Breaking Health

In this episode of Breaking Health, guest host Payal Agrawal Divakaran, partner at .406 Ventures, speaks with Jeremy Friese, CEO of Humata Health, about prior authorization and how Humata is helping from “both sides of the fax machine.” Friese also discusses his thoughts on the future of AI adoption, how the regulatory landscape looks, and more. He also shares what the transition between physician to entrepreneur was like, what it's like to found and grow companies, and how to select the right VC partners. Links from this episode:  HealthEdge  .406 Ventures Humata Health  

In this year's first episode of Breaking Health and to celebrate Heart Health Month, guest host Payal Agrawal Divakaran, partner at .406 Ventures, speaks with Jeffrey Wessler, MD, MPhil, CEO of Heartbeat Health, about virtual cardiovascular healthcare, how Heartbeat makes it possible for physicians and patients to give and receive treatment through telemedicine, and the advances in technology the company is making. Dr. Wessler also shares his thoughts on selecting VC partners, the dynamic for physician entrepreneurs as it relates to fundraising, and the significance of Heart Health Month.  

In this episode of Breaking Health, guest host Payal Agrawal Divakaran, partner at .406 Ventures, and Kate Condliffe, CEO and co-founder of Diana Health, discuss providing accessible maternity care and the future of women's health. Condliffe shares how her company empowers and supports women to live their best lives, how Diana Health works with hospitals, and how to choose the right fundraising partners. Divakaran and Condliffe also delve into how the new presidential administration will make an impact on women's health into 2025, including the women's research movement, abortion, and potential major changes around Medicaid. Links from this episode:  HealthEdge.406 VenturesDiana Health 

In this special video episode of Breaking Health / In this episode of Breaking Health, guest host Payal Agrawal Divakaran, partner at .406 Ventures, speaks with Kristina Saffran, cofounder and CEO of Equip about providing accessible eating disorder treatment for patients everywhere. Saffran shares the origins of Equip, busts some myths surrounding eating disorders, and explains how her company pays for health plans. She also discusses the importance of working with the right cofounders, picking the right VC partners, navigating rough patches, fundraising, and more. Divakaran and Saffran also share their thoughts on contemporary topics and trends in the industry in a lightning round. Links from this episode:  HealthEdge .406 VenturesEquip 

In this episode of Breaking Health, host Steve Krupa speaks with Jon Maschmeyer, partner at Permira. Maschmeyer discusses what it's like working with executives and what they learn from him about investments, what sector has the most activity today in terms of deal flow, what attributes he finds exciting when considering a deal, and the key to working with private equity as a management team. He also shares his thoughts on how lower rates for high-volume drugs affect other countries, specialty pharma, and how healthcare has evolved in the past 20 years. 

At the Digital Healthcare Innovation Summit WEST 2024, leaders of the AI technology industry discussed the tangible progress that's been made, identified which tools are useful (and not so useful), and charted the realities—and sensationalism—around how generative AI will reshape the future of health systems, care delivery, and personalized treatments. They also shared their thoughts on new challenges that have arisen, such as what characteristics are associated with organizations that can make it in this new age, regulatory framework, liability cases that have occurred since AI's deployment, and more.   Links from this episode:  DHIS West 2024 PANEL DISCUSSION: Generative AI in Healthcare: Hype or Hope 

When is the best time to make an investment? In the healthcare industry, this can be tricky to determine. In this episode of Breaking Health, host Steve Krupa speaks with Andrew Adams, Co-Founder and Managing Partner at Oak HC/FT, about organizing capital into the right companies, where the healthcare industry is going in terms of deployment of technology, and the state of the market today. With a broad and impressive portfolio, Adams provides valuable insight and techniques on finding the right opportunities to invest, as well as value-based hotspots and new ventures that Oak HC/FT is conducting.   Links from this episode:  HealthEdge  Oak HC/FT 

When patients receive prescriptions, many find themselves at a loss over the lack of information on the medications' clinical uses, costs, and more. In this episode of Breaking Health, host Steve Krupa speaks with Kyle Kiser, CEO of Arrive Health, about giving patients the ability to access information on medications to help them make better healthcare decisions. Kiser also delves into what real time benefits are, the company mantra “Lucy up,” and how Arrive Health calculates and provides valuable data to their customers, such as general savings. He also talks about his journey from being a healthcare insurance wholesaler to starting Arrive Health, as well as tips for aspiring entrepreneurs on patience and perseverance. Links from this episode:  HealthEdge Arrive Health 

From sports goods salesman and stand-up comedian to co-founder and CEO of a software company, Chris Severn is helping patients by providing price transparency in healthcare through an easy-to-use platform. In this episode of Breaking Health, host Steve Krupa speaks with Severn about how he got the idea for a service that provided patients with upfront quotes, the value of such price transparency, and how to compare plans to help patients discern the best rates. Severn also shares his perspectives on new laws' impact on the healthcare industry and the potential future of a competitive market for medical procedures. Links from this episode:  HealthEdgeTurquoise Health 

For the past few years, digital health has made great strides in providing new ways of healthcare access for patients. But this also means new challenges and obstacles have emerged. This year, at the Digital Healthcare Innovation Summit, leaders in women's health talked about how they and their companies are finding ways to help patients access healthcare more easily, as well as the creation of sustainable business models, understanding the market, and how to measure success. They also share their own experiences of working with patients and what inspired them to find new ways to help the underprivileged. Finally, they address generational needs and differences and discuss their hopes for the future of women's health. Links from this episode:  HealthEdge  

Kamal Jethwani began his medical training in India and soon found himself more intrigued by solving of the administrative issues around care delivery. This interest came to a head when he found himself on the front lines of crisis response when his 10-bed emergency department received—and treated—1,700 patients in 72 hours. Afterward, Jethwani realized that there was a whole field of medicine focused on the design of care delivery, he told Breaking Health host Steve Krupa. He knew he had found his focus. After coming to Harvard to earn a master's in public health and finish his medical training, Jethwani worked closely with digital health tools to improve care for patients. He launched Decimal.health during the pandemic to solve the administrative issues around connecting both patients and providers to evidence-based, valid, repeatable, reliable digital health tools.  Links from this episode:  HealthEdge  Decimal.health 

Vijay Kedar, co-founder and CEO of Tomorrow Health, was raised in a family of physicians, often joking that he was “pre-med coming out of the womb.” However, it wasn't until he took on managing his mother's care through stage III colorectal cancer and acute respiratory distress syndrome that the idea for Tomorrow Health was born. In this episode, Kedar speaks with host Steve Krupa about using technology to coordinate high-quality home-based care for patients and families who find securing such care increasingly difficult to navigate. Kedar also discusses how home-based care improves health outcomes, alleviates the administrative and healthcare burden for providers, and is often the most economical option for patients requiring long-term treatment. He says, “Treating a patient with the same conditions at home can be one-tenth the cost of doing so in a hospital-based setting and one-third the cost of doing so in a post-acute setting like a skilled nursing facility.” Kedar goes on to outline how Tomorrow Health's launch during the pandemic essentially changed how home-based care was ordered, delivered, and purchased to meet an ever-growing demand.  Links from this episode:  HealthEdge  Tomorrow Health Vijay Kedar's direct email 

AJ Loiacono's experience in supply chain consulting for pharmaceutical manufacturing afforded him a world-class education in supply chain logistics, drug pricing, and software implementation. However, it wasn't until he worked with healthcare payers that he realized the glaring problems in the U.S. drug pricing system and that pharmacy benefit managers retained much of the control and profit. He says, “The reason why our drug pricing is the way it is today… is because no one has either had the resource, bravery, or perseverance to stand up and say, ‘This is what's wrong, and we're going to fix it instead of profiting off of the system.'” Looking to disrupt the status quo, Loiacono founded Capital Rx. As one of the fastest growing healthtech companies in America, Capital Rx reconstructs prescription pricing and puts savings back in the patient's hands. Loiacono speaks with host Steve Krupa about his desire to simplify drug pricing and increase transparency, how Capital Rx's novel cloud-native enterprise pharmacy platform, JUDI, reduces labor costs by up to 80%, how they maintain a 99.5% retention rate with their clients, and why their books have demonstrated a negative drug trend for the past three years. Links from this episode:  HealthEdge  Capital Rx JUDI Enterprise Pharmacy Platform Capital Rx Facebook 

Dr. Schneider's interest in medicine began when she was diagnosed with type 1 diabetes as a preteen living in a small rural Minnesota town. After becoming a physician, her journey to CEO started with a return to her roots and a desire to help decrease the exorbitantly high mortality rates observed in rural communities across the nation.  In this episode, host Steve Krupa speaks with Dr. Jenny Schneider, CEO of Homeward Health, about the company's recent launch, how it leverages technology to scale healthcare for underserved patients, and the mobile clinic that builds trust with rural communities and increases access to care. Schneider says, “The good and bad news about healthcare is that it's so highly inefficient that there's a lot that can be improved… Our ability to engage and allow people to interact with the healthcare system allows them to improve their health and ultimately costs less money.”  Links from this episode:  HealthEdge  Homeward Health 

From working nights in the Prudential mailroom during college to securing leadership roles at big names like IBM Watson Health, Allscripts, and Pfizer, Steve Tolle, now general partner at HLM Venture Partners, has seen it all. With a multi-faceted skill set and a wealth of knowledge in technology and healthcare, he eventually transitioned from an operator to an investor at one of the nation's oldest and most established healthcare venture capital firms. Given his background, it is no surprise that Tolle knows a thing or two about the growing needs of the healthcare industry and how to spot a winning investment. In this episode, Tolle speaks with Breaking Health host Steve Krupa about HLM's focus on behavioral health, member engagement, access to care, value-based care enablement, and tech-enabled services. He also talks about the six-point test every company must pass before he considers investing and what each founder should know to win over investors in under five minutes. Links from this episode:  HLM Venture Partners HealthEdge Software 

Healthcare's most vulnerable patients meet a fragmented system when they seek to simultaneously address chronic comorbidities, behavioral health challenges, and social needs (i.e., navigating access to food, transportation, and housing). In response, ConcertoCare employs a multidisciplinary team and offers an integrated approach to clinical care, behavioral health, and social services. The organization takes its name from a musical composition involving a soloist and an orchestra. With ConcertoCare, the patient (soloist) and interdisciplinary team (orchestra) work in tandem to meet the patient's needs beyond clinical care. Chairman and CEO Julian Harris, MD, MBA, talks with Breaking Health host Steve Krupa about the company's clinical model, delivering exceptional care backed by technology and data, developing a brick-and-mortar health center, and its role in helping senior patients receive in-home care for as long as possible. Links from this episode:  ConcertoCare 

Payers and providers spend unnecessary time and energy approving medical and diagnostic procedures. CEO and Co-Founder Siva Namasivayam, believing that the digital health market has yet to leverage the full power of technology, launched Cohere Health in 2019 to transform utilization management into proper care management. Cohere Health employs individual and cohort medical data, records, and proprietary algorithms to generate approvals for nearly 90% of authorization requests. Evidence suggests that Siva and his team will soon realize their goal of a 96% approval rate. With more automatic approvals, providers can focus on what matters most while patients receive timely and appropriate care. Additionally, payers experience up to 15% savings when Cohere Health suggests cost-effective yet high-quality alternative treatment options. Siva and his team serve over 5.5 million members and approximately 100,000 physician offices today. 

 When Bill Taranto pitched the Global Health Innovation (GHI) Fund, he envisioned an independent venture that mimicked a private firm but maintained the backing and power of a big health company. The Fund's partnership with Merck allows them to make groundbreaking investments in the digital health space. Following what is often known as "ecosystem investing," the GHI Fund matches two or more companies, each solving a portion of a healthcare problem, to solve the issue effectively and thoroughly. In addition, GHI maintains a strong focus on the future of healthcare, including patient identification and aggregation as well as data security, integration, analytics, and informatics. Boasting a success rate of over 95%, Bill talks about GHI's mission to scale companies using an integrated approach, data science, and revolutionary technology. Links from this episode: GHI Fund 

After several deployments in the Middle East as a US Air Force Pilot, Unite Us CEO Dan Brillman served as a trusted confidant and aid to fellow veterans looking to secure housing, employment, sustenance, and healthcare. However, he became increasingly frustrated with the fragmented and ineffective system most veterans navigate to secure social services and health resources. As a result, Brillman co-founded Unite Us, a leading innovator among digital health companies designed to build a bridge between healthcare, food, housing, and various other non-profit services. With over 7,000 organizations across 44 states, Unite Us aims to serve every American in need. With Breaking Health host Steve Krupa, Brillman talks about the ecosystem used to supply coordinated care and hold service payers and providers accountable. Links from this episode: Unite Us 

While the pandemic may have dramatically advanced our virtual care ambitions, even pre-pandemic many people noted that care outside of the hospital resulted in improved outcomes for some groups of patients. In a recent conversation at the Digital Healthcare Innovation Summit, leaders in care delivery for a variety of patient needs—as well as payer representatives—explored how innovative care models can better address complex diseases like eating disorders, can engage and empower home caregivers and community pharmacies and physicians, and better employ a limited healthcare workforce. In many ways, the panelists explained, it's a logistics problem. But smarter approaches to predictive modeling, assessment triage, and needs-matching are helping solve some of our biggest healthcare disparities.  PANEL MODERATOR: Billy Deitch, Partner, Oak HC/FT PANELISTS: Mark Prather, MD, Co-Founder & CEO, DispatchHealth Kristina Saffran, Co-Founder & CEO, Equip Brandon Kerns, President & CFO, Russell Street Ventures Katherine Knutson, MD, MPH, Senior Vice President, United Health Group; CEO, Optum Behavioral Care LINKS:Cambridge Healthtech Institute   Breaking Health   HealthEdge  https://dhis.net/  

Sid Viswanathan doesn't believe that a pre-existing passion is essential to entrepreneurial success, instead he recommends choosing an area with plenty to learn. “Find something you can spend a lot of time obsessing over,” he told the Breaking Health podcast. When he co-founded Truepill, Viswanathan didn't know much about healthcare, but now it is a passion. “It's such a meaty industry; there's so much stuff to do,” he said. Truepill launched as a virtual pharmacy in 2016, offering everything from the digital consumer-facing front end to pill packing and shipping on the back end. But the vision, Viswanathan said, is virtual healthcare, which now includes telemedicine and diagnostics as well. Truepill serves as a collaborative partner, he said, for payers, life sciences, healthcare, and providers.  Breaking Health boiler: Conversations between VCs and entrepreneurs typically occur in boardrooms or coffee shops. In the Breaking Health Podcast, you get a seat at the table. Healthcare Chief Executive Officer Stephen Krupa, HealthEdge Software, Inc., brings his more than 20 years' investor experience insight to revealing conversations with the most disruptive CEOs in healthcare. Listen to understand how these leaders are building the companies—and fostering the cultures—that will change everything.  Breaking Health Links:  Cambridge Healthtech Institute Breaking Health HealthEdge  Truepill  

Enam Noor has been an entrepreneur since he graduated from college with a degree in computer programming. After honing his skills in digital analytics and digital workflow, he's taking what he learned and applying it to the healthcare field. His company, Insightin Health, brings vast healthcare data to bear on care decision-making, empowering health plans to use data as an asset—not just an operational byproduct. By tearing down silos and combining data from physician practices, pharmacies, customer service interactions, and much more, Insightin is using machine learning and natural language processing to drive the next best action for customer health. 

Reimbursement coverage for behavioral health services hit a milestone in 2008 when Congress passed the Mental Health Parity and Addiction Equity Act (MHPAEA) which required insurers to equalize coverage for behavioral health and medical health benefits in terms of co-pays, deductibles, lifetime caps and access to providers. Fast forward to present day when demand for behavioral health services outpaces the availability of treatment and the COVID-19 pandemic ushers in unprecedented levels of anxiety and isolation. A panel of behavioral and mental health executives dig into how the care model has shifted during the pandemic, what changes are still essential to deliver quality behavioral health care, the unique role technology can play in behavioral health care, and how both payers and providers are currently defining value for their patients.   

“A lot has happened in healthcare in the past two years,” Lucienne Ide, Founder and CEO of Rimidi, says. “We went from a miniscule adoption of telemedicine—much less remote monitoring—to now everybody's looking at the future and saying, ‘This is here to stay. How are we going to do it in a scalable and sustainable way?'” Rimidi has the plan. Ide's focus is patients with chronic diseases. Episodic care is not working for them, she says, and a once-a-year or once-a-quarter trip to the doctor feels more like being called to the principal's office than a health-focused partnership. At Rimidi, Ide and her team are building sustainable progress by pushing healthcare past just digitizing data into true decision support for both patients and providers, innovating in care delivery and doing the “dirty work” of truly setting patients up for success. Ide and host, Steve Krupa, talk about the pain points in shifting to a value-based models; how EHRs, patients, and providers are responding to Rimidi's decision-support tools; and her best advice for healthcare entrepreneurs.Lucienne Marie Ide, MD, PhD, is the Founder and Chief Executive Officer of Rimidi, a cloud- based software platform that enables personalized management of health conditions across populations. She brings her diverse experiences in medicine, science, venture capital and technology to bear in leading Rimidi's strategy and vision. Motivated by the belief that we can do so much better as individuals, in industry and society, Lucie left clinical medicine to join the ranks of healthcare entrepreneurs who are trying to revolutionize an industry.

Doctors making house calls might seem like a relic of the past, but the act of caring for patients in their own home is experiencing a revival. Only this time, it's highly dependent on technology. This special episode features a panel discussion from a Digital Healthcare Innovation Summit (DHIS) Spotlight Episode earlier this year. Moderated by Ellen Herlacher, Principal, LRVHealth, this panel offers insights from entrepreneurs who founded some of the most innovative tech startups that are bringing change and disruption to the home health field. Hear how they've approached this dynamic and fast-moving market, learn about the challenges they've faced and their strategies for overcoming them, and leave with an understanding for where they see the biggest opportunities ahead.

Like many healthtech leaders, Walter Jin didn't start his career in this industry. He began as an investment banker and then joined what was a much smaller Carlyle Group based in Washington DC in the 90's. The firm had originally focused on aerospace defense but wanted to diversify, and since Walter happened to be doing healthcare deals for them, he was then asked to start their healthcare group. In 2008, he retired from Carlyle and started his own investment firm Three Fields Capital, but after a few years, he decided to take a step back from the finance world when his parents got sick. Walter continued some investing on the side via a family office and was eventually approached by Oscar Salazar (Uber co-founder) about Pager. Originally the “Uber for Doctors and Nurses,” Pager had promise but was plagued by challenges with affordability, supply chain, and access. Walter saw potential though, so he invested in the company, served as Chairman for about 3 years, helped it pivot to a platform focused on access and steerage, and then became CEO, the role he has had for about 3.5 years. Tune into this episode to learn more about Pager's origins, its new focus and business model, how the company has been able to white-label its platform to embed within many provider/payer stacks, and healthcare's response to this rapidly growing company, plus Walter's thoughts on the future of the health system and digital care.

John Kao is a seasoned entrepreneur and executive. After beginning his career at FHP International, he then started four other companies in succession: Secure Horizons USA, PacifiCare Health Systems, The TriZetto Group, and CareMore Medical Enterprises, before then being compelled to found Alignment Healthcare. Alignment's origin is a bit more personal to John though, as the business idea arose from his and his mother's experiences as she had a heart attack. After experiencing a lack of consistency around clinical information, particularly post-discharge home healthcare; poor communication post-discharge about cardiac rehab; and medication mismatches pre- vs. post-hospitalization, John felt he couldn't be the only one going through this, so he started Alignment Healthcare. He felt there was a huge need for proactive care at the home and/or virtually for the 20% of seniors who are frail or have polychronic conditions, and that the cost savings arising from providing better care for this population could be reinvested in the other 80%. Tune into this episode to learn more about Alignment Healthcare's origins, its unique business model, its strong values, and the healthcare market's response to the now-public company, plus a candid conversation about some of the most valuable lessons John has learned transitioning from an entrepreneur to a CEO.John Kao is Founder and CEO of Alignment Healthcare, a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Mr. Kao has had a long career committed to the healthcare industry and has served in executive roles at CareMore Medical Enterprises, The TriZetto Group, PacifiCare Health Systems, Secure Horizons USA, and FHP International. Mr. Kao believes strongly in the tenets of servant leadership and serves on various boards of non-profit organizations. He received his bachelor's degree from Santa Clara University and his MBA from UCLA Anderson Graduate School of Management.

Mark Frank has what he calls “professional ADD.” He naturally likes trying different things and building new skills, which is ultimately what led him to become an entrepreneur. Even while serving in the Army after college, Mark still found entrepreneurial aspects as a platoon leader; after all, he was responsible for everything his unit either did or didn't do. He used to think of himself as an operator or executive, which was his role at his first startup, but now he looks for ideas/opportunities, makes note of them, and eventually either whittles them down into business opportunities or sets them aside. After a challenging and frustrating experience finding a therapist (balancing location, schedules, insurance, and fit is a real nuisance), Mark realized the huge opportunity to help both patients and therapists connect more easily. Hence, SonderMind was born. Tune into this episode to learn more about SonderMind's origins, its unique business model, how it has tackled some of the big problems in the therapy space, including access to care and providing valuable business support to therapists, plus a conversation about the current challenges and opportunities with many mental health benefits.

After losing his Holocaust-survivor dad as a result of three medical errors at a US academic hospital, Raphael Rakowski was driven to start Medically Home. Trained as an engineer who then successfully launched a few prior companies, Raphael was prepared to try to address the problem of high fixed cost burdens at medical facilities that he felt affected quality of care. He and his co-founders started Medically Home almost 13 years ago with the vision to provide high acuity, complex care, in a home setting. Thankfully, after some behind-the-scenes backing from Mayo Clinic, a momentous decision by CMS to provide a reimbursement code for their care model, and a boost in demand for out-of-hospital care during Covid, the company has recently really taken off. Tune into this episode to learn more about Medically Home's technology and patient experience, as host Steve Krupa chats with Raphael about the company's business model, tipping point, traction gained with both patients and providers, and future.Raphael Rakowski has devoted his career to transforming and transcending the ways in which companies provide essential services to the public, particularly in the healthcare industry. Raphael is a life-long entrepreneur, and his knowledge and expertise extends into sectors such as healthcare, consumer products, and renewable energy. In 2000, Raphael was the President of American Healthways, a Share care company, which focuses on using behavior change to track a person's health. Following this, Raphael founded SAMI (Show All Medical Information) in 2010, a company designed to use modern healthcare technology to provide a simple search platform for families and their doctors. Raphael was also a co-partner at Intersection Partners, a group that helps launch and operate healthcare service companies. Raphael is now currently the co-founder and executive chairman of Medically Home, a company revolutionizing healthcare by providing hospital-level care for high-acuity patients in the comfort of their own homes. Through a combination of 24/7 virtual monitoring and in-person home visits, patients in Medically Home have higher rates of positive outcomes and lower readmission rates than traditional hospital patients.

As a former Partner at Deloitte, Rajeev Ronanki established and led Deloitte's Life Sciences and Healthcare Advanced Analytics, Artificial Intelligence, and Innovation practices. He then was offered a chance to join Anthem and lead their transformation to becoming a digital-first enterprise. Rajeev viewed this a great opportunity to help transform healthcare, so he accepted the position. How did he start to tackle this challenge and develop a vision for this insurance giant? First, by simply defining what “digital” meant within Anthem. Once aligned on that, he was able to start implementing automation of core business practices and developing an application to engage consumers in a more personalized manner. Then, the real value came. Leveraging over 10 million users on their digital platform, Anthem was able to improve their app based on user feedback collected on the platform (they tested an average of 180 user experiences per day!). More impactfully though, the group could start deriving real healthcare insights. Tune into this episode to learn more about Anthem’s new digital-first approach, as host Steve Krupa chats with Rajeev on the company’s digital revolution, its partnerships with startups and investors, the opportunity for more upfront diagnosis, and even Rajeev’s thoughts on blockchain’s utility in healthcare.Rajeev Ronanki serves as Chief Digital Officer at Anthem, Inc. He is leading the transformation of Anthem to become a digital/AI-first enterprise through driving the vision, strategy, and execution of Anthem’s Digital, Artificial Intelligence (AI), Exponential Technology, Service Experience, and Innovation portfolios. Through these efforts, Mr. Ronanki is enabling Anthem to harness the power of AI and data to better understand healthcare consumers and provide tailored, personalized care. His experience spans over 20 years of innovation-driven industry and social change across healthcare and technology.  

Having been both an operator and an investor in the healthcare industry, Fay Rotenberg knows the challenges and silos all too well. She was encouraged when she first met the co-founders of Firefly Health though. Initially, she had agreed to meet with them 1 day per week, then that grew to 2 days per week, then 3, and before she knew it, she joined the company as President and CEO about 3 years ago. Firefly is striving to shift healthcare from episodic to continuous care. They are a virtual-first clinical network consisting of primary care, behavioral health, and specialty care, all accessible via a world-class navigation platform. Think of Firefly as a mini and virtual Kaiser, as they are now also expanding into full benefit models for employers. By reducing costs and improving outcomes, they have begun to achieve concierge medicine at scale. Patients interact with their platform an average of 41 times per year and receive a response within 5 minutes, while doctors also love being part of their team-based care approach, as it allows them to focus on tasks that are most value added for them. Tune into this episode to learn more about Firefly Health, as host Steve Krupa chats with Fay on the company’s mission to provide half priced health care that is twice as good, its start with insurers as original customers (now somewhat competitors), its growth to over 50 employees, and its future including developing a health plan replacement for employers.

In his final rotation at Harvard Medical School, Andrew was baffled by how many patients were googling their symptoms to make decisions about whether to seek care. Things became personal though when his own father hesitated and waited too long to seek medical attention while experiencing a mini stroke (thankfully he survived). Andrew became convinced that there had to be a way to reduce the effort and hesitancy deterring potential patients from engaging with healthcare professionals. So, he took three years off from medical school and co-founded Buoy Health. The goal was to develop an AI chatbot that could help people answer the simple question: “When do I need to go to the doctor?” Built upon manual review of thousands of medical articles and incorporated user feedback, Buoy quickly became a truly machine-learned algorithm that could not only account for medical best practices but also user demographics. Today, buoy.com services over 30 million people, including being the official COVID-19 screening tool for both Massachusetts and Virginia. The company has also developed a “Back with Care” feature to help employees return to work and is about to release a vaccination module as well. Tune into this episode to learn more about Buoy Health, plus hear host Steve Krupa chat with Andrew on his transition from medical student to entrepreneur, what he wished he knew before starting the business, and Andrew’s vision for the company’s future.

Having started working in the healthcare space directly after graduating, Bryan quickly learned the ins and outs of health insurers, broker distribution, and self-insurers. After a decade in the industry, Bryan decided to pivot to a much smaller company and became both the CEO and just the 3rd employee at RxBenefits in 2005. He then realized the opportunity to help smaller, self-insured companies handle their pharmacy benefits by carving those out. RxBenefits developed a platform connected directly to the major Pharmacy Benefit Manager systems, which enabled them to directly and cost-effectively ingest claims and operate as an apparent larger entity. This approach helped them deliver mid-market employers an average direct pharmacy savings of 27% and an indirect clinical savings of 10% per year. Hear host Steve Krupa chat with Bryan on his transition to a much smaller company, how RxBenefits has leveraged their niche in pharmacy benefits for mid-sized companies, and Bryan’s vision for the company’s future

While working as a graduate student intern for a clinical documentation company, Jeff discovered his passion for the healthcare industry. He stayed there for 10 years and benefited from strong mentoring and development opportunities before seeing the company through its exit. Fast-forward 6 years- after another successful exit as a senior manager at a different business- Jeff was introduced to the concept of payment integrity and started ClarisHealth to help solve challenges in this area. Having grown from 3 to over 140 employees, Jeff sees ClarisHealth’s focus as helping plans tackle their entire payment integrity continuum (post-pay to pre-pay) with a longer-term vision of increasing payer-to-provider transparency. ClarisHealth’s Pareo platform is a multi-module SaS solution that helps health plans and payers grow recoveries from 1% to 7% or more. Hear host Steve Krupa chat with Jeff on his decision to start the business and how it has benefited both payers and providers.

Starting out as a minor league baseball broadcaster, Ben Albert realized he was better at the business side of his role than the on-air aspect. He then landed at a healthcare consulting company and became hooked on healthcare- so many silos and opportunities for automation! After a successful exit at the helm of Care Team Connect, Ben decided to start and lead Upfront Healthcare to help patients navigate the unending waters of their medical journeys. By applying analytics to scheduling, billing, and operational data to develop each patients’ profile, the company can direct patients through an app-less experience to their next right service, which can be booked right then. Not only do patients enjoy this much easier experience, but providers benefit from the improved revenue profile for each patient and reduced administrative overhead. Listen to host Steve Krupa chat with Ben on how he progressed from deciding if he should start the business to now running a company servicing over 1 million patients in less than five years.

Host Steve Krupa chats with Aver CEO Bill Nordmark about Bill’s career in the healthcare payer and reimbursement space, including his decision to take over the reins at Aver. Hear Bill share helpful insights on retrospective vs. prospective payment systems and how he is leading Aver on the quest to increase quality of care while reducing costs by helping payers expand and bundle payment programs.

Steve sits down with Zipari Founder and CEO, Mark Nathan to discuss how his career set him up for entrepreneurship, as well as the motivation and inspiration for starting a health insurance consumer experience platform. Mark shares the challenges associated with taking a homegrown business technology and creating generally available software and gives his best advice for entrepreneurs starting a company.

Greg discusses his early days as a professional musician and shows how creativity and problem-solving helped transition his career into software development, and led him to working in healthcare, helping providers and patients by innovating payment data. He discusses developing new, data-enabled products and using advancements in tech to expand a company footprint.

No fan of traditional PBMs, Steve Krupa talks with Jake Frenz, founder and CEO of SmithRx, creator of a new tech-based PBM player.

Breaking Health Host Steve Krupa catches up with Peter Foley, founder and CEO of LetsGetChecked, a company that’s empowering patients to monitor their own health through diagnostic tests. Hear how Foley and his team built patient convenience into a powerful business.

Chris Molaro calls his six years in the US Army leading a Field Artillery platoon his biggest honor. But he says his “biggest leadership failure” came after his platoon redeployed back home. In this episode of the Breaking Health podcast, Host Steve Krupa connects with a young veteran who is using inspiration from a tragic loss of one of his soldiers to depression to improve mental healthcare for everyone. “We could have intervened if we had a better system in place,” Molaro says.

Our Host Steve Krupa has a visitor. Aetion CEO Carolyn Magill pops by Steve’s office at HealthEdge to explain how Aetion raised a round of capital it wasn’t seeking. She also delves deeply into how Aetion’s analysis of different types of data – genomic, socioeconomic, EHR’s – can change how healthcare is delivered and how are costs covered.You can WATCH this Breaking Health podcast interview here.

In this podcast, Ardy Arianpour, CEO of Seqster (pronounced Seekster), shares the origin story for creating what he calls, “the Mint.com of health care. Seqster is creating a clear, direct, one-password-only channel between patients and ALL their healthcare data – EHR, genetic and fitness, etc. The start-up is marking its offering to payers and providers and already has secured access to data from 3,000 hospitals and 45,000 physician offices as well as DNA Labs and data-collecting Medtechs like ResMed and DexCom. Hear Arianpour vision for the future of healthcare data.

Vital Connect CEO Nersi Nazari talks data with Host Steve Krupa in this episode of the Breaking Health podcast. VitalConnect has developed a line of sensors capable of tracking conditions of patients at home and in the hospital. According to the company, its VitalPatch wearable biosensor is a lightweight, wireless, and records eight patient vital signs. The VitalConnect Platform integrates the VitalPatch biosensor with mobile and cloud-based software and analytics. The company closed on $33 million in a Series C last year, drawing capital from Baxter Ventures and MVM Life Sciences.

A few years ago, technology veteran Doug Hirsch was given a prescription that he wasn’t 100% sure he needed, especially after the first pharmacy he brought it to told him the drug would cost over $400. Hirsch walked out with the unfilled prescription and decided to shop around. What he discovered was a prescription marketplace that seemed to offer little rhyme or reason. This mystery led to the creation of GoodRx and an app that allows patients to shop around more easily. Six years later, GoodRx users have saved over $10 billion and one-third of prescribing physicians recommend it to their patients. In this podcast, host Steve Krupa talks with Hirsch about the value of PBMs and the future of GoodRx.

Punit Soni’s LinkedIn profile includes Intel, Google, and Motorola. But Soni tells the Breaking Health podcast that he believes the “largest, most interesting” tech company will be in health care. Can Suki be that company? Soni sees an enormous opportunity to help physicians be physicians by replacing keyboards with AI-enabled digital assistants that can record electronic health record (HER) documentation. Can this digital assistant improve patient care and reduce physician burnout by getting docs away from data entry and back to doctoring? “We want the doctors to be the bosses of their own lives,” Soni says. “They need to rediscover the joy of practicing medicine.” Suki already is an interesting company to watch.

Lark CEO and Founder Julia Hu had launched two cleantech start-ups early in her career, but a childhood managing a chronic disease predestined her to start Lark Health, developer of an AI-empowered “coach” that can help people with chronic disease manage their own health.

Arvind Rajan left his managing director post at LinkedIn intent upon two things – taking some time off with his family and finding a new venture that would be hard, important, and transformative to the world. Rajan and his co-founders, James Chaukos and Vince Kim – saw an imbalance in how patients with late-stage kidney disease were being treated. Cricket Health – identified as one of the Fierce 15 Companies in healthcare – is working to balance the scales in favor of patients by building teams of nephrologists, dieticians, even experienced patient mentors to help people before they reach kidney failure.

Breaking Health Host Steve Krupa returns to the Big Chair, reconnecting with old friend and former portfolio company CEO Tony Miller. In this podcast, the pair unpack the strategy of Bind, the “on-demand healthcare insurance” company working to change how employers insure their employees. Find out more at yourbind.com.

Susan DeVore has been in and around the healthcare industry for most of her life – long before she became president and CEO of Premier Inc., a company that unites an alliance of more than 4,000 hospitals and health systems and approximately 165,000 other providers and organizations to transform healthcare. It’s a little-known fact that Susan’s roots at Premier date back to her childhood when her father, a biomedical engineer, worked for a predecessor to the company. After working at Ernst & Young – including time as a partner and senior healthcare industry management practice leader, among other roles – she got the call to interview at Premier. No one was aware of Susan’s company legacy at that time, but after she joined, there were longtime employees who remembered her attending the company picnic or other gatherings as a young teenager. Susan’s lifelong focus on improving the healthcare system and her current role at Premier – driven by insight from such a vast network of care delivery organizations – combine to give her an incredibly valuable perspective for solving healthcare’s biggest challenges. Premier’s network enables it to maintain a dataset that encompasses roughly 45% of patients in the US. Those data inform Susan’s leadership and the decisions the company makes to help solve cost and quality challenges and develop a unique model of care delivery. At the HIMSS Global Conference & Exhibition in February Susan will be delivering a keynote session titled, “Healing from Within: Leading Change, Inspiring Action.” But you can hear her first on this episode of Breaking Health Podcast. Susan’s conversation with Keith Figlioli covers a number of pressing topics including: • Reducing Waste in the System – Susan talks about how there’s still 30% waste in the system and three times unwanted variation in care delivery, and how these challenges can’t be solved by insurance companies or the government. She believes the only way to tackle them is head-on, from within the system, and shares her thoughts about how data, technology, and influence within healthcare systems are all critical to driving transformation.• Changing the Social System – the decades-old social system that the healthcare industry is built upon is one that’s difficult to change. But it’s starting to change in experimental ways, driven by innovators and early adopters who recognize that it’s unsustainable for healthcare costs to grow at twice the rate of the economy, and who want to do something about it. Susan talks about how and why it’s easy to stay in a fee-for-service world and shares her thoughts on the main barriers to change.• The Path to Alternative Payments – as Susan sees it, the big thing that’s holding health systems back from adopting alternative payment models is uncertainty. If providers that haven’t adopted or are only experimenting in alternative payments think there’s a chance that fee-for-service might last longer, it’s much harder for them to make the leap. However, she talks about her view of federal regulations and how the “training wheels are coming off” to force change more quickly.• The Next Big Thing: Making Big Data Small – while increasing access to healthcare data is playing an important role in transforming the industry, one big challenge right now is the sheer volume of data that exists. Susan talks about how the next big thing on the horizon will be figuring out ways to make vast amounts of data more usable. She talks about how to get “small data” into the workflow so it’s available for physicians and patients to use in making informed decisions that change the care being delivered.To hear Susan DeVore talk about these topics and more, listen to this episode of Breaking Health Podcast.

IntelyCare CEO David Coppins details his company’s solution for nursing staffing shortages. The company makes its own nurses available to providers through a software scheduling tool, removing a lot of the juggling and guesswork. Earlier this month, IntelyCare announced a $10.8 million round led by Leerink Revelation Partners with participation from Longmeadow Capital, previous investor LRVHealth and Bill Mantzoukas, an entrepreneur who has owned and operated a series of skilled nursing facilities.