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Claims Denied: A Hospitalogy Podcast
Claims Denied: A Hospitalogy Podcast episodes
- Standard as Possible, Different as Necessary: Inside Jefferson Health’s Payvider Bet and LVHN Integration (with Dr. Baligh Yehia, President of Jefferson Health)
Which model won after Jefferson Health and Lehigh Valley Health Network merged? Dr. Baligh Yehia says that’s not the question Jefferson asks.
Blake sits down with Dr. Yehia, President of Jefferson Health, to talk about running a 33-hospital system that wants to be an operating company, not a collection of hospitals.
He breaks down how Jefferson is integrating LVHN, why the team lets AI-era rebuilds replace the usual model bake-off, and what it takes to align incentives when a payvider only covers part of your patients.
In this episode:
- Why “standard as possible, different as necessary” is the default Jefferson is building around, and why quality came before back office in the LVHN integration
- Why payviders are one of the few models that can truly align incentives, even with no commercial book (Medicaid, Medicare Advantage, and ACA only), and how Jefferson still removes friction, like skipping prior auth for plan members moving to the next site of care
- The goal of handing 10 million hours back to clinicians in 3 years
- “Nursing out loud”: ambient for nurses is in 3 pilots, and the early wins are nurses eating lunch and clocking out on time
- Why AI won’t fix misaligned payment models, and will just run automated denials and automated appeals at machine speed
---
Assort Health’s AI agents complete the work that turns patient demand into care, including scheduling, intake, referrals, forms, medication refills, and payments. Customers have increased appointment volume by 5%, expanded staff capacity by 115%, and captured up to $4.3 million in new annual revenue per 100 providers.
To learn more, check them out today at https://www.assorthealth.com/hospitalogy
---
For expert analysis on healthcare M&A, strategy, finance, and markets, join 80K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/
Like our podcast? Listen to previous episodes of Claims Denied 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/
51 min - Members Leave Carriers, Not Brokers (with Will Johnson, Co-founder and CEO of Gyde)
Claims Denied is back for a new season, and Blake kicks it off by driving down from Dallas to Austin, and sits in-studio with Will Johnson, co-founder and CEO of AI startup Gyde (http://gydehealth.ai/).
Will is 17 months post-incorporation with a decade at Oscar behind him, and he brought a thesis Blake hadn't heard anyone articulate this cleanly: Healthcare's real front door isn't the carrier or the PCP. It's the broker, and there are fewer of them every year while the job gets harder every year.
They get into why Will thinks commission rates stay flat while ACA premiums rip 14%, why an AI founder calls himself "a huge software bear," why roll-up is a banned word inside his own M&A shop, and the Capstone deal he thought was dead until a February coffee in Austin.
Healthcare keeps trying to go around the broker. This episode makes the case for going through them.
---
Assort Health’s AI agents complete the work that turns patient demand into care, including scheduling, intake, referrals, forms, medication refills, and payments. Customers have increased appointment volume by 5%, expanded staff capacity by 115%, and captured up to $4.3 million in new annual revenue per 100 providers.
To learn more, check them out today at https://www.assorthealth.com/hospitalogy
---
For expert analysis on healthcare M&A, strategy, finance, and markets, join 80K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: https://hospitalogy.com/
Like our podcast? Listen to previous episodes of Claims Denied 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/
1 hr 4 min - CMS Isn't Asking Anymore: Inside the Mandatory Bundle Era (with Tim Elliott, CEO of Navvis)
Second time's the charm! Blake welcomes back Navvis CEO, Tim Elliott, for a new conversation that goes deeper than round one.
Blake and Tim get into why CMS finally ditched its "voluntary" posture on value-based care, what actually happens in the first 60 days when a mandatory bundle lands on a health system, and why specialists, not just primary care, are now squarely in CMS's crosshairs.
They also cover physician enterprise 2.0, where AI is actually moving the needle on burnout (spoiler: it's not just ambient scribes), and Tim's read on what health systems get wrong heading into 2027.
Genuinely one of Blake's favorite VBC conversations this season.
And if you missed Tim's first appearance on Claims Denied from June 2026, be sure to check out that episode here.
---
Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models.
https://navvishealthcare.com/vbc
---
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? Check our previous episodes of Claims Denied here: https://hospitalogy.com/podcast/
Be sure to leave us a review, and share our podcast with colleagues.
---
Follow Tim Elliott on LinkedIn: https://www.linkedin.com/in/tim-elliott-b246aa151/
Follow Blake Madden on LinkedIn: https://www.linkedin.com/in/blakecmadden/
58 min - Mentorship, Physician Entrepreneurship, and Owning the Pipes: Dr. Ramon Lizardo's Journey Through Scaling Tele911
Blake sits down with Dr. Ramon Lizardo, ER doc turned three-time operator turned investor, and former CEO of Tele911. This one goes places Blake didn't plan for.
Ramon shares his impressive journey: Getting into medical school on a single borrowed application he found in his backpack a month later. He left a $300K+ clinical job for $40K base and a $25K bonus, with debt. Then he built a company that turned Baltimore, Fort Worth, and San Francisco into cities where calling 911 puts a physician on your screen in 37 seconds. When the Key Bridge collapsed, the city called him at 3 a.m. and asked him to go live early.Blake pushed him on the physician hierarchy, on why nobody teaches doctors how money works, and on the digital health profitability problem. He also told Blake, on the record and before anyone else, where he's going next.Ramon even suggested a working title for the episode: "Health Tech Physician-founder Can't Control His Children" (His five-year-old and eight-year-old were negotiating a treaty in the next room the whole time.)This is the best kind of episode. Genuine, honest, and one not to miss!---
Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models.
https://navvishealthcare.com/vbc
---
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? Check our previous episodes of Claims Denied here: https://hospitalogy.com/podcast/
Be sure to leave us a review, and share our podcast with colleagues.
---
Follow Ramon Lizardo on LinkedIn: https://www.linkedin.com/in/ramonlizardomd
Follow Blake Madden on LinkedIn: https://www.linkedin.com/in/blakecmadden/
58 min - Primary Care's Choke Point Was Never Knowledge (with Matic and Catalyst Health Group)
We're doing something special with this latest episode of Claims Denied. Blake packed up and drove out to Plano, TX on a 100 degree August morning to record this one live on site, and the location is half the story: Matic's team works out of a suite inside Catalyst Health Group's headquarters. That's not a real estate footnote. That's the business model.
Blake sits down with Calvin Carter, CEO and co-founder of Matic (https://maticinside.ai/), and Dr. Chris Crow, CEO and co-founder of Catalyst Health Group (https://www.catalysthealthgroup.net/).
Calvin spent 15 years at Bottle Rocket building consumer apps for Chick-fil-A, Southwest, and half the news networks in America before an algorithmic trading side project put him next to Dr. Alex Shepherd, an engineer with a PhD in adversarial training for hallucinations who decided to go to medical school because "finance is a zero-sum game."
The group gets into why Dr. Crow thinks every lab-built AI product is just the EMR story repeating, why he called direct primary care a cottage industry born of burnout rather than a model worth scaling, and what happens to a physician's panel when you stop making them the bottleneck.
Dr. Crow also went on record with "Natty or bust" for the Texas Longhorns, and Blake is ready to hold him to it!
---
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? Check our previous episodes of Claims Denied here: https://hospitalogy.com/podcast/
Be sure to leave us a review, and share our podcast with colleagues.
---
Follow Calvin Carter on LinkedIn: https://www.linkedin.com/in/calvincarter/
Follow Dr. Chris Crow on LinkedIn: https://www.linkedin.com/in/drcrow/
Follow Blake Madden on LinkedIn: https://www.linkedin.com/in/blakecmadden/
1 hr 16 min - Handl Health and the Death of Cost Shifting (with Ahmed Marmoush, Co-founder and CEO of Handl Health)
Blake sits down with Ahmed Marmoush, CEO and co-founder of Handl Health, fresh off their Series A funding, and this one covers the full arc of where employer-sponsored insurance is heading.
Ahmed's path is unlike any guest we've seen on Claims Denied: From a clinical pharmacist in New Zealand's single-payer system, to a consultant alongside the country's former Director General of Health, to an $800 bill for a routine physical in LA that turned into a company. (They offered him 50% off if he paid within a few days. He compared it to haggling in an Egyptian street market. He's not wrong.)
They get into why cost shifting is dead, how variable copay plans really work, what's inside Handl's value index, and why Ahmed is betting on being the enablement layer between brokers and carriers instead of building yet another health plan.
If you touch benefits strategy, brokerage, or health plan ops, this one's worth the commute.
---
Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models.
https://navvishealthcare.com/vbc
---
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? Check our previous episodes of Claims Denied here: https://hospitalogy.com/podcast/
Be sure to leave us a review, and share our podcast with colleagues.
---
Follow Ahmed on LinkedIn: https://www.linkedin.com/in/ahmed-marmoush-25169961/
Follow Blake Madden on LinkedIn: https://www.linkedin.com/in/blakecmadden/
55 min - The End of Managed Care? How Northwell Built a $2.5B Direct Contracting Machine (with Nick Stefanizzi, CEO Northwell Direct)
Blake sits down with Nick Stefanizzi, CEO of Northwell Direct (https://northwelldirect.northwell.edu/) — the man running the most ambitious direct-to-employer play in the country.
Since going live in 2022, his team has built a platform serving 70+ employers and unions, 300K members, and $2.5B in medical spend, with 97% retention. Then they landed 32BJ: 20% validated savings, $46M in year one, live as of April.
Blake and Nick get into all of it — why Northwell runs Direct as a standalone company (Nick literally negotiates rates against his own parent system), what they rented instead of built, how the 32BJ deal came together in 10 weeks, and what happens to managed care when health systems stop asking permission.
If you're a health system exec, benefits leader, or union fund trustee, this one's required listening.
---
Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models.
https://navvishealthcare.com/vbc
---
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? Check our previous episodes of Claims Denied here: https://hospitalogy.com/podcast/
Be sure to leave us a review, and share our podcast with colleagues.
---
Follow Nick on LinkedIn: https://www.linkedin.com/in/nickstefanizzi/
Follow Blake Madden on LinkedIn: https://www.linkedin.com/in/blakecmadden/
57 min - Insurance Is the Inflation: Your Health Plan Costs the Same as a Tesla Model Y, and What Collective Health is Doing to Fix it
This episode hits the affordability crisis head-on, as Blake sits down with Ali Diab, CEO and co-founder of Collective Health (https://collectivehealth.com/).
Ali started the company after his own hospital claim got denied, and has spent the decade since building what he calls the “Stripe” of healthcare benefits — for employers today, and potentially insurers and health systems tomorrow.
In this episode, Ali makes the case that health insurance itself is the real inflationary catalyst in American healthcare.
Ali doesn't do the polite version. He calls the MLR a cost-plus contract, compares network "discounts" to markdowns off the Neiman Marcus price, and told me about the time he was charged $340 in coinsurance for a $125 knee brace on his own company's plan.
We dig into why self-insurance and direct contracting are eating the fully-insured market alive, why small employers are legally boxed out of self-funding, and why he thinks healthcare pricing needs an SEC.
Also: World Cup takes. Ali's a winger-turned-number-nine and I broke two leg bones playing this sport, so we earned the tangent.
Follow Ali Diab on LinkedIn: https://www.linkedin.com/in/alidiab/
Follows Collective Health on LinkedIn: https://www.linkedin.com/company/collectivehealth/home/
---
Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models.
https://navvishealthcare.com/vbc
---
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? Check our previous episodes of Claims Denied 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/
59 min - 25K Patients Deep and Zero Physician Equity: Inside MGB and Regent's Site-of-Service Bet, and their New ASC Ownership Playbook
For this week's episode, Hospitalogy's Blake Madden puts two people on opposite ends of the same handshake into one virtual room: Travis Messina, CEO of Regent Surgical, and Niyum Gandhi, CFO of Mass General Brigham (MGB), who runs one of the most-watched integrated systems in the country.
Nominally, this episode is about ASCs. Really, it's about what a system does when it could build anything itself — and chooses to partner instead.
Blake walked in carrying a grudge from his valuation days, when every ASC cap table he cracked open had physician ownership baked in like it was law. Niyum spent 20 minutes calmly arguing the opposite.
They also get into MGB's $3B insurance arm (don't call it a provider-sponsored plan to his face), a 25,000-patient endoscopy wait list, robots doing oncology, and the best AI adoption framework Blake's heard a CFO articulate.
Travis also reminded Blake that his Geogia Bulldogs bounced Blake's Texas Longhorns during the College World Series — which Blake is choosing to forgive.
Follow Travis Messina on LinkedIn: https://www.linkedin.com/in/travis-messina-4460565/
Follow Niyum Gandhi on LinkedIn: https://www.linkedin.com/in/niyum-gandhi/
Follow Mass General Brigham on LinkedIn: https://www.linkedin.com/company/mass-general-brigham/
Follow Regent Surgical on LinkedIn: https://www.linkedin.com/company/regent-surgical/
Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models.
https://navvishealthcare.com/vbc
---
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/
1 hr 13 min - Addiction Treatment and Why Your Claims Data Is Lying About Gambling Disorder
Featuring: Elliott Rapaport (Founder of Birches Health) and Dr. Doug Nemecek (Senior advisor with Birches Health and former Cigna/Evernorth CMO)
---
This episode with two experts in the mental health space (Elliott Rapaport, Founder of Birches Health, and Dr. Doug Nemecek, a senior advisor with Birches Health and former Cigna/Evernorth CMO for behavioral health) was one of the more eye-opening conversations Hospitalogy’s Blake Madden has had on payor behavioral spend.
Think about this: 39 states + DC have legalized online gambling, FanDuel and DraftKings are sponsoring everything that moves, and yet payors will tell you they don't "see" the gambling disorder volume in their claims data. That's because it's getting coded as depression or anxiety. F63.0 never makes it to the bill.
Blake, Doug, and Elliott get into the real prevalence numbers (a recent Pennsylvania study puts roughly a third of the state somewhere on the gambling-risk spectrum), why specialty networks for behavioral process addictions are about to follow the same pattern Equip ran in eating disorders, and what AI actually does in this model (spoiler: it's not replacing the therapist).
Blake also pushed Elliott on the "anti-capitalism" of building a clinical model that explicitly wants patients to use you less over time. Elliott’s answer was sharp.
Follow Birches Health on LinkedIn: https://www.linkedin.com/company/bircheshealth/
Follow Doug on LinkedIn: https://www.linkedin.com/in/douglasnemecek/
Follow Elliott on LinkedIn: https://www.linkedin.com/in/er1/
---
Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models.
https://navvishealthcare.com/vbc
---
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/
1 hr 2 min
About Claims Denied: A Hospitalogy Podcast
From the publisher's feed
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 Mondays. Subscribe to get the latest!