This episode announces the launch of CMS's ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model - a groundbreaking payment innovation that enables technology-enabled care organizations to treat Medicare fee-for-service patients with chronic conditions through outcome-aligned payments rather than traditional fee-for-service. Abe Sutton (Director of CMMI) and Jacob Shiff (Chief AI & Technology Officer at CMMI) explain how the model addresses a fundamental gap in healthcare: while commercial and Medicare Advantage patients have access to digital therapeutics and technology-enabled chronic disease management, original Medicare beneficiaries have been left behind. ACCESS changes this by paying providers monthly fees for managing conditions like diabetes, hypertension, obesity, behavioral health issues, and musculoskeletal pain - but only when patients achieve measurable clinical improvements. The model is designed to be deflationary rather than inflationary, encourages innovation by simplifying go-to-market for digital health startups, integrates with existing risk-bearing models like ACOs, and represents a broader CMMI strategy to shift from activity-based to outcome-based payments while leveraging new AI capabilities to democratize high-quality care.

The episode explores how Warner Thomas is transforming Sutter Health into a digitally-enabled, ambulatory-focused health system that can navigate major industry headwinds through growth rather than contraction. Thomas discusses Sutter's aggressive expansion of its physician network and ambulatory footprint, the system's push to dramatically improve consumer experience through technologies like online booking and ambient AI documentation, and their strategic pivot toward value-based care models as Medicare payment pressures intensify. Throughout the conversation, he emphasizes that successful health systems must embrace AI and digital tools not as futuristic concepts but as immediate operational necessities, while maintaining focus on integrated care delivery that keeps patients at the center—a philosophy shaped by his experience building integrated systems at Ochsner and now applied to reimagining Sutter's historically hospital-centric culture into one that blends physical and digital care delivery across the full continuum.

This episode features Viren Shetty, Vice Chairman of Narayana Health, discussing how his father founded a cardiac surgery hospital in India 25 years ago that revolutionized healthcare delivery by applying manufacturing efficiency principles to drastically reduce costs while maintaining quality. The conversation explores how Narayana Health scaled from one cardiac center to 19 multi-specialty hospitals across India and one in the Cayman Islands by implementing supply chain optimization, standardization of care, physician specialization, and high-volume operations—enabling them to perform cardiac surgeries at a fraction of Western costs. Shetty discusses the challenges and opportunities of operating in India's largely out-of-pocket healthcare market, the hospital's expansion into insurance and primary care to become a fully integrated provider, their measured approach to AI adoption, and why their high-volume, efficiency-driven model wouldn't directly translate to the US healthcare system despite offering valuable lessons in operational excellence and cost reduction.

This episode captures Walid Mehanna's perspective on how Merck KGaA has approached enterprise AI adoption through a federated strategy that prioritizes people over technology. The core message is that successful AI implementation requires building organizational capability across three dimensions - people, processes, and technology - rather than seeking a single transformative solution. Walid argues that companies must establish a broad foundation of AI literacy (exemplified by their internal MyGPT tool reaching 25,000 users) before pursuing specialized applications, while maintaining human accountability to prevent complacency. He emphasizes that AI works best when it's treated as an experimental, iterative capability distributed across the organization rather than controlled centrally, with success depending on persistence through the inevitable J-curve of initial productivity drops. The conversation reveals how a large multinational navigates the practical realities of AI deployment - from managing regulatory complexity across different geographies to making pragmatic build-versus-buy decisions - while maintaining focus on the fundamental principle that AI should augment human expertise rather than replace human judgment and responsibility.

In this episode, Jacob sits down with Joshua Meier, co-founder of Chai Discovery and former Chief AI Officer at Absci, to explore the breakthrough moment happening in AI drug discovery. They discuss how the field has evolved through three distinct waves, with the current generation of companies finally achieving success rates that seemed impossible just years ago.

Elliot Cohen—PillPack co-founder and now co-founder of General Medicine—joins Jacob Effron and Nikhil (Out-of-Pocket) to unpack what “best care” really means in 2025. He explains why General Medicine is building a broad front door to care. Elliot also revisits the PillPack vs. PBMs saga, what Amazon Pharmacy got right (and what was unexpectedly hard), and how AI is already raising the bar in intake, clinical prep, and follow-up.

Flashback episode in honor of Hinge Health's IPO this week. In the episode, Jacob and Nikhil sit down with Daniel Perez, the Co-Founder and CEO of Hinge Health, a digital clinic for patients with joint and muscle pain. They discuss Hinge Health’s strategy for selling to employers, how digital health solutions can reach and retain users, the role of software x hardware in disrupting healthcare, and more.

Jacob and Nikhil sit down with Otto Sipe. Otto is the CEO and Co-Founder of Photon Health, which enables patients to select their own pharmacies with price and inventory transparency. The company has raised over $16 million from investors including Flare Capital Partners and Notation Capital. They discuss where pharmacies and PBMs are headed, the evolution of E-Prescribing, the impact of GLP-1s & AI, and more.

Jacob and Nikhil sit down with Dr. Rushika Fernandopulle. Rushika is the former CEO and Co-Founder of Iora Health, a primary care provider centered around value-based care and Medicare that was acquired by One Medical for $2.1 billion. They discuss why we’re still in the second inning of value-based care, intersections of tech and healthcare, what it takes for VBC to succeed, and more.

Jacob and Nikhil sit down with Frank Wu, the Co-Founder and CEO of Taro Health. Taro Health is a health insurance plan currently live in Maine and Oklahoma that offers unlimited primary care and mental health visits. The company has raised over $18m from investors like Hummingbird Ventures, Quiet Capital, and FPV Ventures. They discuss creating value in InsurTech, building a health plan for Direct Primary Care providers, what’s next for health insurance, and more.

Jacob sits down with Erik Wexler, the President and CEO of Providence. Providence is a non-profit, faith-based health system with 51 hospitals and 1,000 clinics across seven states. They discuss how to think about new AI opportunities with discipline, the value of health system partnerships, programs to support health equity, and more.

Jacob and Nikhil sit down with Daniel Perez, the Co-Founder and CEO of Hinge Health. Hinge Health is a digital clinic for patients with joint and muscle pain, having raised $800M+ from investors like Coatue and Tiger Global. They discuss Hinge Health’s strategy for selling to employers, how digital health solutions can reach and retain users, the role of software x hardware in disrupting healthcare, and more.

Jacob sits down with Hemant Taneja, the CEO & Managing Director of General Catalyst. GC is one of the world’s largest venture capital firms, most recently raising an $8B fund in 2024. The firm has invested in companies like Livongo, Cityblock Health, and Hippocratic AI. They discuss the possibility of a $100B healthcare company, how buying a health system can accelerate partnerships, what will succeed in AI, and more.

Jacob sits down with Stef van Grieken, Co-Founder & CEO of Cradle. Cradle has raised over $100M from investors like IVP and Index Ventures to build and expand their AI-enabled protein engineering platform. They discuss how Cradle plans to use their new Series B funding, what’s been happening in AI bio, the technical underpinnings of Cradle’s platform, and more.

Jacob sits down with Dr. Angela Fitch, the Founder and CMO of knownwell. knownwell has raised $25 million from investors like a16z and Flare Capital Partners to provide weight-inclusive primary care and metabolic health care. They discuss the future of obesity care, where we are with GLP-1s, the need to expand coverage, and more.

Jacob and Nikhil sit down with Parth Mehrotra, CEO of Privia Health. Privia is a physician enablement platform partnering with 4500+ providers towards practice improvement and value-based care. They discuss the most important ways to manage risk, building effective physician enablement solutions, the future of value-based care programs & contracts, and more.

Jacob and Nikhil sit down with Bryony Winn, President at Carelon Health. Carelon is the diversified services business within Elevance Health (formerly Anthem), serving 1 in 3 Americans through advanced primary care, behavioral health, specialty enablement, and whole health solutions. They discuss what payers are thinking about, making value-based care work, creating effective provider partnerships, and more.

Jacob sits down with Kristina Saffran, the Co-Founder and CEO of Equip. Equip delivers at-home, virtual eating disorder treatment for both adolescents and adults. They discuss Kristina’s journey to founding Equip, getting payors on board, evidence-based treatments for eating disorders, and more.

Jacob and Nikhil sit down with Savvy CEO Suril Kantaria to discuss the future of the ICHRA market and what he would do differently if he was starting Savvy today.

Jacob sits down with Amir Dan Rubin, the CEO and Founding Managing Partner at Healthier Capital. Amir previously served as the CEO of One Medical and Stanford Health Care, as well as an EVP at United/Optum. They discuss payer-provider integrations, lessons learned from leading One Medical, applications of generative AI, and more.