Venture Doctors

Shiv Rao is a practicing cardiologist and the founder and CEO of Abridge, used across roughly three hundred health systems in the United States. He argues the ambient note was never the point. It was a wedge, chosen because he believes a conversation between a clinician and a patient is the most human signal in healthcare and it sits upstream of every record the system runs on. What he wants to build on top of it is an AI native health system.Brenton and Galym ask what the assistant actually does now that notes are only one of its skills, why he thinks automating tasks matters more than automating roles, and how a company stays coherent when the model layer underneath it keeps changing. Shiv also explains why clinicians have become the bottleneck on shipping, and how he recruited a cardiologist who is also a twenty year software engineer after seeing him on X.He walks through an assistant that reads a complicated chart days before a visit, files a prior authorization on its own while the doctor keeps moving, and flags a patient who may qualify for a trial. He talks about what changed in his thinking between med school, residency at Michigan, and running a provider facing portfolio inside a health system. And he explains why his 83 year old father left practice roughly two decades earlier than he might have, and why that story still sets the bar for how easy any of this has to feel.Chapters00:00 The Clinic Prep Vision: Abridge Working Behind the Scenes01:43 From History Major and Skateboarder to Physician07:12 Cardiology and the First Healthcare Software Project11:57 What Abridge Is Today: Building an AI-Native Health System15:21 Clinical Jobs the Assistant Can Do: The PET Scan Example20:09 Pre-Charting Reimagined: Gaps, Prior Auths, and Clinical Trials24:15 Computer Use Demo: From Generative AI to Actions28:17 The North Star: A Cardiologist Who Retired Too Early30:02 Clinician Scientists: Building for Doctors, by Doctors33:03 Open Weights and Staying Adaptable39:56 Scaling AI Across the VA43:27 Life Sciences and Public Health: Spotting an Outbreak Early46:06 Rearchitecting the Provider and Payer Relationship52:44 Rapid Fire: Overrated, Underrated, and Investor Advice

Farzad Mostashari spent roughly a decade in public service before he ever ran a business: first at the NYC Department of Health then as the National Coordinator for Health IT, where he helped move the nation’s doctors onto electronic records. The number he cared about most, blood pressure control, did not budge. It was then that Farzad began to build Aledade, which partners with thousands of independent primary care practices and ties their success to whether patients stay healthy.

Galym, Brenton, and Farzad get into why American healthcare can pay well for treating a stroke but has no billing code for preventing one, whether AI is about to repeat the pattern that digitization set, and what a company owns once the underlying technology stops being hard to build.

Farzad explains why he thinks founders in their forties are underestimated, why Aledade trained its own model on screenshots of other companies’ software, and why he believes the real differentiator in healthcare AI is trust rather than capability.

Chapters:

0:00 Why There's No Billing Code for Preventing a Stroke

7:52 Public Health Surveillance to the National EHR Rollout

15:01 Will AI Just Serve Fee for Service?

19:25 Inside Aledade and Its Three Flywheels

23:00 When AI Becomes a Commodity, Trust Is an Edge

30:59 Rapid Fire on Bow Ties and Overrated AI

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Medicare pays for activities, not outcomes. Jacob Shiff wants to change that. As chief AI and technology officer at the CMS Innovation Center, the R&D arm of Medicare and Medicaid, he helps direct an agency that he says spends roughly $2 trillion a year without the health outcomes to show for it. His answer is ACCESS, short for Advancing Chronic Care with Effective, Scalable Solutions, a new payment model that pays clinical organizations based on whether patients actually get better, measured by things like blood pressure, A1c, and depression symptoms.

Brenton and Jacob first met a decade ago at Flatiron Health, before Jacob founded a healthcare AI company and then went to work in government. Brenton and Galym ask what changes for a patient on Medicare, why fee for service often breaks down when software is the treatment, and whether an AI agent titrating blood pressure medication can be trusted.

Chapters:

0:00 Welcome to Venture Doctors

0:47 Introducing Jacob Shiff

1:25 Jacob Shiff's Path from Founder to the Government

3:29 The Listening Tour

7:51 The Access Model and How It Works For Patients

15:40 Expanding Beyond Medicare

19:17 AI Regulation and The Tempo Pilot

23:18 Government Service and Startup Speed At Scale

26:14 Advice for Founders Working with the Government

27:24 Underhyped Opportunities In AI And Healthcare

28:45 A Belief Most People Disagree With

29:57 What Jacob Is Digging Into Next

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Web: www.lsvp.com

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The content here does not constitute tax, legal, business or investment advice or an offer to provide such advice, should not be construed as advocating the purchase or sale of any security or investment or a recommendation of any company, and is not an offer, or solicitation of an offer, for the purchase or sale of any security or investment product. The views expressed by our guests do not necessarily represent the views of Lightspeed. For more details please see lsvp.com/legal.