIn: https://www.linkedin.com/in/mattsakumoto/  Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 51K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

What does it take to build a real between-visit care engine at scale? In this episode, Blake talks with Sean Duffy, CEO and co-founder of Omada Health, about why the “visit model” is structurally broken for chronic disease, and what Omada is doing about it.  Sean breaks down Omada’s provider model, why they’re leaning into GLP-1 support as employers and plans grapple with cost and adherence, and why Omada ultimately decided to add prescribing capabilities as the GLP landscape explodes from “two injectables” to a future of dozens of options.  Sean also shares Omada’s practical approach to AI: not chatbot theater, but automation that makes care teams faster, more personalized, and more effective. Listen to hear why: -GLP-1s don’t work like a “vaccine moment”; behavior + psychology still decide outcomes -The next GLP wave is about complexity (single/dual/tri-agonists, orals, pricing tiers) -AI can expand margins, but there’s a bigger unlock -The moat is personalization: making a 23-year-old in Seattle and a grandma in Boca both feel like the program was built for them Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads. Tom serves as the AI member of a patient’s primary care team . Learn more at ⁠⁠⁠⁠⁠Lumeris.com/platform⁠⁠⁠ ⁠ Follow Blake on LinkedIn: ⁠https://www.linkedin.com/in/blakecmadden/⁠ For expert analysis on healthcare M&A, strategy, finance, and markets, join 66K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠https://hospitalogy.com/⁠ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

What happens when a health system stops treating ambulatory like a side project and starts running it like a strategic priority? In this episode, Blake talks with Brent Davis, CEO of the Primary Health Division at AdventHealth. Brent explains why AdventHealth created a standalone division to build “outside-the-hospital” businesses with the focus, capital, and talent they rarely get when they’re managed inside hospital infrastructure.  He breaks down the division’s three north stars - primary care preeminence, winning in the home, and value-based care competency - and shares the hard-numbers story: ~$500M committed over six years, primary care visits up sharply, and the operating subsidy meaningfully down. Listen to hear why: -“Primary care is subsidized” isn’t a strategy.-Co-located clinics, standardized templates, and smarter staffing are the unsexy moves that actually change unit economics.-The next frontier isn’t just urgent care and senior clinics.-Value-based care isn’t one grand theory; it’s market-by-market underwriting. Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads. Tom serves as the AI member of a patient’s primary care team . Learn more at ⁠⁠⁠⁠Lumeris.com/platform⁠⁠ ⁠ AdventHealth: https://www.adventhealth.com/ Follow Brent Davis on LinkedIn: https://www.linkedin.com/in/brentwdavis/  Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 66K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

Welcome to Claims Denied, a podcast from Hospitalogy. In this episode, Blake sits down with Charlie Martin (the “wartime general” behind General Care, HealthTrust, OrNda, and Vanguard), founder and chairman of Martin Ventures, and Devin Carty, CEO of Martin Ventures, for a rare, behind-the-scenes masterclass on how healthcare systems actually get built, fixed, and scaled. Charlie unpacks the gritty reality of turning around broken hospitals (including a wild Detroit Medical Center story) and why most operators never truly manage costs until they’re forced to.  Devin connects those battle scars to Martin Ventures’ current playbook: building and backing companies at the intersection of value-based care, AI, and capital-light services, with an obsession for talent, culture, and aligned incentives. If you want the real talk on why healthcare transformation is still so hard, and where the next decade of value creation is headed, don’t miss this one. Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads. Tom serves as the AI member of a patient’s primary care team . Learn more at ⁠⁠⁠Lumeris.com/platform⁠ ⁠ Martin Ventures: https://www.martinventures.com/ Charlie Martin: https://www.martinventures.com/our-firm/ Follow Devin Carty on LinkedIn: https://www.linkedin.com/in/devincarty/ Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 51K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

Welcome to Claims Denied, a new podcast from Hospitalogy. In this episode, Blake discusses the year in review and what to expect next with Clete Madden (yes, that’s Blake’s dad!) and the JTaylor Podcast Crew, including Herd Midkiff, Kyle Kirkpatrick, and Anna Brewer. If it feels like healthcare keeps “solving” the same problems with shinier tools, this conversation gets right to the why. The group breaks down what’s actually changing (AI adoption getting real, consumer expectations rising, the deal market re-accelerating), and what’s about to get messier (Medicaid/ACA changes, 340B economics, Medicare Advantage’s growing gravitational pull). It’s part year-end reckoning, part 2026 forecast, with a few spicy detours on GLP-1s, cash-pay “parallel” systems, and who really controls innovation: the people or the payors. Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads. Tom serves as the AI member of a patient’s primary care team . Learn more at ⁠⁠Lumeris.com/platform ⁠ Subscribe to the JTaylor Healthcare Podcast: https://podcasts.apple.com/us/podcast/the-jtaylor-healthcare-podcast/id1577266916  Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 51K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

In this episode, Fairview Health Services CEO James Hereford joins Blake Madden to unpack what a real health system turnaround looks like when you inherit “zero trust” and six years of organizational drift.  James walks through his unconventional path into healthcare, why lean management systems (not “lean tools”) became Fairview’s operating backbone, and how labor control, throughput, and supply discipline powered a $350M recovery without sacrificing quality, service, or engagement.  James and Blake also dig into the economics of specialty pharmacy/340B, and where Fairview Health has been able to win with AI. You won’t want to miss James’ conversation about his biggest AI implementation failures, the need to give employees agency, and the mistake most orgs make when they fall in love with technology. Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads.   Tom serves as the AI member of a patient’s primary care team . Learn more at ⁠Lumeris.com/platform Fairview Health Services: https://www.fairview.org/ Follow James on LinkedIn: https://www.linkedin.com/in/james-hereford/ Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 51K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

Welcome to Claims Denied, a new podcast from Hospitalogy. In this episode, Blake talks with Pete McCanna, CEO of Baylor Scott & White. Pete explains how legacy health systems are built like “castle walls” (supply-driven, organization-centric, and built to protect themselves), but this design fails customers who are outside the four walls.  Pete walks through what it takes to transform a health system from supply-driven to demand-driven, which is essential in this new age of healthcare consumerism.  Listen to hear why: 50%+ of encounters start at the wrong site of care. Better routing is the real capacity unlock, not more hiring. Find out which move Pete says is a capacity strategy hiding in plain sight. If every system innovates solely on Epic, there's no differentiation, just commoditization.  Baylor refuses to let anyone get between them and the customer (and “customer” isn’t semantics). Epic can run the clinical backbone, but Baylor’s betting the winner is whoever owns orchestration, access, and the relationship. There are 3 buckets of AI strategy: customer solutions driven by AI, workflow efficiency for large organizations, and individual assistant tools for your daily work. Baylor's focused on bucket 1 to see how it can turbocharge their service offerings. Tom™ is the agentic AI that delivers orchestrated Primary Care as a Service, expanding  care capacity and patient engagement while reducing clinicians’ busy workloads.   Tom serves as the AI member of a patient’s primary care team . Learn more at Lumeris.com/platform Baylor Scott & White Health: https://www.bswhealth.com/ Follow Pete on LinkedIn: https://www.linkedin.com/in/peter-mccanna-784619104/ Follow Blake on LinkedIn: https://www.linkedin.com/in/blakecmadden/ For expert analysis on healthcare M&A, strategy, finance, and markets, join 51K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/ Like our episodes? Be sure to leave us a review, and share our podcast with colleagues.

Welcome to Claims Denied. Join one man’s quest to learn everything there is to know about the business of healthcare. Blake Madden and friends cut through the fluff to talk shop with influential healthcare leaders across innovation, strategy, finance, policy, and more. Learn about disruptive health tech startups, hear war stories, stay up to date on emerging health system transformation strategies, and listen in to scalding hot takes on pressing topics and the future of the industry. New episodes drop Tuesdays. Subscribe to get the latest!