The Clinical Realist

Virtual nursing gets sold to hospital boards as a staffing patch. Put a camera in the room, put an experienced nurse behind it, and the math on the slide works. Almost nobody in that boardroom asks the question that decides whether it works on the actual unit: what does this do to a shift in week three?

Julie Tuel is System Vice President of Nursing Care Transformation and Clinical Digital Care at CommonSpirit Health, a system with more than 2,200 care sites across 24 states. As of CommonSpirit's March 2026 reporting the virtually integrated care model covered 1,075 beds, on the way to roughly 3,000. She is a critical care and stroke nurse by training, and she has spent this stretch of her career on the unglamorous part of the work: taking virtually integrated care from a concept that presents well to a care model that survives contact with a real med-surg floor and real nurses who did not ask for it.

Dr. Sarah Matt asks for the first 90 days, not the strategic vision. Tuel's answer is that there is no system-level first 90 days at all. Every hospital and every unit is run as its own project, because the thing that breaks first when you scale a care model is not the technology and not the workflow. It is the culture, and a standard pushed out uniformly will hold for a quarter and then stop holding.

On outcomes, Tuel gives numbers and then does something unusual with them. CommonSpirit has measured a 43 percent reduction in first-year RN voluntary turnover, and she immediately says it is not all attributable to virtually integrated care: it also reflects the nurse residency program and local and national nursing leadership. The program has also measured a 37 percent reduction in CAUTIs and CLABSIs and a 20 percent increase in nursing communication scores on HCAHPS.

Other things covered: why CommonSpirit's model is deliberately not an admissions, discharges, and transfers model, and what changes when the virtual nurse is part of the care team instead

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Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

The encounter ends, the patient goes home, and then a bill arrives. Amy Stillman argues that a medical bill is not a payment reminder. Patients frequently do not understand what happened to them, what they owe, or what they are supposed to do next, and the bill lands after the frightening part is already over.

Stillman is Chief Product Officer at Cedar, where she has run product, design, research, and data science since 2019. She is an industrial designer by training, not an engineer and not a revenue cycle specialist, which turns out to matter.

She and Dr. Sarah Matt cover where Cedar sits among payers, EHRs, and clearinghouses, and why a patient should not be reduced to a single true or false signal from one system. Much of the conversation is about Cora, Cedar's AI agent, which Stillman says resolves about 40 percent of its calls, and which is designed against three measures at once: cost to serve, resolution rate, and patient satisfaction. She makes the case for tracking resolution rather than collection, since the right outcome may be a corrected insurance record, a Medicaid redetermination, financial aid, or a discount paired with a payment plan. She also names the group Cedar finds hardest to help: patients just above the financial aid cutoff, called ALICE by United Way, asset limited, income constrained, but employed.

Find Amy: cedar.com | linkedin.com/in/amystillman

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Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

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Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

Start with a number. In a registry of about 6,000 patients on GLP-1 medications, roughly 45 percent have taken two or more versions of the drug, most often moving from semaglutide to tirzepatide. The largest published study, about 127,000 adults, puts 12-month switching closer to 20 percent. Nobody can fully verify either figure, because no single system holds the whole record.

Shashi Shankar spent nearly a decade at Genentech working on real world data before co-founding Novellia, where he is chief executive. The product pulls a patient's records out of every patient portal they have ever logged into, across roughly 25 years of care. Biopharmaceutical researchers pay for de-identified access. Patients never pay at all.

He and Dr. Sarah Matt walk through where records actually fragment: community clinic to lab to academic specialist, and inside a single health system when the hub and the community site sit two hours apart. Shankar describes the load carried by family caregivers, and explains why he considers tokenized data brokerage a poor substitute, with each join between data sets hitting at 15 to 20 percent and leaving a snapshot frozen in time. Matt presses on the part still unsolved: the record reaches the patient, and it still does not reach the prescriber.

Find Shashi: novellia.com | search his name with Novellia on LinkedIn

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Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

💼 Work with Dr. Matt:
Looking for a keynote speaker or strategic advisor?
Visit: drsarahmatt.com

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Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

Anthony Guerra has asked roughly the same question about 600 times. He founded Health System CIO in 2010 and has covered health information technology since 2005, which is 16 years sitting across from the people who sign off on what technology actually enters a hospital: CIOs, CMIOs, and Chief Information Security Officers, across three or four full technology cycles.

Most people in health tech can tell you what a CIO says about AI right now. Almost nobody can tell you how the answer moved. Dr. Sarah Matt asks Guerra exactly that: not the vocabulary, which turns over every 18 months, but the posture. Where the hedging went, what they stopped apologizing for, and what they are still unwilling to say into a microphone.

What comes out: why governance is the fix that solves the downstream problems, and why nobody yet owns responsibility for agentic activity. Why shadow IT is an indicator rather than a failure. Why a successful pilot is proof the pilot worked and nothing more. Why nobody gets fired for staying in suite. The number one CIO skill, which has very little to do with technology. And healthcare's structural inability to say no, shut it off, or cancel the contract, which Guerra argues is about to become a very large problem when the thing you need to shut off is an agent.

Find Anthony: healthsystemcio.com | linkedin.com/in/anthonyguerra

—

Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

💼 Work with Dr. Matt:
Looking for a keynote speaker or strategic advisor?
Visit: drsarahmatt.com

🔗 Connect on Social:
LinkedIn: https://www.linkedin.com/in/sarahmattmd/
YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

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Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

You cannot will your way to better healthcare outcomes. Agency, it turns out, is not a mindset problem: it is a neurological one, a design one, and a systems one.

Kris Nessa has spent her career on both sides of the vendor-to-health-system interface, including Cleveland Clinic, Cerner, Dell, and SHI International. She knows exactly which technology promises do not survive contact with a real ICU at 3 AM.

Erica Olenski is the Founder and Principal Strategist at Monarch Futures. She also co-founded August's Artists. She has navigated the healthcare system as a caregiver in ways that most technology architects never will, and she has drawn a direct line from those experiences to the design of systems that actually return agency to the people inside them.

This episode is about what happens when you put a technology executive and a systems strategist in the same room and ask them: who is the healthcare system actually designed for?

Monarch Futures: monarchfutures.com

August's Artists: augustsartists.org

—

Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

💼 Work with Dr. Matt:
Looking for a keynote speaker or strategic advisor?
Visit: drsarahmatt.com

🔗 Connect on Social:
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YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

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Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

Somewhere in your organization there is an AI tool in year two of its contract, performing worse than the day you signed. The model did not change. Your patients did.

Arvita Tripati calls what accumulates in that gap trust debt, and she has watched it accrue from three different chairs. She spent nearly two decades bringing regulated products to market across digital health, medtech, diagnostics, clinical research, and AI. She ran product and quality, so she was accountable for what happened after a health system said yes. She ran security as a CISO, so she was the person who killed deals that had already been promised to a board. Her deployment work includes rolling KardiaMobile out across all fifteen NHS Academic Health Science Networks, plus vendor implementations at Memorial Sloan Kettering, Cleveland Clinic, and Mayo.

In this episode of The Clinical Realist, Dr. Sarah Matt and Arvita Tripati work through three things buyers do to themselves. Nobody owns drift for their own population, because clinical ops assumes the vendor is monitoring and the vendor is monitoring, just not against that health system's patients. The pilot runs on enthusiasts who absorb an implementation burden ordinary staff will not, so it proves something the contract cannot rely on. And security arrives late, after the organization is already committed, which turns review into a waiver conversation instead of a go or no-go.

What you will take away:

- What trust debt is, in one sentence you can say to a board

- What a deployment that dies at renewal looks like at month three versus month fourteen, and the tell a COO could have caught at month six

- Why enthusiast-staffed pilots systematically mislead the contract that follows them

- What changes when security reviews before the commitment instead of after

- The question to ask about population drift before you sign, not at renewal

Vahana Labs: https://vahanalabs.ai

Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd

Subscribe to The Sarah Matt Briefing: https://drsarahmatt.com/newsletter-signup

—

Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

💼 Work with Dr. Matt:
Looking for a keynote speaker or strategic advisor?
Visit: drsarahmatt.com

🔗 Connect on Social:
LinkedIn: https://www.linkedin.com/in/sarahmattmd/
YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
 
—
Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

Ask a health system CEO about their women's health strategy and you will hear two things. Labor and delivery. Mammography. Then they wipe their hands, and the checkbox is checked.

Priya Bathija spent nine years at the American Hospital Association building maternal and child health policy at national scale. In 2022 she left to found Nyoo Health, where she now advises hospitals and health systems on women's health strategy: what to build, what it returns, and which of the 400 point solutions sitting in the inbox are actually worth a pilot.

Her argument in this episode is not a moral one. It is a P&L one.

Procedures performed on female anatomy are reimbursed up to 30 to 40 percent less than comparable procedures on male anatomy, and that gap quietly drives service line decisions whether anyone says it out loud or not. McKinsey has put a number on what health systems leave on the table by not screening women adequately, and the number is billions. Women are 51 percent of the population, use roughly 10 percent more healthcare than men, and make the care decisions for their children, their spouses, and their parents. They are the most important customer in healthcare. Most systems are not treating them like a customer at all.

Then there is the part that lands hardest for anyone who owns a dashboard. Priya asks audiences how many of them stratify outcomes data by sex. Most do not. The ones who raise a hand are doing it for maternity care, which does not apply to men. One healthcare leader told her they could not stratify by sex because they do not collect that data. What Priya said back is the clip to send to your analytics lead.

Dr. Sarah Matt brings the bedside read: what happens when a research patient asks you to interpret her own scan, why digital literacy is not evenly distributed across a panel, and why treating all women as one population is the same error the field just spent a decade unlearning about everyone else.

What you will take away:

- Why a women's health strategy that stops at L&D and mammography is a revenue decision, not a care decision

- The reimbursement gap between female and male anatomy procedures, and how it shapes what gets built

- The business case for midlife and menopause programs, and the referral economics that follow

- What happens to your record when a patient gets hormones or a GLP-1 from a virtual provider you are not connected to

- Why almost nobody stratifies outcomes by sex, and the cop-out leaders use to avoid it

- Where consumer-facing AI actually helps patients (appointment prep, reading their own results, disputing a bill) and who should pay for it

- How to pick the one women's health investment your community needs instead of the one with the best shine

Find Priya: LinkedIn https://www.linkedin.com/in/pbathija | Nyoo Health https://www.nyoohealth.com | The Women's Health Playbook, wherever you listen

Mentioned in this episode: Meghan Rabbitt, "The New Rules of Women's Health"

—

Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

💼 Work with Dr. Matt:
Looking for a keynote speaker or strategic advisor?
Visit: drsarahmatt.com

🔗 Connect on Social:
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YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

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Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

Most clinical trial eligibility criteria are written by people who have never run a site.

Lisa Sonneborn has run one for 15 years. She built the first stand-alone clinical trial facility in Upstate New York, focused on Alzheimer's and NASH research. Watched sponsor after sponsor send protocols with visit schedules, lab windows, and exclusion lists that were scientifically defensible and operationally unworkable. She would look at the eligibility section and know within the first three line items whether the trial was designed for the patients or for the data.

In 2024, she co-founded Ichor Research in Syracuse: diagnostic trials for cancer, neurodegeneration, metabolic conditions, substance abuse. The markets large CROs do not prioritize. The patients clinical research has historically passed over.

In this episode of The Clinical Realist, Dr. Sarah Matt and Lisa Sonneborn cover the specific protocol features that flag a trial was designed without a real site in mind, what the visit-burden dropout math actually looks like at a small independent site, how AI lands in practice at a three-person team in Upstate New York, the case for running diagnostic research in Syracuse, and what a different five-year future for clinical trial access looks like if small independent sites actually win.

What you will take away:

- The eligibility list red flag that signals a protocol was not designed for real patients

- What dropout math looks like at a small site versus what the protocol assumed

- How AI is actually used at Ichor Research versus the pitch version

- Why small independent sites reach patients that large CROs skip

- What Lisa built differently the second time, knowing what she learned from selling the first business

Find Lisa: LinkedIn https://www.linkedin.com/in/lisa-sonneborn-ma-lmhc-17047a63/ | Ichor Research https://ichorlifesciences.com

Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd

Subscribe to The Sarah Matt Briefing: https://drsarahmatt.com/newsletter-signup

—

Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

💼 Work with Dr. Matt:
Looking for a keynote speaker or strategic advisor?
Visit: drsarahmatt.com

🔗 Connect on Social:
LinkedIn: https://www.linkedin.com/in/sarahmattmd/
YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
 
—
Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

People whose care is scattered across multiple providers, with no single person or system holding the whole picture, have more than double the risk of dying, even after accounting for how sick they already are. Amy Andrade has spent her career on that gap.

In this episode of The Clinical Realist, Dr. Sarah Matt talks with Amy Andrade, Co-Founder and Chief Product Officer of Alphiniti and a biomedical data science researcher at Meharry Medical College. Alphiniti is building person-centric data continuity, infrastructure that keeps one person's record connected across health, financial, and legacy systems instead of scattered across every institution they have ever touched. Amy is also an active advisory client, so this conversation flips the mic on a build Sarah has watched from the inside.

The conversation covers what continuity looks like as a shipped product rather than a slide in a deck, the split between institutional (B2B) and consumer-facing (B2B2C) buyers, why AI tools built to fix fragmentation can fail silently for the people already falling through the cracks, the middleware critique and where it does and does not hold up, and how a company Alphiniti's size competes for this category before Big Tech, already signaling interest in the same space, claims it.

What you will take away:

- Why fragmented data carries a measurable mortality cost, not just an inconvenience

- What continuity actually means as a product, not a pitch-deck slide

- How B2B and B2B2C buyers value the same infrastructure differently

- Where the data-continuity-as-middleman critique is fair, and where it isn't

- What has to be true for a company like Alphiniti to win this category

Find Amy and Alphiniti: alphiniti.com

Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd

Subscribe to The Sarah Matt Briefing: https://drsarahmatt.com/newsletter-signup

—

Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

💼 Work with Dr. Matt:
Looking for a keynote speaker or strategic advisor?
Visit: drsarahmatt.com

🔗 Connect on Social:
LinkedIn: https://www.linkedin.com/in/sarahmattmd/
YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
 
—
Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.

Most healthtech founders solve a real clinical problem, get piloted in a few systems, and then discover that solving the clinical problem was never the same thing as building a company someone would actually buy. Dr. Roxie Mooney, DBA, has spent her career on that exact gap.

In this episode of The Clinical Realist, Dr. Sarah Matt talks with Dr. Roxie Mooney, founder and CEO of Legacy DNA, where she works with midmarket healthtech and pharmacy companies, often private-equity backed, who are twelve to thirty-six months out from an acquisition or a capital event. She holds a Doctorate in Business Administration focused on commercializing healthcare technology. She helped scale BioPlus Specialty Pharmacy from roughly 750 million dollars to 2 billion in revenue, which led to back-to-back acquisitions by Nautic Partners and then Elevance Health, and she has been part of four successful exits.

The conversation covers what an acquirer is actually buying, why most healthtech companies are commercially unready long before they think they are, pilotitis from the commercialization side, the first metric a strategic acquirer opens the diligence folder to find, where pharma and healthtech commercial logic split, and what the current deal climate means for a company eighteen months from an exit.

What you will take away:

- What a strategic acquirer is actually buying, beyond the clinical science

- The signs a founder does not yet understand what makes a company acquirable

- Why pilotitis is the enemy of exit readiness

- The first metric in the diligence folder

- A clear read on the current M and A climate for healthtech

Find Roxie: LinkedIn https://www.linkedin.com/in/roxiemooney/ | Substack https://healthinnovatorsedge.substack.com | Book: How Health Innovators Maximize Market Success | Company: Legacy DNA (https://legacy-dna.com)

Book a Discovery and Clarity Session: https://calendly.com/sarahmattmd

Subscribe to The Sarah Matt Briefing: https://drsarahmatt.com/newsletter-signup

—

Resources & Links:

📖 Get the Book: "The Borderless Healthcare Revolution" is available now on Amazon and major retailers.

💼 Work with Dr. Matt:
Looking for a keynote speaker or strategic advisor?
Visit: drsarahmatt.com

🔗 Connect on Social:
LinkedIn: https://www.linkedin.com/in/sarahmattmd/
YouTube: https://www.youtube.com/@DrSarahMatt-ClinicalRealist

📧 Subscribe to The Briefing: drsarahmatt.com/newsletter-signup
 
—
Disclaimer:
The views expressed on this podcast are those of Dr. Sarah Matt and her guests. They do not necessarily reflect the official policy or position of any affiliated institutions. This content is for informational and educational purposes only and does not constitute medical advice or a professional consulting relationship.