Podcasts about Aetna

The land of Big Tech Therapy has been making headlines. I cover some of them in this episode.*The links shared below are a reference only and do not necessarily reflect the opinions of Marie Fang, Private Practice Skills, or its sponsors.If you'd like a great summary of all that I covered, check out ZynnyMe's article:https://www.zynnyme.com/blog/alma-headway-and-the-big-questionIf you feel compelled to do something, this r/therapists post links to several options at the systemic level:https://www.reddit.com/r/therapists/comments/1tvzpov/support_and_advocacy_for_therapists/Build Better Health's Mental Health Insurance Reform Task Force's Petition (if you'd like to sign):https://actionnetwork.org/petitions/we-demand-a-system-that-reflects-the-true-value-of-mental-health-careThank you to Paubox for sponsoring this episode. Paubox makes HIPAA-secure email and forms easy and streamlined. Check them out here:⁠https://hubs.la/Q04k58tL0⁠*Get $250 off your first year with Paubox with coupon code "SKILLS"*Bonus Deal:* If you add the Paubox badge to your website you get an extra $100 off your first year - that means you can get your whole first year free if you apply both deals!Citations:Alma has investments from Cigna and Optum:https://cignaventures.com/alma-raises-130m-in-series-d-funding-led-by-thoma-bravo-to-advance-its-mission-to-simplify-access-to-high-quality-affordable-mental-health-care/Health Care Service Corporation (HCSC), the parent company of several Blue Cross Blue Shield programs, invests in Headway:https://www.hcsc.com/newsroom/news-releases/2023/strategic-investment-headway-behavioral-healthReference: HCSC is parent company of Blue Cross Blue Shield:https://www.hcsc.com/who-we-areRula backed by Blue Venture Fund:https://bhbusiness.com/2024/09/17/digital-mental-health-platform-rula-health-expands-to-50-states/Reference: Blue Venture Fund invests on behalf of Blue Cross Blue Shield:https://blueventurefund.com/Headway and Alma announce 30 percent cut in Optum Rates, January 2025:https://clearhealthcosts.com/blog/2024/11/2-digital-mental-health-platforms-cut-pay-rates-for-therapists-with-unitedhealths-optum-stirring-anger/Aetna cuts rates with Alma-contracted therapists:https://bhbusiness.com/2026/05/21/aetna-cuts-rates-with-alma-contracted-therapists/r/therapists megathread on Aetna's rate cuts through Alma:https://www.reddit.com/r/therapists/comments/1tj1bl1/megathread_aetna_alma_reimbursement_changes_90837/APA urges Aetna to halt rate cuts:https://updates.apaservices.org/apa--american-psychiatric-association-urge-aetna-to-pause-reimbursement-rate-cuts-for-behavioral-health-cliniciansAetna Launches Aetna Mental Health on Demand:https://www.aetna.com/insights/news/aetna-launches-mental-health-on-demand.htmlCVS Announces Aetna Mental Health on Demand:https://www.cvshealth.com/news/condition-management/aetna-launches-aetna-mental-health-on-demand-to-provide-real-time-access-to-care-and-ongoing-support.htmlProof News Article: "Woman's Talkspace Therapy App Sessions Exposed in Court"https://www.proofnews.org/womans-talkspace-therapy-app-sessions-exposed-in-court/FTC Sues Amazon for Monopoly Power:https://www.ftc.gov/news-events/news/press-releases/2023/09/ftc-sues-amazon-illegally-maintaining-monopoly-powerClass Action Lawsuit Against Headway:https://www.classaction.org/news/headway-hit-with-class-action-over-alleged-disclosure-of-patient-info-to-googleClear Health Costs Article: "Therapists have misgivings on the platforms: Alma, Headway etc. and the business of therapy”https://clearhealthcosts.com/blog/2025/11/therapists-have-misgivings-on-the-platforms-alma-headway-etc-and-the-business-of-therapy/Website: www.privatepracticeskills.comThis podcast is not intended as professional or legal advice. Be sure to seek the services of a professional if you are in need of them.

We spoke with Carrah Kalat, Aetna's Chief Marketing Officer. Last year, Travelers donated $4 million to area charities, with $2.8 million from the Birdies program, matched by Webster Bank and Aetna, which offers a 15% match on donations. Over 220 charities are participating this year. Aetna's involvement reflects their commitment to community support, having been deeply rooted in Connecticut for over 173 years. The program allows donations to be matched, enhancing the impact of charitable contributions.

We spoke with Krissy Dorsey, Executive Director of the CJK Foundation, about their involvement in the Travelers Championship. The CJK Foundation, which aims to make mental health accessible, receives a 15% match on donations thanks to Webster Bank and Aetna. The foundation focuses on community support and provides financial assistance for mental health treatment, including co-pays and sliding scale therapy.

THIS SPONSORED PODCAST EPISODE IS BROUGHT TO YOU BY CVS HEALTH.In this sponsored episode, James Margiotta, Chief Growth Officer at CVS Caremark, joins Health Affairs Publishing's Jessica Bylander to unpack the role of pharmacy benefit managers (PBMs), their impact on prescription drug costs, and the value PBMs bring to the health care system.James has nearly 35 years of experience driving innovation, operational excellence, and enterprise value across the healthcare system. In his current role, James leads the team responsible for partnering with clients to identify their unique needs and bringing forward strategic solutions to meet their objectives.Throughout his career at CVS Health, James has scaled businesses across CVS Caremark, CVS Accountable Care, Minute Clinic, Aetna, and CVS Pharmacy — each with its own challenges, cultures, and market dynamics.James and Jessica's conversation explores how PBMs help employers, health plans, governments, and unions manage rising prescription drug costs while balancing affordability, transparency, and member experience. James explains CVS Caremark's approach to controlling costs, dives into the growing demands for price transparency, and how artificial intelligence may transform pharmacy benefits and member navigation services.

THIS SPONSORED PODCAST EPISODE IS BROUGHT TO YOU BY CVS HEALTH.In this sponsored episode, James Margiotta, Chief Growth Officer at CVS Caremark, joins Health Affairs Publishing's Jessica Bylander to unpack the role of pharmacy benefit managers (PBMs), their impact on prescription drug costs, and the value PBMs bring to the health care system.James has nearly 35 years of experience driving innovation, operational excellence, and enterprise value across the healthcare system. In his current role, James leads the team responsible for partnering with clients to identify their unique needs and bringing forward strategic solutions to meet their objectives.Throughout his career at CVS Health, James has scaled businesses across CVS Caremark, CVS Accountable Care, Minute Clinic, Aetna, and CVS Pharmacy — each with its own challenges, cultures, and market dynamics.James and Jessica's conversation explores how PBMs help employers, health plans, governments, and unions manage rising prescription drug costs while balancing affordability, transparency, and member experience. James explains CVS Caremark's approach to controlling costs, dives into the growing demands for price transparency, and how artificial intelligence may transform pharmacy benefits and member navigation services.

In this episode of Medsider Radio, we sat down with Karthik Ganesh, CEO of OnMed.OnMed is the healthcare technology company behind OnMed CareStation, a “Clinic-in-a-Box” designed to expand access to primary and urgent care. Before OnMed, Karthik served as CEO of EmpiRx Health, leading the company through rapid growth and a successful private equity transaction in 2021. Throughout his career, he's held leadership roles at QualCare, CareAllies, and Aetna, and advised healthcare organizations through Deloitte and EY.In this interview, Karthik discusses why hybrid care models still require a human touch, how enterprise healthcare buyers evaluate value propositions differently, why brand and culture should shape execution early, and how operating under constraints can sharpen innovation.Before we dive into the discussion, I wanted to mention a few things:First, if you're into learning from medical device founders and CEOs and want to know when new interviews are live, head over to Medsider.com and sign up for our free newsletter.And if you're ready to level up your medtech game, you should check out Medsider Courses — 8-week masterclasses covering topics like fundraising, M&A and exit planning, design and development, clinical and regulatory strategy, and commercialization.These courses, featuring hard-earned lessons from elite medtech CEOs, can be purchased individually or come free with our All-Access Pass.If you'd rather read than listen, here's a link to the full interview with Karthik Ganesh, which includes a link to ScottBot — an AI version of host Scott Nelson trained on every Medsider interview and playbook. Feel free to ask ScottBot any questions you'd like!KEY MOMENTS FROM THE INTERVIEW(03:04) - Karthik's obsession with healthcare access, and the “broken doorway” problem behind OnMed (05:51) - How OnMed combines telemedicine and brick-and-mortar care into a “Clinic in a Box” (09:04) - The OnMed metrics that surprised Karthik most, including a 37% patient return rate, and the reasons behind the company's success (09:22) - What OnMed designed differently after realizing that patients approach healthcare with their guard up (15:27) - The pitfalls of B2C healthcare and how OnMed was built as a B2B company by intention (22:01) - How Karthik reshaped OnMed around clarity, structure, and high performers (30:23) - What “brand” actually means to Karthik (39:37) - How OnMed tailored its value proposition for payers, providers, employers, and universities (45:45) - Karthik's fundraising philosophy: constraints keep companies inventive

Walter Sterling talks with Ross Coulthart about the Murchison meteorite, 7-billion-year-old stardust, amino acids, the building blocks of life, possible evidence of ancient Martian life, NASA secrecy, lunar anomalies, Mars structures, and what may still be hidden from the public. Walter also speaks with Dave Scott about the latest UFO file releases, public frustration over “pong dot” videos, possible red herrings, American military technology, UAP disclosures, religious reactions, and what could come in the next government drop. Plus, Walter takes calls on NASA, Vatican archives, COVID vaccines, Fauci, school shutdowns, CVS and Aetna, prescription drug conflicts, Florida Stories, gender reveal chaos, kangaroos, strange arrests, and Congressman Brandon Gill pressing NPR over bias, Marxism, reparations, looting, and taxpayer funding. Learn more about your ad choices. Visit megaphone.fm/adchoices

Kristy Ellmer has spent her career leading large-scale transformations across industries, countries, and operating environments. In this conversation, she explains why most change efforts fail — not because of bad strategy, but because organizations underestimate the human side of execution. A central idea from the discussion is the imbalance between the "what" and the "how" of transformation. Leaders spend enormous energy defining strategy, targets, and operating levers, but far less time on the behaviors and systems required for adoption. As Ellmer explains, "transformations or change are failing… on the elements of the how. It's not because there was bad strategy." She argues that many executives rush from alignment into execution before the organization is ready. One of the most counterintuitive lessons from her work is the need to pause after agreement is reached: "You need to take… up to two months to get organized." Without the right operating structure, early momentum eventually stalls. The conversation also explores why momentum must be designed intentionally. Discussing transformation work at Aetna, Ellmer explains the importance of visible early wins and helping employees understand "what's in it for you." She emphasizes that leaders are "responsible for momentum," not just strategy. Another major theme is resistance to change. Early in her career, Ellmer believed that "everybody will just get on board because things are right." Experience taught her otherwise. Different groups respond to different incentives, fears, and motivations. Her advice: "Be curious" about why people resist rather than assuming they are unwilling to change. She also challenges traditional views of change management, arguing that communication plans and training sessions alone are insufficient. "There is real science now out there on how humans really change," she says, and organizations that ignore that science struggle to achieve lasting adoption. The discussion also covers: why long transformations create fatigue when organizations never create "endings" how senior leaders should think about AI adoption versus AI hype why most companies are integrating AI as a workflow tool rather than fully replacing human work what separates successful consulting partners from those who simply "tick boxes" why career growth often comes from "leaning into uncertainty" Throughout the episode, Ellmer returns to one principle: organizations execute change more effectively when they treat employees with the same intentionality they would apply to external customers. "It's your job to sell the change," she says — not simply announce it. Kristy Ellmer is a Managing Director and Senior Partner at BCG and a former Chief Transformation Officer, with decades of experience leading multiyear transformations inside global organizations. She is a coauthor of the book, How Change Really Works. Get Kristy's book, How Change Really Works, here: https://tinyurl.com/2zb4p63d Claim your free gift: Free gift #1 McKinsey & BCG winning resume www.FIRMSconsulting.com/resumePDF Free gift #2 Breakthrough Decisions Guide with 25 AI Prompts www.FIRMSconsulting.com/decisions Free gift #3 Five Reasons Why People Ignore Somebody www.FIRMSconsulting.com/owntheroom Free gift #4 Access episode 1 from Build a Consulting Firm, Level 1 www.FIRMSconsulting.com/build Free gift #5 The Overall Approach used in well-managed strategy studies www.FIRMSconsulting.com/OverallApproach Free gift #6 Get a copy of Nine Leaders in Action, a book we co-authored with some of our clients: www.FIRMSconsulting.com/gift  

Is your practice going out of network to make more money? Fantastic, but make sure you listen to this episode first. Kiera talks about all the numbers you absolutely need to know before you make the decision, and other, smaller considerations you could make instead. Episode resources: Subscribe to The Dental A-Team podcast Schedule a Practice Assessment Leave us a review Kiera Dent- Dental A Team (00:00) Hello, Dental A Team listeners this is Kiera and today I am excited to chat with you about a pretty popular topic that people are always wanting to ask questions about they want to get to know like Kiera, I just want to go out of network. And I say, great, let's talk about it. Let's have a really good conversation about what going out of network actually means what it looks like for you and your practice and how we're able to support you on that.   So if you're new to the Dental A Team, welcome, I'm Kiera Dent. I love all things dentistry. My last name really is Dent and I believe that our job is to positively impact the world of dentistry in the greatest way possible. I think that we are so lucky and so blessed to be able to work in dentistry, to be able to serve and help so many patients. And so I hope that you just know that you're doing a great work out there, that you are changing lives, that you are benefiting so many people. And I am so glad that you've chosen to spend your time with Dental A Team.   If you love our podcast, please, like, please go leave us a review. Like, subscribe, share. It helps us out so much. You have no idea. Just like you want patients to leave you great reviews after you see them. Leaving us a great review for the podcast actually helps us reach more practices and that's our ultimate goal. And I do read them and I'm so grateful for your amazing reviews. So let's talk about going out of network. Going out of network, everybody wants to do it because they want to make money, right? Like I am getting these terrible reimbursement rates and so that's why I'm going to do it.   But what I want you to realize is when you go out of network, you actually become a marketing company. Okay, I hope you heard that. When you go out of network, you become a marketing company. And what that looks like is you now have to work to retain these patients. So when I help practices go out of network, like that's totally fine. You're allowed to do it, but let's make sure we look at the numbers. Let's make sure we do the math. How much is it going to cost for us to market to these new patients? How is it going to be for us to retain these new patients? How are we going to be able to actually get these patients to stay with us long-term?   Now we don't have the insurance clause that's keeping patients here. Also, if you don't know, insurance companies do often send letters to your patients telling them, hey, if you just go down to this other dentist, they're actually an in-network provider. I kid you not, you think that it's dirty, they're allowed to play dirty. So just so you know, when you do this, you start facing this huge uphill battle and I've had practices almost go belly up after going out of network. That's not to say that going out of network's wrong.   but I even have practices that are fee for service right now and they're like we just cannot drive new patients because trying to compete with people in network is so hard and I think about it like Let's just run the fees and I know you sit here and you dream about this grand day of like but Kiera if I was out of network I could get paid so much for a crown and I'm like, yes But then you're only doing like two crowns instead of 20 crowns So there is a volume game, which is not a wrong game to play But I just want you to like realize that you really have to drive your marketing. You have to be   top notch, you have to look to see how you're gonna drive patients to your practice. You have to beg, you will have an uptick in your spend on marketing when you go out of network as well. So it's not all flour, sunshine and gravy. And so sometimes I just look at like, what's the biggest pain point and could we maybe drop one or two insurance companies instead of dropping all of them. If you have more patients than you know what to do with and I'm talking you are booked out seven, eight, nine months to get your patients back in. It might be worth considering, could we drop one or two plans?   Or could we expand and add in more providers before we drop insurances? So look at our lowest paying reimbursables and see what if we just drop those and offer them our membership plan so they become these fee for service patients. But with the membership plan, they are more tethered to the practice, right? Because they're paying for this, they're going to be coming in two times a year. You have two opportunities to see them. I will tell you as a fee for service patient myself, I do not usually go in two times a year. And it's because I'm like, I gotta pay like 300 bucks. But when they have a membership plan,   They don't think like that. They're like, put my cleaning is free. Just like they think of with insurance. So when you're going out of network, really starting to think about all these possibilities of like, all right, what are we going to need to change to be able to drop? So when I have people looking at this, I think about number one, what is the cost to benefit ratio? And if we lost all these patients, let's pretend none of them come, let's go for our worst case scenario, would we be able to sustain? Do I have enough patients to be able to sustain that? And am I willing to do that? Some practices,   Totally, they're good to go. They're like, yes, Kiera, I'm just fine. I can absolutely 1000 % handle this. Other people are like, no, I can't. If I lost all those patients, we would not be able to sustain. So that's the first step before we go out of network. The second step is let's make sure we're prepared to go out of network and handle all those phone calls. And how are we going to save and maintain and retain these patients? Can we get them on membership plans? Third, what are you gonna do about the insurance companies that are calling your patients constantly?   When you out of network, you move into a marketing company. You are constantly striving to keep these patients with you, retain these patients, make sure that they're always there. They're no longer just coming to quote unquote automatically. And so I think about it like, let's run the opportunity cost for when we're going out of network to see, is this something I really want to do? do you want to do this? And I think so many people are like, okay, I'm going to just do this.   we're going to run, we're going to do, and then like, let's maybe do a little bit of prep work. And so there is out of network, like collection verbiage, there is an out of network plan. ⁓ There is all of this. And I just think like, when we go through it, you want to make sure that you are fully prepared financially, mentally, emotionally, as a team, we are locked and loaded and we are good to go. And so if you've looked at those numbers and you're set,   I really want you to think about how you're going to be a marketing company. And so when we look at this, thinking about how can I retain all these people? How can I make sure before I go and drop, like truly before you go and drop insurance, how can I make sure all these patients are going to continue to come back to us? Is it something that we can do of like, can I put into place and start reaching out membership plans? Can we work on our patient experience? Can we make sure like, what's gonna set us apart from the insurance company down the street?   I have a doctor and they are amazing and they are fee for service and they've been fee for service for years. I'm talking like they are so lucky. They've got the Taj Mahal of a practice. It's gorgeous. They've got state of the art technology. Their fees are really not that much higher, but they have like, could you not multiple practices? There's probably 10 around them that are all insurance driven and they're like, but our dentistry should speak for itself. And I'm like, I don't disagree with you, but when times get tighter, things get harder.   People are gonna look at this. guys, I have even, Kiera Dent, who knows dentistry, I have switched. I have a doctor who's fee for service. This is embarrassing. Me as a patient, I'm going to tell you. I have a dentist fee for service. I know they do great dentistry, but they're fee for service. My husband, he's got a great dentist who's got a great hygienist. They're in network with my husband's insurance. I was like, well, I'll just go to them for my cleanings. And if I ever have work that needs to get done, I'll go to the fee for service practice.   Even myself, because I'm just like, well, is it really worth the cost? Like, it's just a cleaning. Like I could just go to the other dentist and you might be like, no cure. But you got to think about the patient. I know you think your dentistry is amazing, but to that patient, a cleaning is a cleaning is a cleaning. Unless they love your hygienist or they love you, they love your front office. They love something about your practice so much that they're willing to pay almost like I pay $300 out of pocket versus insurance. pay $30 a month.   and I get to go have a great cleaning by this amazing hygienist. I also can look at my x-rays, but I think about it, this is where I say you've got to be a marketing company. What's going to make this person continually come to you and choose you every single year when the insurance companies are hitting them, the economy's hitting them, the price is hitting them, and they don't know if your filling is better than the dentist down the street that is closer to them, is in network with them, and they don't need to drive to you. How do you set yourself apart?   So ways that fee for service practice, like I'm telling you, I got the Taj Mahal. They're amazing. They're great. But even then they struggle. And so I think before we decide we wanna drop out of network, I really want you to just make sure, am I committed to being a marketing company? I'm doing the reels. I'm doing the social media. I'm putting like a freaking banner outside. I am asking for reviews and referrals. I'm making sure that we concier all of our patients. We're doing follows with them. Our doctors are giving them a call afterwards. Like I'm talking next level.   So I go to a fee for service chiropractor. She's amazing. She does a nerve and I have actually some like weird nerve things going on. And so I really love her. She's fee for service. But when I have like something that comes up in my life and I message her, it is an above and beyond over the top on her of like, absolutely care. I take care of yourself. I'm going to reappoint you. I'll reschedule you. It is a white glove service when I work with her. And so I'm willing to pay a premium. I also am able to get in on the weekends. If I need something from her, I message her and she's like, yep.   I, she can do house visits for me, but I think you have to realize like when people are paying out of pocket full price, just doing great dentistry is not enough for them. They are expecting great customer service, great experiences. Why should I be paying my money? And sometimes that's not even enough. And you can say, we've got say to the art this, we've got say to the art that. So what this practice we had to do for fever service, they get a tour every single time we walk them through, we have towels for them. We walk them to the front. They have a dedicated treatment coordinator.   There's somebody who's dedicated for phones. We have a dedicated concierge who sits in the front office who brings things for you. That's the welcoming and greeting who sits there and chit chats, who knows every single patient by name. That is the level of concierge service and marketing for these fee for service practices. If you've got competition around you. If you don't, podcast doesn't apply to you. But I think when most people are thinking about going out of network, they're just like, I'm going to go like screw it. Delta Dental, Aetna, I'm so sick of your freaking fees. I'm going to now be paid what I'm worth.   I don't disagree with you. You are worth that. But I also want to make sure that you're fully prepared to be that high level concierge doctor that has to do so much more to retain these patients. I have another doctor who went out of network, literally almost went bankrupt. ⁓ The practice is struggling. They don't have enough patients. They are constantly trying to recruit new patients. They're looking at it and they're looking to rejoin in network because everything is falling apart. Family's falling apart. Life has fallen apart. Profitability has fallen apart.   because they just did not realize how much effort it is to try to bring in new patients on your own. So one way you could look before you even go into it is look at your new patients and see how many new patients are we attracting just by reviews and referrals alone before I go out of network. And if I'm not bringing in a lot of people by reviews and referrals right now as the best dentist, they love me. I've got like this healthy cult following with them. If I don't have that, I might wanna work on that to see what are the patients who are fee for service   Why are they coming here? Ask them, ask people like, you can survey your patient base. Like what would you guys love? Like if you had to pay a little bit more for dentistry, what would it be? Are you more, because they don't know the difference of a great dentist and a not so great dentist. And I think that that's what people don't realize is our dentistry, as much as I wish that it was a differentiator for patients, it's not. They don't know if that filling in that crown is better than the dentist down the street who's in network. They have no idea.   What they're looking at is cost and even a great experience, they still might come down to cost. And I'm not here to say that it's all cost because I believe that people are willing to pay for great experiences. You look at why does Chick-fil-A do better than McDonald's? We look at why is Target oftentimes better than Walmart, but is it really? And who are you? And I don't think all patients come for cost. I think there is a lot of space in today's world to stand out of knowing their name, driving it, but we also have to be careful because   We are facing real people are like, how's the economy and is it impacting dentists? And I'm like, those who are doing regular dentistry, no, it's not. They're great. But those who are outside of that, so we're talking all on X cases, cosmetic cases, fee for service patients. If they don't have a loyal patient base right now, people are considering costs. They are considering what are we going to do? And I know that that's why you are also probably considering fee for service. What about fee for service? What about this? What about that?   those pieces I think are very much needing to be highlighted and addressed of, all right, if the economy is pushing dollars, what can we do to offset that? If I'm needing to increase our fees to offset dollars within our practice for profit margins, what else can we do for this? And I really think for you to look at when you're going out of network to say, is this something I'm willing to do? Is this something our practice is fully equipped with?   Are we getting enough reviews and referrals just by being a great practice today to go out of it? And am I willing to like up my ante, not just being a great dentist, because you dropped that network guys, they're going to like fly away to a practice that does accept them. And like I said, your insurance company is going to try to convince them because they get a lot more money when it goes through an in-network provider than an out-of-network provider. And they're going to, they hustle them. And so for you to just accept that you will be a marketer, you will be constantly looking for patients.   you'll be constantly trying to fill your books and is it something you want to do? And is that an additional piece you want to add to your already big to-do list or is it not? And you might be hearing like, Kiera's pro insurance. I'm not, we have a lot of offices that are out of network, but I will say my out of network ones, every single call, it is always a, do I get more new patients? How do we get patients? Unless you're in a really busy area, I have a few where like them cutting insurance was the best thing they could have done because they just were inundated with patients.   and it was like kind of pruning a tree and they needed to prune. So them dropping insurances strategically, they were okay if they lost every single patient, they would still be able to take care of their entire team. All the people, they even had like a dental office across the street moving. They're like, that's fine, take our patients. Like we are good with that. But I will say, if you are not prepared to do that, I might just add a pause for you before you go out of network. So thinking about going out of network, run your numbers to see, can we survive when we lost all the patients?   Number two, I want you to think about are we prepared to be a marketing company and what do we need to do to make sure people stay? Number three, look at our reviews and see how many of them and our referrals and our new patients, how many are coming from reviews and referrals of people referring us and would they continue to do so? Please like check your ego, pretend you are not this person. Will they continue to do so if you go out of network? Four, what can we proactively do to make patients want to stay here? Can we start adding some of these concierge pieces or is it like, hey, when we go out of network, we add these concierge pieces.   Can we get people more on membership plans? So when we go out of network, it doesn't hurt us as much because they're tethered to our practice already. I would be prepping and preparing you and this is what we do with our offices before they do it. Some offices still choose to go out of network and I say that's fine. But again, every choice has a consequence, whether positive or negative that you need to be aware of to make the best decisions. And I believe better insights, better knowledge result in better decisions. So if you need help going out of network, you're like, my gosh, these are things that I need help with.   please reach out before you do it. Hello@TheDentalATeam.com. This is how we're able to help you. This is how we're able to just make sure that you've thought through all the pieces and then whatever path is best for you, we're able to guide you through it. And if you've already decided to go out and now we're kind like, shoot, I don't have all these things in place. Great. This is what we do. So reach out. Hello@TheDentalATeam.com. This is what we specialize in. This is what we're experts in and you can choose. It's like, it's a choose your own adventure.   Just make sure you know what the ending looks like for either opportunity so you choose the best decision for you, your practice, and your patients. And as always, thanks for listening, and I'll catch you next time on the Dental A Team

Most sales managers will tell you that the only way to write seven figures in new business is to follow a rigid, uncompromising metrics plan—100 dials a week, three meetings a day, come hell or high water. But what if the secret to elite production isn't a strict script, but rather what we call "opportunistic chaos"?My guest, Thomas Cox, Vice President at Lockton, joins me to share how he broke records by generating $1.7 million in new business in a single year using an unconventional approach to prospecting. Thomas walks us through his background - from playing college basketball when he wasn't cut out for it, to enduring Navy SEAL boot camp, to making the high-stakes jump from carrier rep to broker. We discuss how to drop your ego to learn a new industry, why your physical and mental health dictates your "commission breath," and how to master the art of being "always around, but never in the way." If you are feeling completely drained by your current sales routine, this episode is a breath of fresh air.▶▶ Sign Up For Your Free Discovery Callcompletegameu.com/agaKEY MOMENTS(00:00) Intro(01:26) The Accidental Walk-On: Riding the Bench as a 6'4" Center in LA(03:17) 29 Days in Boot Camp: The Navy SEAL Dream and an Earth-Shattering Injury(04:40) The Airport Encounter: How a MetLife Executive Launched Thomas into Insurance(08:12) Shifting Territories: Climbing the Corporate Ladder at MetLife, Aetna, and Guardian(10:08) Burn the Ships: Making the Unconventional Leap from Carrier Rep to Broker(12:21) The Reality Check: Why Your Golf Buddies Shouldn't Be Your First Prospects(14:56) Dropping the Ego: Sitting Next to Account Teams to Learn the Watch is Made(18:19) Breaking Records: Writing $1.7 Million in New Business In One Year(20:30) Reversing the Drain: Moving from Hated Cadences to Relationship Networking(23:52) The Health Journey: How Physical Wellness Eliminates Your "Commission Breath"(26:42) Outcomes vs. Tactics: Managing a Calendar Without a Rigid Activity Plan(28:36) Opportunistic Chaos: Blocking Time to Go Ballistic on Messaging(31:37) What Separates Mentally Tough Producers from the Rest of the Field(35:58) Thomas's Lightning Round: Whoop Data, Tonal Lifting, and Singing the National Anthem at a Royals GameCONNECT WITH ANDY NEARY

In this episode, Lisa Baird, Chief Executive Officer of Aetna Better Health of Missouri, joins the podcast to discuss keeping community needs at the center of healthcare strategy. She shares how her organization is reaching members in rural areas, improving access to care, and navigating evolving Medicaid eligibility requirements while continuing to support vulnerable populations.

We spoke with Travelers Championship Tournament Director Nathan Grube about the Birdies for Charity program, which offers a 15% match on donations thanks to Webster Bank and Aetna. Over 220 charities are participating this year.

Special discounts up for AIE Melbourne (LS discount) and AIE World's Fair (group discounts up to 25% - CFPs still open for Autoresearch and Vertical AI) Cya there!Abridge did not start as an “GPT wrapper”. It was founded in 2018, years before the Cambrian explosion of AI application layer companies. OpenAI launched ChatGPT publicly on November 30, 2022 and by then, Abridge had already spent years doing the unglamorous work of building trust for one of the highest context, most important workflows in healthcare: the conversation between a patient and a clinician.Abridge's original wedge was clinical documentation. Listen to the visit, generate the note, reduce the clerical burden, and let clinicians spend more time with patients instead of the EHR. By focusing on how doctors actually document, how health systems actually buy, how EHR integration actually works, how clinicians verify outputs, and how missing context during a visit turns into downstream friction across billing, prior authorization, quality, and follow-up, the adoption of LLMs became a force multiplier on a workflow already optimized for sensitive context gathering.The company has scaled fast: Abridge says it is projected to support 80M+ patient-clinician conversations this year across 250 large and complex U.S. health systems, with support for 28+ languages and 50+ specialties. It raised $300M at a $5.3B valuation in June 2025, after a $250M round earlier that year.Today, Janie Lee and Chaitanya “Chai” Asawa of Abridge join us for another crossover pod with Redpoint's Jacob Effron (who is on the board of Abridge) to dive into how Abridge is building the clinical intelligence layer for healthcare starting with ambient documentation, then expanding into clinical decision support, prior authorization, payer/provider/pharma workflows, and eventually real-time agents that act before, during, and after the patient conversation. We go inside the product, data, infra, evals, workflow, privacy, and org design choices behind bringing AI into one of the highest-stakes enterprise environments from 100M+ medical conversations and specialty-specific evals to real-time alerts, EHR integration, de-identification, clinician-scientist teams, and why healthcare may solve some of the hardest AI problems first.We discuss:* Why Abridge started with clinical documentation, “pajama time,” and saving clinicians 10–20 hours a week* The transition from ambient scribe to clinical intelligence layer: save time, save money, and save lives* Why conversations between patients and clinicians may be the most important workflow in healthcare (patient visit summary feature)* Chai's “healthcare-coded Glean” framing: context is king, but healthcare raises the stakes on safety, evals, and rollout* Why Abridge wants AI to feel like “air conditioning”: always in the background, but only interrupting when it truly matters* The prior authorization example: turning a denied MRI weeks later into real-time guidance while the patient is still in the room* Why payer policies, EHR data, medical literature, and hospital-specific guidelines make the problem hard, and also create the moat* How Abridge thinks about ambient form factors: mobile, desktop, in-room devices, nursing workflows, multimodality, and future AR* The multi-sided healthcare customer: CMIOs, CFOs, CIOs, clinicians, patients, payers, and pharma* The hardest AI problem at Abridge: high-quality, low-latency, low-cost real-time support in a high-stakes clinical setting* When Abridge uses frontier models vs proprietary models, and why its unique data from medical conversations matters* Why “every agent is a coding agent underneath,” and how the EHR can be thought of as a filesystem for healthcare agents* How Abridge approaches personalization across individual doctors, specialties, and health systems* Why “AI slop” is AI without context, and how edits, memories, and clinician preferences create a data flywheel* Abridge's eval stack: LFDs, LLM judges, in-house clinicians, third-party evaluators, specialty-specific evals, and progressive rollout* HIPAA, PHI, de-identification, one-way anonymization, customer contracts, and learning from healthcare data safely* What changes when you operate at 100M+ conversations: reliability, cost, post-training, model routing, and infrastructure optimization* Why the same clinical conversation can serve doctors, patients, payers, pharma, and future clinical-trial workflows* How Abridge works with EHRs, and why deep interoperability is table stakes for clinician adoption* Why healthcare AI has regulatory tailwinds, why 80/20 does not work here, and why high-stakes domains may drive AI forward* Why Abridge embeds “clinician scientists” into product and eval teams* What Chai learned from Glean about search, quality, and durable AI infrastructure* Why the future of AI infra may look like context layers, event-driven systems, Kafka, Temporal, sockets, CRDTs, and tools built for humans* Why Janie changed her mind on “PRDs are dead,” and why crisp written clarity matters more in complex AI products* How Abridge uses Claude Code, Cursor, and coding agents internallyAbridge:* Website: https://www.abridge.com/* X: https://x.com/AbridgeHQJanie Lee:* LinkedIn: https://www.linkedin.com/in/janiejleeChaitanya “Chai” Asawa:* LinkedIn: https://www.linkedin.com/in/casawaTimestamps00:00:00 Introduction and what Abridge does00:02:05 From ambient documentation to clinical intelligence00:04:04 Clinical decision support and context as king00:06:57 Alert fatigue, proactive intelligence, and prior authorization00:12:36 Ambient AI form factors and healthcare customers00:16:59 The hardest AI problems in healthcare00:18:26 Frontier models, proprietary data, and model strategy00:21:07 The EHR as a filesystem for agents00:24:03 Personalization, memory, and clinician preferences00:30:40 Evals, LLM judges, and progressive rollout00:36:47 HIPAA, de-identification, and privacy00:39:21 100M conversations and operating at scale00:44:10 EHR integration and the clinical intelligence layer00:46:39 Healthcare regulation, latency, and high-stakes AI00:50:11 Clinician scientists and long-tail quality00:53:04 Lessons from Glean and durable AI infrastructure00:57:03 The future of agentic healthcare workflows00:57:34 PRDs, product clarity, and building serious AI products01:03:11 AI coding tools at Abridge01:04:06 OutroTranscriptIntroduction: Abridge, Clinical Intelligence, and the Latent Space x Unsupervised Learning CrossoverSwyx [00:00:00]: Okay. This is a special crossover Latent Space Unsupervised Learning pod.Jacob [00:00:07]: Very excited to do this.Jacob [00:00:08]: At this point, we get together once a year.Swyx [00:00:10]: Once a yearJacob [00:00:11]: And this is a fun occasion to get to do it on.Swyx [00:00:13]: I really wanted to talk to Abridge but I felt very underqualified because healthcare is not something we cover very intensely. It just so happens that Redpoint's our big investors and supporters of Abridge.Jacob [00:00:27]: Anytime you want to have a portfolio company on your podcastJacob [00:00:29]: Please, by all means.Swyx [00:00:31]: So we'll introduce our guests. Chai and Janie, welcome to the pod.Janie [00:00:34]: Thanks for having us.Chai [00:00:35]: Thank you.Janie [00:00:35]: We're excited to be here.Chai [00:00:36]: Thank you.Swyx [00:00:36]: So for listeners, what do you guys do, just to situate you guys in the company?Janie [00:00:42]: Abridge is a clinical intelligence layer for health systems. We really started with documentation and building for clinicians and as we think about reducing the burden that clinicians have, they're spending 10 to 20 hours a week on documentation. There's a massive doctor shortage in the country. We also think that conversations between patients and clinicians are probably the most important workflow in healthcare. It's where care is given and received but if you think about the 20% of our GDP that goes towards healthcare, almost everything is a derivative of that conversation, whether it's the claim, the payment, the actual diagnosis given, the treatment. And we've started with a conversation to reduce the burden for doctors on documentation but we're really excited about the path ahead as we become this broader clinical intelligence layer.Chai [00:01:34]: I'm Chai. I work on clinical decision support at Abridge.Swyx [00:01:37]: Yes.Chai [00:01:37]: And so as Janie said, we're uniquely situated where we started off with the clinical note. What I'm really excited about and where we're expanding towards is what are all the things you can do before the conversation, during the conversation and after the conversation if you did have access to all the context about patients, payer guidelines, medical literature and put that together and to serve, how healthcare could look fundamentally different.Swyx [00:02:01]: And that's the context engine that you guys have?Chai [00:02:04]: Yes.Swyx [00:02:04]: Is that what it's called? Okay.Swyx [00:02:05]: So historically, as I understand it, the company started in 2018. A lot of people would be familiar with the AI voice notes form factor that doctors would be “Well, do you consent to being recorded?” It replaces handwriting and what have you. But it sounds like more recently there's been a big transition in the company. Tell me about the broader transition.From Documentation to Clinical Intelligence: Save Time, Save Money, Save LivesJanie [00:02:26]: So from a transition perspective, we really think about our journey as The first act was: how do we help save time? And that's where a lot of that original product was.Swyx [00:02:37]: By the way, one of those interesting statsSwyx [00:02:39]: On your landing page was, doctors spend time after hours.Janie [00:02:43]: They call it pajama time.Swyx [00:02:44]: Why is that pajama time?Janie [00:02:46]: Doctors after work in their pajamasSwyx [00:02:48]: In their pajamas. OhJanie [00:02:49]: At home are just writing and catching up on their notes every day.Janie [00:02:53]: Some of our favorite customer love stories, we have a Slack channel called Love Stories. We have clinicians telling us, “Abridge has helped us, from retiring early or we're now finally able toJanie [00:03:06]: go home and eat dinner with our kids for the first time.”Chai [00:03:08]: Save the marriage in some cases.Swyx [00:03:10]: One of the quotes was “We're not divorcing anymore.”Swyx [00:03:12]: I'm asking, “Why?”Swyx [00:03:14]: Because they're working too much.Janie [00:03:16]: But, in terms of where we're going and where we're expanding, we really think about our second and third acts around how do we help health systems save and make more money. Health systems are operating with record-low operating margins. It's getting harder and harder to serve patients and they have regulatory, some tailwinds but also a lot of headwinds coming their way and AI is ripe for helping on the saving and make-more-money piece. And then ultimately, how do we help save lives? The fact that our software and our product is open millions of times a week before, during and after a patient walks in the room, gives us massive opportunity with products like clinical decision support, which Chai is building but so many others to improve patient outcomes and probably one of the most important workflows and problems to be going after right now.From Glean to Healthcare: Context Is KingJacob [00:04:04]: One thing that's interesting, Chai, is you came over to Abridge from Glean and clinical decision support, which for our listeners is, in the context of a visit, helping a doctor figure out the right type of care. It's really a search problem in many ways, going through lots of different data sources. Very analogous to your previous role as one of the earliest engineers over at Glean. I'm sure a lot of our listeners are curious what's similar about the problems that you're going after now and what feels different, now that you're in healthcare.Chai [00:04:33]: Very similar. Taking a step back, with every wave, there's a lot of very similar patterns that happen across different products. A lot of social networking products look the same. A lot of credit-based products look the same. And we're seeing that very similar in the agent era with many companies, of course, in Redpoint's portfolio and so forth. And the key insight between both companies is that you have amazing models but context is king. Context is what puts them to work. So I see it in a lot of ways, a lot of similarities in this is a healthcare-coded version of Glean but the differences are really interesting. A couple things that come to mind. First and foremost, the rigor of the setting we're in. The downside risk is extremely high here in healthcare. It can be fatal in some cases. You prescribe something that the patient is allergic to for example. Whereas at Glean, it's “Oh, you got the question wrong.” It wasn't the end of the world in most cases. And so what does that mean? That shapes our evaluation strategy, both offline evaluation, progressive rollout and there's a lot more we could go into there. Second thing that comes to mind is, vertical versus horizontal. In both cases, there's a large variance but when Glean is, it's a much more horizontal company, there's a variance of personas, companies that you're working with. We also have a variance of personas, different types of specialties, different hospital systems. But the variance is a little more narrow. So from a product perspective, you're able to focus far more, especially when you have a maturing technology and you're building new products that never existed before. It lets you go after them much more easily and especially in healthcare where so many problems were solved with labor and process, that it's extremely ripe for AI to keep helping augment and enable. And the final thing that's really interesting, Abridge specifically compared to many other companies in the AI area, is the modality we started with where we're ambient and we're always listening in the background. And many more AI products will go that way but it's how we started. And that's the greatest form of AI we can create, AI that's seamless. You're not looking at your screen. It's always there. It's always helping you out and being proactive. The Jarvis vision that, every hackathon I went to over the past decade, there was always a Jarvis competitor. But Abridge very much started from the opportunity and continues to go that way.Ambient AI and Alert Fatigue: When Should the Product Interrupt?Jacob [00:06:57]: One thing that is super interesting then from a product perspective is you have this always-on seamless in the background and then you have to decide when you break the wall almost and say, “Hey, clinician, you might not have thought about X,” or whatever it is that you want to do. And in healthcare traditionally there's been this idea of alert fatigue and a million pop-ups and then a doctor just ignores all of them. It's probably a pattern that a lot of builders are thinking through now. How do you think about the right way to intervene or to pop up in a doctor visit?Janie [00:07:26]: It's such a good question. Alerts are notorious in healthcare specifically. Over 90% of alerts are ignored. The first and most important thing is context is everything, as Chai alluded to and I also think about how do we go from being reactive alerting to really proactive intelligence at the point at which it matters most. One thing we like to say is we want our product to feel like air conditioning. It should be in the background just making things better and if there is something that has great clinical risk and we're acutely aware that intervening now and not later is incredibly important, we should decide to act. But if you think about proactive versus reactive, instead of alerting a clinician during a visit when they're with their patient having a pretty serious and sensitive conversation, how do we prep a clinician before they walk into the room with that patient? And so historically, clinicians might have to manually go through charts with a patient that they've had over the course of months or years and they'll try to suss out what are the things they should be doing. You can imagine a world with Abridge. We'll summarize all of the most recent context for you, tell you based on the reason for a visit the patient is coming in for the types of things you should be discussing. And so you're going into that conversation prepped rather than walking in cold to that patient visit and then having this product interrupt you five or 10 times throughout the visit. And there might be times where it's really important to interrupt. We have a product called Prior Authorization and so this is when you may go into a doctor's office with knee pain. They'll prescribe you an MRI and so many of us have had this experience before, where in four weeks you'll get a call saying, “Hey, Sean, that MRI that you were prescribed wasn't approved and why don't you come back in? We'll figure it out.” In a world with Abridge, we might choose to quietly but still alert a doctor in that visit. And alert is probably not even the word we would want to use. Before a patient leaves, we would want to tell the doctor, “Hey, Doctor, before Sean leaves, you should ask him, has he had physical therapy and has his pain lasted for more than six weeks? Because the Aetna plan that he's on in California requires six things. We've already confirmed four of them have been met ‘cause we have all the context. But these two last criteria, if you can address with Sean before he leaves the room, we could guarantee that your MRI is approved before you leave.” And so when you think about clinical usefulness, impact to the patient, there are instances in which if we can catch a doctor while the patient is still in the room, as we think about save time, save money, save lives, we get to check all of those boxes. But when doctors have 15 minutes between visits, we have to be really thoughtful about when it matters.Prior Authorization: Reducing Latency in CareChai [00:10:23]: There's this interesting product opportunity AI has is reducing latency in the world. For example, prior authorization is an example of where care gets delayed and so great AI can reduce that. And the problem with alerts before partially is a technical problem: the quality of your alerts really matters. They're going to get ignored if you get alerts that... Similarly in engineering, where they're noisy alerts that you can't act on. But if you can make really high-quality alerts with both the context, as Janie said, and really high-quality models, then you can create a whole other game.Janie [00:10:53]: And I really like that experience because it starts to tease apart, what makes this so hard and unique. One, to make that prior authorization example possible, think about all the data that you need to have. You need to integrate with the electronic health record to know all of the patient context. Do we have access to your previous labs, previous imaging? And then to match you and to know that you're on Aetna, we have to collect all of the different payer policies and they vary by state. Some of these payer policies live on websites. Some of them live in unstructured 50-page PDF files.Jacob [00:11:31]: I thought this episode wasJacob [00:11:31]: To make sure we didn't scare people from healthcare.Janie [00:11:34]: But when you think about the things that make it hard, it also gives you the moat.Janie [00:11:39]: And then the second is the AI and the model quality we need to be able to hang our hat on. And so the bar, similarly when I worked at Opendoor, I worked on pricing models. Every outlier wiped out the margins of 30 and so similarly here in healthcare, the bar for accuracy is so high. And then I'd say the last is workflow is everything. If insurance companies deploy AI, it typically happens too late and this is when you have the notorious comical examples of AI just fighting each other when it's too late. But if we can pull forward the use of both the AI but also the ability to solve problems when the patient's in the room, you can start to collapse what typically takes weeks or months after your visit, ideally down to minutes or real-time. And it's where healthcare is both very difficult but also extremely rewarding if you can crack it.Product Form Factors: Mobile, Desktop, In-Room Devices, and ARSwyx [00:12:36]: Just to get some baseline on the form factors, because I've seen some videos on your website and stuff. You guys talk a lot about ambient AI. Is it primarily on the phone? Is there any other form factor that people get Abridge in? Is there an Abridge room setup where it's always on? I don't know.Jacob [00:12:55]: An Abridge podcast studio.Janie [00:12:58]: Primary form factor is mobile and desktop. UsuallyJanie [00:13:00]: Clinicians are walking in and out of rooms with mobile but at the end of the day, when they're closing out their notes or wanting to prep for the day ahead, they might use desktop. We have been having a lot of really interesting partnership conversations with a lot of these in-room device companies as you think about the power of multimodality and even more data, as you think about all of what is not captured today. It is fascinating to think about, especially even as we go into building and scaling our nursing product. It's one where nurses constantly, as they're walking in to check in on a patient for two minutes or maybe even 30 seconds,Janie [00:13:43]: Starting an Abridge experience is probably going to take longer than the visit. And so what can we do with in-room devices that are always on starts to raise really interesting and fun product questions.Swyx [00:13:54]: I was thinking, the way in tech companies we have all these Google MeetSwyx [00:13:58]: And other things, we might as well set up entire rooms with just Abridge tech.Chai [00:14:02]: Very much. AR glasses and related form factors are also relevant: how do we bring the information to the clinician in real-time without a screen, while still letting them focus on the patient?Swyx [00:14:18]: Do you think they want that? I'm skeptical of AR, but I'm curious what you've tried.Chai [00:14:26]: Admittedly, it's not a near-term product roadmapChai [00:14:29]: By any means. I'm being far-fetched.Jacob [00:14:31]: There's some sick AR stuff for surgeries.Swyx [00:14:33]: Really?Jacob [00:14:33]: When people are trying to visualize, you're about to make an incision but you want to see, what the cut might look or what the body might look like inside and they can layer in imaging.Swyx [00:14:43]: That's cool.Chai [00:14:45]: At some point in the future.Janie [00:14:46]: But there are a lot of our largest customers and at the largest health systems integrating already and so even as we think about building into it, unlocks a lot of product capabilities.Swyx [00:14:57]: And just to establish the terminology. Sorry, and I know I'm asking basic questions somewhat for myself but also for the audience who might beHealth Systems, Buyers, Clinicians, Patients, and PayersSwyx [00:15:05]: Less integrated. When you say health systems, it's like the Johns Hopkins, the Kaiser Permanentes.Janie [00:15:09]: Mayos, the Kaisers of the world.Swyx [00:15:10]: These are your customers, right? And the outcome that you deliver for them is happier doctors, reduced cost of processing, reduced mistakes. It's weird in a sense that I feel like there's also, a secondary customer, the customer of the customer and I don't know if you — do you think about it that way?Janie [00:15:28]: The other interesting and complex part of building product is we have our buyers, who are the chief medical information officersJanie [00:15:39]: The chief financial officers, the CIOs of these large health systems. Our users today are clinicians but if you think about who downstream is impacted, it's patients. And so as we build, with every product in mind, we think about who we're building for, who the secondary user is and what does that mean either in terms of experience, security compliance, ROI that we have to make tangible. And so like you said, time savings is one of them. But for CFOs, they care a lot more than just time savings. We have to show for every dollar you put into Abridge, because you have more compliant documentation or because you have fewer queries coming from your billing team, we save or add real dollars to your bottom line or top line, are things that we're constantly thinking about because of the dynamic across all three sets of users.Chai [00:16:32]: There's a whole other axis too with the payers and pharmaChai [00:16:35]: as well. Connecting all these three big stakeholders in healthcare isSwyx [00:16:39]: Do the payers ever see your data? Sorry, the payers meaning the insurers, right?Chai [00:16:44]: Yes.Swyx [00:16:44]: They also see Abridge data?Chai [00:16:47]: NoSwyx [00:16:47]: Like the direct integration to you guysChai [00:16:48]: They wouldn't see the raw Abridge data but when you're working together on something like prior authorization, whatever information they need, we'd communicate to them.Jacob [00:16:59]: That's cool. I would love to dig into the AI side. You still have a lot of problems on the AI side. And so maybe to start at the highest level, what's one of the hardest problems you have to solve in AI at Abridge today?The Hardest AI Problems: Quality, Latency, and CostChai [00:17:11]: To make things simple, let's take, building off the prior auth example. So one thing Janie talked about is okay, this data is all over the place and there's this combinatorial explosion of procedures, payer policies and even sometimes different health systems. There can be some cross-product of all of these different considerations you have to take into account. But what's really hard about this problem is doing it real-time in the conversation. So, in any AI product, usually the three KPIs you care about are quality, latency and cost. Now, what we're saying is we want you to do this real-time in the conversation, guiding the clinician. How do we do it in a way that does not break the bank? But we're using — But we also need very intelligent models because you're working with this cross-product of data and this, all this context layer as well. So you need high intelligence and high-quality because you don't want the alert fatigue but you also need to be fast and cost-effective. And so that's where a lot of clever engineering goes. It's okay, without getting into all the details here, can you model these policies in some intermediate representation or other things that you can do that can make this problem tractable? And of course, the Pareto frontier is always changing but we are also trying to do this now.Model Strategy: Third-Party Models, Proprietary Data, and Medical ConversationsJacob [00:18:26]: What implications has that had for what you take off-the-shelf and say, “ what? We don't need to be world-class at X. We'll just take this from the model providers or from some infrastructure player,” and what you're “No, this is where we spend most of our time focused on”?Chai [00:18:38]: This is, the fun challenge in AI?Jacob [00:18:42]: It changes every three months? SoChai [00:18:42]: Of course, with the shifting landscape, we try to be extremely thoughtful on predicting the trends of where third-party models are going and where we can uniquely go. And, sometimes when you talk about AI models, we're the models are just going to get infinitely better. But I don't think... It may be in the grandness of time you could say that but, within every month, every quarter, there's specific ways they're getting better. They're training on a lot more, coding data to be better coding agents, for example. And soChai [00:19:14]: We have to think about where are the things that won't — unique data that we're uniquely training on or to step back a little, where is a proprietary model bringing advantage to us is if it can give higher quality or lower cost and latency for similar quality, very similar to many other companies. And when we can do that is when we have proprietary data. So, for example, we have on the order of eighty million or hundreds of millions now getting close to of medical conversations.Jacob [00:19:44]: It's insane.Chai [00:19:45]: This is a unique data set. And this data set, it's very interesting because this data set is effectively a large part of the trace between the patient and the provider. That's where the quote-unquote debugging happens in healthcare. We have these traces at scale, as in as, our CEOs even called it, an exhaust that comes out of our product. And so when you have these traces, that's how you can train better agents on certain use cases, whether it's your transcription diarization use cases or so on or like note generation models and we can do that much cheaper and faster. But we're always also working with these third-party model providers. We closely collaborate with them and that's how we predict where the trends are going. The thing that I think about a lot is that, I know that the model providers are going to train much more on agentic workflows and so forth, so that's great, so that you have a better agentic harness. But the other thing that's interesting is that the model providers, because a large class of the consumer model providers is healthcare queries, that they might, optimize to train a lot of healthcare data to encode the knowledge in its weights. And this is just a great thing for us as well, where the off-the-shelf models can keep bett-getting better at general healthcare information, such that what our strategy is, we have a constellation of models, we can use something for this, that and, we only care about, at the end of the day, the best product experience.EHR as File System: Agentic Workflows and Real-Time InterfacesJacob [00:21:07]: And, you have, overall capabilities improving. I'm curious, as these models get better, is there something you look at and you're “, three months ago, we really couldn't do that but God, the the latest models really allow us to do it”?Chai [00:21:19]: So here's something interesting that I've, been toying with. So all models are... This wasn't super obvious a year ago but now it's become clear and clear that almost every agent is a coding agent underneath the hood? So you give it whatever file system, it can write its own code and so forth. So when you think about within healthcare and the use case that we have, you can think of the EHR effectively like a file system. It's just — it's a storage of all this information. It's a lot of information there that cannot fit into the context window, at least of today's models and you want to use that context effectively for all these product use cases we're talking about. And so if you have better agents that can, manipulate data, read that data, treat it as a file system as we see they're going and we know model companies are investing this way, then that very directly benefits us.Swyx [00:22:09]: Yeah. Okay, cool. Again, just establishing basic things. But we're going back to the model stuff. I'm really interested in double-clicking more on the real-time, element, which is pretty important for both of you. Is it — Is real-time just batches of every one minute, every five minutes? Is that how we do it? Or is there some more native, genuinely real-time in the sense that OpenAI has a real-time API or Gemini has a real-time API?Chai [00:22:35]: Yeah. Yeah. So today it is more on the on the batch basis but there's interestingChai [00:22:41]: Prototypes that we have that we're still not fully, full time, voice in text out or in that sense. But, can you trigger your models, your agents or agentic workflows, depending on the right times in the conversation?Chai [00:22:58]: And so you can imagine, different techniques to bring this latency down and, you want to bring the feedback loop down as much as you can. And so a lot of clever engineering there without fully... Maybe one day we'll do full voice in and text out, train a model to do something like that.Swyx [00:23:15]: You do — People don't want voice in voice out?Chai [00:23:18]: Now we aren't creating experiences that are, during the conversation, inter — It's almost likeSwyx [00:23:25]: Might be too disruptiveChai [00:23:26]: Too disruptive until, who knows, maybe eventually you could have full voice agents once we — the quality and we improve the comfort of the technology. But right now gra — that change is much more gradual and it's more text focus, text out.Janie [00:23:42]: And so much of currently what our product is trying to do is allow a clinician to focus on their patient and maybe at some point but right now patients, clinicians don't want a third voice, at least in a literal voice in that room. And so how do we be there with all the contacts and information ready at hand when there's the right moment?Personalization: Individual Doctors, Specialties, and Health SystemsJacob [00:24:03]: Jenny, one thing I'm curious about is how you think about, personalization in the product. I imagine, every doctor is a special snowflake in their own way, has their own way they like to do things. There are probably a bunch of different approaches you could take to doing that, both within the model layer itself but then also just with clever prompting or engineering. How do youJacob [00:24:20]: Deliver on that?Janie [00:24:21]: It's such a good question. Personalization is massive for us. We think about personalization at three levels. The first is at the individual, the second is at the specialty level and then the third is at the health system or the organization level. To your point, there are a lot of individual preferences. You-When a note is produced, it almost is a reflection that is so deeply personal of a doctor's work and how they give care. And so do they have preferences on things like style? They might want bullets versus paragraphs, really concise versus comprehensive. They also might have phrases that they really like to use or the templates that they want every note to be structured. And, we see it in our feedback all the time. We want two spaces in between sentences or I refuse to use this tool. And so that's something that we've had to build in. And the tricky part is how do you make sure that stylistic preferences don't interrupt accuracy and quality and that's something that we've really had to refine and hone over time. Second is at the specialty level. A cardiologist note or workflow is going to look very different from a dermatologist workflow.Jacob [00:25:32]: I assume cardiology notes are the highest stakes for you guys, given your CEO is a cardiologist.Jacob [00:25:36]: It's “Oh my God, make sure we get this one.”Janie [00:25:37]: Shiv, our CEO, is still a practicing cardiologist. He rounds once a month. And so, first call when we want just quick and easy user feedback too.Janie [00:25:46]: But, specialties require a lot of personalization, both in terms of what does the product look and so we make sure that as new users onboard, we catch that and the product proportionally reflects that. But also on the back end, evals at the specialty level, they are hard-earned to calibrate and get. What does a really great dermatology note look like? What makes it complete? What makes it compliant and billable is very different than a primary care doctor. And so it's not just about what does the product experience look but on the back end tuning and really deepening our understanding for the specialists. What does great output look like? And that's, a problem that we need to calibrate internally, externally, online, offline but, takes lots of cycles but is necessary in a high-stakes environment. And then at the health system level, for products like clinical decision support, you have health systems who've spent years or decades refining their best practices and they want to know, “Hey, we love your clinical decision support product but how do we embed our own hospital guidelines into them to inform clinicians before, during or after a visit what brest — best practices should look like?” And as you think about, deepening moats as well, when health systems, trust us with that data, allow us to productize it and directly into the clinical workflow, makes us a really great partner to health systems who want to build something that truly meets their needs, their practicing guidelines.AI Slop, Memory, and Product Data FlywheelsChai [00:27:23]: And I want to add onto that. The for the clinical documentation problem, it's very similar to AI writing that doesn't feel like your own and then we call that slop. But the way I describe one framing of slop is like AI without context. But we have all that context and both the clinicians, can have it and can guide it. And so part of the other interesting exhaust for us is, memory is, one of these new systems recordsChai [00:27:49]: Almost.Janie [00:27:50]: And we also have all the edits people make on our product and when you think about a data flywheel and how we get better over time becomes really powerful as a mechanism to just going deeper in personalization.Jacob [00:28:04]: It's interesting. I love this idea of working with systems on the guidelines they built up over a long time. I feel like so many of the best AI app companies today are... The question is: How do you take the expertise that a law firm or a bank has built up over many years and then add that as context and also a special sauce over, a an AI tool? And so seems like y'all are really doing that very effectively.Janie [00:28:24]: We're now starting to have our customers ask, “What are other customers doing?”Janie [00:28:28]: “And how are they doing it?”Janie [00:28:30]: And as we think about having visibility across such a large set of care being delivered right now, a really interesting place we could also partner.Swyx [00:28:40]: I'm just curious. I — This may be a nothing question but, how different are health system guidelines from each other? Don't they all converge to the same thing? And if not, where do they differ?Chai [00:28:52]: At a really high level, they're going to talk about very similar things but the difference is probably in some more of the details. “Oh, you should refer to specialists only when XYZ conditions are met,” or so forth and maybe different organizations have different practices and guidelines around that. But high level, talking about similar things but the details are what, of course, that shapes the context and the decisions you make.Swyx [00:29:15]: And this all goes into the context engine and it might affect the notes but maybe not.Chai [00:29:21]: The — For these local pathways, we're definitely thinking about it a little more for our clinical decision support product.Chai [00:29:26]: So yeah.Swyx [00:29:27]: Which is your stuff, yeah.Swyx [00:29:28]: And then the memory which you raised, let's just tell us more about that. What have you tried in memory? What's the structure of the memory? What works? What doesn't work?Chai [00:29:38]: There's, of course, many different ways you could do memory, where it's okay, can you bake it into the model weights or can you do it in some external store? For us, what's interesting is, of course, when you think the models are rapidly changing, whether it's in-house or third-party, baking into the model weights, sometimes you worry that it could be a little throwaway. And so, how do you... You need to find a way that you decompose the problem, the preferences from the underlying models and so forth. The thing we're right now most both that's easiest to start with and we're excited about is having, a separate store for memory, where you have, for example, a memory sub-agent that's, working in the background, figuring out what are the important parts of the clinician's actions that we want to remember for the long term. And then you can also imagine, other things where in the — you have background jobs that are running that are collating these, memories similar to Sleep, of course and what other pattern, patterns products do as well. Learning over all these action, all the action data we have, again, note edits, the conversations they did and the actual transcripts.Evals: LFD, LLM Judges, and Clinical SafetyJacob [00:30:40]: What about evals? How in the world do you... It is such a complex product surface area. We would love to hear you riff on that and also how has that evolved? I'm sure you've gotten better at it, so any learnings along the way.Janie [00:30:50]: From an evals perspective, we, from day one when we build any new product or feature, we think about, what does good look like? And there are table stakes things like clinical safety but then you start to get deeper into what does good quality look like. And when you go into something like our core product, there's stuff like style and completeness and there's things like does this note become something that can be billable, which is very high stakes for a health system. We have a number of ways in which we get confidence for this. We have, internal in-house clinicians who do what we call an LFD process to give us our very first pass at is this or isn't this a good enough output, look at the effing data.Jacob [00:31:41]: LFD?Chai [00:31:42]: That's why I was smiling. I was “Is Janie going to mention what it stands for?”Jacob [00:31:46]: I was not... There's like a million acronyms.Jacob [00:31:48]: How am I supposed to know that I don't? So “Oh yeah, of course, an LFD.”Swyx [00:31:51]: I've never heard of LFDs.Chai [00:31:53]: It's a bridge for sure.Janie [00:31:55]: I got through three days and then I had to ask someone.Janie [00:31:58]: I thought it was just me that didn't knowJanie [00:32:01]: It's our internal process.Swyx [00:32:02]: But look at the data as a meme in ML, ‘cause you tend to not look at it. You just want to look at number go up.Chai [00:32:06]: Exactly.Swyx [00:32:07]: But yes.Janie [00:32:08]: But so, we make sure we look at the data and then as we think about all of the components of good output, we, one, create LLM judges across all of these and we make sure with annotated data and either internal or external evaluators, we feel like these judges are calibrated. And then depending on the stakes, we also work with in-house and third-party evaluators across all of these before we ship any big change. And the goal is, in terms of evolution, how do you go from this process taking months, down to weeks, down to days? Some of it is, a true science and ML problem. A lot of it's also just, hard operational work. Have you planned ahead in terms of what you need? Have you really optimized the capacity that you need across all of the different specialties you need? Have you gotten a really good sense of which third parties are great to work with for what use cases? This takes a lot of domain, expertise and, lots of mistakes and errors in figuring that out. And so as much of it is an ML problem, so much of it has also been operational gains that are hugely important, where domain-specific expertise is everything.Specialty-Level Evaluation and Progressive RolloutsJacob [00:33:23]: But it's funny, ‘cause I feel like people talk about healthcare like it's one giant market and the reality isJacob [00:33:26]: It's, dozens and dozens of sub-markets. And so it feels like in your evals you have to build that up across the board, probably.Swyx [00:33:34]: And is specialization the primary cardinality at... That's the word that comes to mind.Janie [00:33:40]: Sometimes, depending on the product or the use case. And so if we're making a note improvement or feature for a particular specialty, definitely but we have products that are for nurses. We have products that, are really aimed at making the document or the output a lot more billable. And so we'll want to work with coding teams and not necessary clinicians. And so likeJacob [00:34:05]: Coding meaning healthcare coding.Janie [00:34:06]: Yes. Yes.Jacob [00:34:07]: NotChai [00:34:07]: Yes. I see you.Swyx [00:34:07]: Other kinds.Janie [00:34:09]: But is this output proportional to the work that was delivered? Is there sufficient documentation to justify the amount that a health system may end up charging? And so, specialty sometimes but also domain, very different across all of the different products that we're working for. And building out that network is, not easy and is where a lot of our operational investments have gone into.Chai [00:34:35]: And I view a lot of analogies to self-driving cars here, where, part of it is we really want progressive rollout of features to test in the real world is this useful? Is this going to work? One big difference compared to past lives is before I'd build a product, maybe I'd alpha it and then I'd like GA it the next week, ‘cause I'm “Go, move fast, ship,” and whatnot. But the mentality is like you... I want to make contact with the reality as quick as possible but I want a progressive rollout. Because as much as I get as large of an offline eval set, I want the distribution of that to match real-life distribution. And over time, by rolling out early, similar to Waymo has a tagline, “The world's most experienced driver,” another thing that can, at least linearly increase for us is, both the size of our evaluation offline and online, that and it all feeds back.Janie [00:35:25]: Something that's been earned over time, speaking of evolution, is just the trust we've gotten with customers. Historically, a lot of these health systems, when they bring on new vendors, their release cycles are quarters, sometimes twice a year. We've gotten our customers onto monthly release cycles, which is pretty fast for health systems but what is more exciting over the last, call it, few quarters, has been, a subset of our customers have said, “We want to innovate with you. We trust you,” and we have a pretty, decent chunk of our customers who say, “We'll develop with you outside of these monthly release cycles. We have a higher tolerance. We know that the stakes are very high but we want to be the first ones using these products, giving you feedback.” And so for a pretty substantial set of our customers, we've been able to convince them to be able to ship, in this gradual way before GA. Something we talk about a lot internally is, trust is earned in drops, earned in buckets and so we still can't do what I used to do when I worked at Loom. We had 30 million users. I'd just be, rolling out experiments left and. The bar is still quite high for iterative rollout but because of the trust we've earned, we're able to learn at pretty high volume very quickly.Privacy, HIPAA, and De-IdentificationSwyx [00:36:45]: Your scale is still pretty huge.Swyx [00:36:47]: One thing I want to... We were going to go into scale? In a sec. One thing I wanted to call up, follow up on evals, which, again, just coming from a generalist engineer point of view, just thinking through what would people be scared of in doing this, the privacy and HIPAAJacob [00:37:00]: Elements of this. I have zero experience in that. What do you have to do? What is surprisingly not that bad?Chai [00:37:06]: So one thing that's really important here from a compliance perspective is very much that any of the data we use needs to be de-identified, any real-world data we use as a basis of online eval sets we're learning from. And so you have to — And there's, very clear, government guidelines, what counts as PHI. And so we've even have built models that can take, for example, a clinical transcript and remove all the key PHI indicators and so you have a scrubbed/de-identified version. And then once you... And so one thing that's important is first you've got to get confidence in that model in the first place? And prove that out. Because, now you have, multiple probabilistic systems on top of each other.Chai [00:37:46]: But once you have that, then you can train on it use it for evaluation and so forth, provided one of the cool things also that you can do from a business side is the right data contracting as well with your partners.Jacob [00:37:57]: Is the anonymization one way? Once it's done, you cannot undo it? Or is there someoneChai [00:38:01]: YesJacob [00:38:02]: Who holds the master key that can... Yeah, okay. So it's one way.Chai [00:38:05]: It's one way. Yeah.Jacob [00:38:06]: That's how it works. I just wanted to... Because, there's a lot of this, learning from feedback and everything that, you would want to debug more but you can't because you just physically don't allow yourself to.Janie [00:38:17]: Some of it's also written in our customer contracts in terms of who can or can't access PHI data, how long do we retain it,Jacob [00:38:27]: Very goodJanie [00:38:27]: Before it gets de-identified. And so we have a pretty high bar for who can access that PHI data, just to make sure that we always respect our customer data and privacy. But that's something that we partner with our customers on too, to make sure that as we want full, as close to precision as possible in that qualityJanie [00:38:48]: We can still use it.Jacob [00:38:50]: But it'll be fascinating to see how that space evolves? Because you think about, I used to work at a company that, did a lot of healthcare data in the cancer space and if you asked, the average cancer patient, “Hey, do you want people, do you want other patients to be able to learn-”Chai [00:39:03]: Take it.Jacob [00:39:03]: “... Learn from your experience?”Chai [00:39:04]: Take it all.Jacob [00:39:05]: They're “Please.”Jacob [00:39:06]: “I'd love, nothing more than for other people to be able to learn fromJacob [00:39:10]: The experience that I had.” And so in the past it was a lot harder to do that learning. But with this technology, that might really be practical and so it'll be fascinating to see how that continues to evolve.Chai [00:39:21]: There's so much in our data set of 100 million conversations.Chai [00:39:26]: You can imagine things like insights that you can give to the clinician. How could you, oh, how could you have reacted to this? In coaching or insights around, which treatments are effective or, like... Because you have this, again, this data source that was never captured before but that's, where, intuition or experience is created from, going back to this idea that the conversation is the agent of truth.Operating at Scale: Reliability, Cost, and Token EfficiencyJacob [00:39:46]: Back to the 100 million conversations, I feel like you have this insane scale that maybe only a few other AI app companies have and everyone else dreams of. So not everyone has had to confront this yet but maybe just talk about some of the challenges of operating at that scale and what, our listeners have to look forward to if they ever get to this level of scale.Chai [00:40:05]: At large and larger in scale, so of course there's a general, infrastructure reliability. When you... In any given startup, you're building the plane while it's flying. So there's some notion of that. But what gets interesting on the AI and ML side for sure is this, as you get at more and more scale, so one, you have the data to first and foremost do this. But, you start thinking about costs or infrastructure in a whole different way at scale versus, a prototype.Chai [00:40:34]: You can use the most expensive model, you can burn as many tokens as you want but when you're doing 100 million conversationsJacob [00:40:41]: Token max on leaderboards are less upsetting than that context.Chai [00:40:45]: . When you're doing that and so that comes for we have the data and we also have the team that's able to post-train based on this and you can optimize for efficiency, especially in areas where you believe that maybe a lot of the quality headroom is less so and you don't expect the other off-the-shelf models to go that way, such that you want to do, efficiency maximization, in terms of compute and tokens.Jacob [00:41:08]: I feel like you guys live in the future in some way where most use cases today are really just in use case discovery mode, where it's “God, I really hope I can find something that can get to scale,” and so you're always going to use the most powerful model. And then the few things that do get to this level of scale, you start to do those optimizations.Chai [00:41:22]: It's a natural trajectory where it's like zero-to-one, we're not talking about any of these optimizations.Chai [00:41:26]: But when maybe we're in the one-to-100 or so forth, then we're in optimization mode and, what works out really well is you've got all this data from zero-to-one that lets you do this.What Comes Next: The Conversation as the Shared Healthcare PlatformJacob [00:41:36]: That's fascinating. I feel like one thing that's so interesting about the Abridge footprint is that you're in the doctor-patient visit in real-time. I always like to say, there's like probably 50 years' worth of product you could build on top of that. What gets each of you, I don't know, what are you most excited about building, either in the short term or medium term or even, long down the line?Janie [00:41:53]: Something that I get really excited about is that the same conversation can serve so many stakeholders. If you think about the conversation, a doctor needs to know what is the documentation, how do I make sure that this fully represent the care I gave? A patient needs to know, “What the heck just happened? This was really overwhelming. What are my next steps?” A payer needs to know, was this the proper and appropriate care given? A pharma company might want to know why isn't this drug being properly used or is there a good candidate for this clinical trial that I'm about to run? And where I get excited is that our product and our platform and our infrastructure can be the same product across all of those things and start to what's today, separate, very expensive, complex systems that serve each one of these stakeholders in very different ways, start to collapse all of that into a singular platform that enables not just more efficiency across the board but also better outcomes for everyone. And, all of us experience healthcare in probably very painful ways and knowing that there is a world in which we can simplify a lot is really exciting to me and it all starts with the conversation.Chai [00:43:15]: It's interesting. Of it very similar to going back to the KPIs that any AI product cares about. How do you increase quality of care? How do you reduce latency to care? And how do you reduce costs? Which is a huge, in healthcareJacob [00:43:28]: They call it the triple aim in healthcare.Chai [00:43:30]: But very similar to building AI products and the thing that really excites me is when we talk about that latency piece, we talked about one example earlier of prior authorization, can you reduce the latency to care? But you can imagine so much more. Oh, as soon as the lab value gets updated, do you have like a background agent that, kicks off and uses all the context to be “Oh, hey, the patient should do this next,” for example. And of flagging that to the clinician who's always in the loop but reducing that latency, to care. And then you can imagine this is much further down the road but it's like even connecting that to the direct patient and the consumer. And so how can you, how can you build a bridge to all of these things?EHR Partnerships and the Clinical Intelligence LayerJacob [00:44:10]: Very cool. The connections piece is just an ever-growing thing. And one of the key partners is the EHR and I wonder what that relationship is like. Will they, look at this as, something that is valuable enough that they want to own someday?Janie [00:44:29]: Our partnerships with the EHR is, we know that we have to be extremely close partners with all the EHRs who we partner with. Being able to not only pull and push all of the data into the right places is, not only table stakes, if we can't do that, health systems don't want to use us. The second and the reality of today is clinicians spend a lot of their days in the EHR. So much of what allowed us to win in the largest health systems was pretty direct and, very close partnerships with some of the largest electronic health records that allowed us to pull and push data with APIs that weren't ready out of the box. And clinicians want to save clicks. Anytime we introduce a new product that, adds two clicks for them in their day, they're “We're not going to use it.”Janie [00:45:21]: They have 15-minute back-to-back appointments with their patients. They're spending, hours during pajama time doing documentation. Every second and every minute counts and so we really think about being deeply integrated into the EHR as also table stakes to getting real usage and adoption. And anything that we build or introduce, we really talk about earn the right internally a lot, which is we have to provide so much value or save so much time that people will use us. But those are the two things that are close to us, is we know that the product won't be used unless it is deeply interoperable.Chai [00:46:01]: And strategically, to your point, it's like what does EHR want to own versus us? EHRs are really focused on the clinical workflows and so forth but some of the things that we're talking about here, I do these traditionally are outside of the domain where it's oh, connecting pairs and providers together with provider policies or the clinical trial matching, as Janie brought up. And so these are, entirely — we position ourselves as building this entirely new intelligence, clinical intelligence layer across, again, providers, pharma and, payers.Chai [00:46:33]: And so that's a it's a whole different ballgame that we try to playChai [00:46:36]: In combination with them.Jacob [00:46:37]: But it's like a different layer of scope.Healthcare AI Regulation, Technical Depth, and What Changed Their MindsJacob [00:46:39]: I'm curious, you are both relatively newcomers to healthcare. People have these, there's lots of futuristic healthcare AI takes of “Oh, everything will look different.”, now that you've been in healthcare for a bit, you live at the edge of AI, what have you, changed your mind on around this, as you think about what healthcare looks like in ten, 20 years? Any updates to your mental model from the time being close to the problems?Chai [00:47:02]: One thing that IChai [00:47:04]: Was hesitant about before and it's a common thing when I'm trying to recruit engineers that people ask me around, is definitely oh, healthcare, heavily regulated space. And it is, rightfully so. You want to keep, the patients at the end of the day safe. But one of the interesting things that, is a that surprised me how much it is coming to the company is there's a lot of really favorable regulatory tailwinds as well. Where you think about, government really wants interoperability between all these systems that we talked about and so agents can access this information. The government just in January, the FDA released updated guidance on clinical decision support, what I work on in such a way that they used to have guidance from like 2022 that required you to have, mention all these options and do all these other things but it's a very forward and forward-looking way. And so for me, what's been really cool to work on is this, there's this very special moment both in AI in general, we all know that but there's a special moment also regulatory in healthcare as well.Janie [00:48:05]: One thing I would call out is for the very reasons things are higher stakes or, potentially considered more difficult in healthcare, it's where some of the hardest AI problems will get solved first, just because the bar is so high. When I first joined, I was “Oh, this is where we'll be on the tail end of where, all of the AI innovation will be able to be applied.” But when you think about, zero error evals or multi-step workflows that have really low tolerance, a lot of the innovation will happen here just because we have to or else we can't ship.Jacob [00:48:42]: ‘Cause like in other domains, you'd much rather just solve the 80%-is-good-enough problems firstJanie [00:48:46]: 80/20 doesn't work hereChai [00:48:48]: And building off that, traditionally, there was a bit of stigma that, oh, healthcare companies are not that interesting from a technical perspective or I've seen that or faced that myself. But these are really hard and fun problems from a pure technical perspective beyond just the impact. How do you bring the latency of this thing down and make it really high-quality?Reducing Latency: Clinical Workflows, Agents, and Implementation RealityJacob [00:49:07]: How do you bring the latency of things down?Chai [00:49:10]: Yeah. Yeah. Yeah. So okay, let's answer the latency question. And maybe hopefully not too redundant with some of the things I've said earlier but some part of it is with any latency, you have to like what is, what is really your bottleneck. In a lot of workflows, it's sometimes it's the model itself. And so that's where like our data flywheel, our post-training team and so forth come in so that can you make the models far more efficient. So that's one aspect of latency. But there's whole other aspects of latency where it's okay, on top of that, if you use a constellation of different models, can you use — can you first use like a — it's like thinking fast and slow. Can you use a cheap, fast model that triages and hands it off to a larger model where you get more intelligence and so forth and so all theseChai [00:49:56]: Clever tricks to make it work.Chai [00:49:58]: And by the way, we are totally — we also realize that the parameter frontier is changing and so these tricks will — may not get us to where we want to be in five years but we need to if we want to build a useful product right now.Jacob [00:50:11]: Should we go to the quick-fire or you want to ask more about Abridge? We can stuff everything that's not Abridge into the quick-fireSwyx [00:50:16]: I don't mind. I was — I feel like Janie was on the topic of more long tail stuff, which isSwyx [00:50:21]: Not the eighty/twenty thing and that really matters. And I'll —, if you have any tips or cool stories or just general approaches that have worked for you that's interesting to dig into.Janie [00:50:32]: One of them is even just how we staff our teams looks different than a traditional software engineering team, I'd say.Swyx [00:50:40]: Let's go.Clinician Scientists, Edge Cases, and Evals at ScaleJanie [00:50:41]: We have a bunch of folks with different roles who are clinicians and so we have this role called the clinician scientist and I heard one of our leaders refer to them as mutants recently. But they are people who've had clinical backgrounds, so MDs typically, who are also deeply technical, somewhere, on the spectrum of like a full stack engineer all the way to like extremely scrappy prompter. But having each of these people embedded within our teams instantly raises the bar for everything that we build because not only are they determining, is this product clinically useful but they're deeply embedded in our whole evals process. And so when we talk about LFDs, when we talk about what is our actual evaluation criteria, you don't want Chai or me creating what those are because we don't have clinical background. But is probably unique to Abridge but has been game changing. And when you think about where the puck is going, you have people build with clinical backgrounds who are technical and where AI tools are going, they just becomeJanie [00:51:53]: More and more, critical and like the killers of the team. And so that's one. And then the second is just the scale at which we do evals to catch that long tail up front before anything ever gets into production is something that we've pretty much like really started to fine-tune, both from a scale but when do we know we need to get several hundred versus several thousand offline responses, what helps us make that quick decision and make this less of an art and as much of a science as possible. But that's also been something we've had to tune over time.Swyx [00:52:27]: And you have partners who opted in to give you those evals.Janie [00:52:31]: So we work either internally or with third-party for offline evals and then we have customers who also agree to give us, whether it's like thumbs up, thumbs down to like choose this or that, a lot of data to get us to what is as close to fully confident as possible.Swyx [00:52:51]: The term that comes to mind isSwyx [00:52:53]: Like active learning on things where you're weak. I feel like it's a lost artSwyx [00:52:58]: Is a lot of the polish that comes into doing something like this.Janie [00:53:02]: Really.Chai [00:53:03]: Hundred percent.Lessons from Glean: Technical Foundations and AI App InfrastructureJacob [00:53:04]: Maybe, on a totally unrelated note, Chai, you had a very, storied run at Glean b

In this episode, Lisa Baird, Chief Executive Officer of Aetna Better Health of Missouri, joins the podcast to discuss keeping community needs at the center of healthcare strategy. She shares how her organization is reaching members in rural areas, improving access to care, and navigating evolving Medicaid eligibility requirements while continuing to support vulnerable populations.

We continue All about AFSPA April with a deep dive into claims. Last year, the Foreign Service Benefit Plan processed more than 2.28 million claims from members all around the world. These included more than half a million overseas claims and thousands of massage therapy claims. If you've ever wondered how we do it, this episode is for you. Kelli Rath from Aetna walks us through the processes, challenges, and successes of processing claims from our unique, worldwide membership.  For more information on claims, please visit www.afspa.org/fsbp/claims. For all of AFSPA's upcoming events, visit www.afspa.org/events.

This episode recorded live at the Becker's Spring 2026 Payer Issues Roundtable features Dr. Benjamin Kornitzer, Chief Medical Officer, Aetna, discussing efforts to reduce administrative friction, streamline prior authorization, and improve care navigation for members and providers. He also shares how Aetna is leveraging AI, interoperability, and digital tools to enhance real time decision making, build trust, and deliver more personalized, efficient healthcare experiences.In collaboration with Hippocratic AI.

Mindfulness meditation involves a willingness to be with ourselves as we are. It offers a way of learning to work with ourselves, and not on ourselves, especially if we are healing from perfectionism. Mindfulness reminds us that not everything has to be "fixed"—and very often, our movement back to wellness starts when we stop trying to change ourselves and simply accept where we are with care and attention.  Cheryl Jones is a mindfulness teacher, health and wellness coach, and author of two books, Thriving When Your Cosmic Egg Is Cracked: A Mindful Journey and Mindful Exercise: A Bridge Between Yoga and Exercise. She was the recipient of the Chairman's Leadership Award and the Norman Vincent Peale Award for Positive Thinking for integrating mindfulness into corporate culture at Aetna. You can find her at www.linkedin.com/in/cherylljones/. The transcription of this guided meditation will be online and in our app at Mindful.org next week.  Stay curious, stay inspired. Sign up for our free newsletter mindful.org/signup or download the app for free at mindful.org/app.  Show Notes Find more from Cheryl Jones here. If you are looking for an in-depth resource to help build essential skills to meet a changing and uncertain world with a core of inner strength, join Melli O'Brien and a host of other teachers for The Seven Strengths, a FREE 7-day online course happening this May 13-19. Learn more and register at www.mindfulness.com/the-seven-strengths.  Go Deeper Healing from perfectionism isn't easy. It takes time and practice. Here are some additional Mindful.org resources to help you build a stronger sense of self-acceptance:  Awareness in Action: Rethinking ADHD Through Mindfulness  What Swimming Taught Me About Self-Compassion and Letting Go  It's Selfish, It's Hokey, and I'll Lose My Edge: 3 Half-Truths About Self-Compassion How Self-Compassion Can Improve Teen Mental Health  This Is What Fierce Self-Compassion Looks Like  Want to try more practices that foster self-compassion? Start here: A 12-Minute Meditation to Embrace All Your Parts  And more from Mindful here: More episodes of 12 Minute Meditation Let us know what you thought of this episode of 12 Minute Meditation by leaving a review or by emailing yourwords@mindful.org.

Episode 173: Steve Cafiero & The Lost Art of Connecting: The Gather, Ask, Do Method for Building Meaningful Business Relationships by Susan McPhersonAbout SteveSteve Cafiero is founder and managing partner of TideShift Partners, where he works with senior leaders to scale their businesses across leadership strategy, organizational alignment, talent development, and change management. Steve clients include executives from major corporations including SAP, AT&T, Gartner, Amazon, Forrester, Calvin Klein, VMware, Broadcom, AETNA, UBS, and several privately held companies. Steve's professional experience includes positions at SAP, Gartner, AT&T, and privately held financial services firms. He holds a bachelor's degree from the State University of New York, and an MBA from PACE University. He and his wife Kim have been active members of the Wilton community for over thirty years. They have two grown daughters, and enjoy traveling, entertaining, and spending time with family and friends.Conversation HighlightsThe transition from traditional networking to connection building for deeper relationshipsKey takeaways from The Lost Art of Connecting by Susan McPhersonHow past experiences, including family stories, shape our approach to leadership and connectionThe significance of vulnerability, trust, and intentionality in professional relationshipsPractical strategies: gather, ask, do—ethical engagement over timeThe role of emotional bank accounts and being present in conversationsHow introversion and extroversion influence our ability to connectLeadership styles rooted in servant leadership and active listeningBuilding community through hosting and expanding networks beyond immediate contactsThe importance of timing and momentum in expanding influenceThe MAIN QUESTION underlying my conversation with Steve is, In this age of disconnection, how are you intentional about how you show up for others to connect with and understand them?Find SteveWebsite: www.tideshiftpartners.comLinkedIn: https://www.linkedin.com/in/steve-cafieroEmail: scafiero@tideshiftpartners.comLinkedIn - Full Podcast Article: CHAPTERS00:00 - The Book Leads Podcast - Steve Cafiero00:58- Introduction & Bio02:49 - Who are you today? Can you provide more information about your work?06:00 - How did your path into your career look like, and what did it look like up until now?22:28 - How does the work you're doing today reconcile to who you were as a child?26:03 - What is your superpower?26:50 - Steve's ability to connect with others00:00 - What does leadership mean to you?36:55 - Can you introduce us to the book we're discussing?50:26 - What's changed in you in the process of writing this book?01:03:45 - What are you up to these days? (A way for guests to share and market their projects and work.)This series has become my Masterclass In Humanity. I'd love for you to join me and see what you take away from these conversations.Learn more about The Book Leads and listen to past episodes:Watch on YouTubeListen on SpotifyListen on Apple PodcastsRead About The Book Leads – Blog PostFor more great content, check out the catalog for my newsletter Last Week's Leadership Lessons, if you haven't already!

Payers are operating at the center of converging pressures: rising costs, accelerating utilization, heightened public scrutiny, and a wave of CMS reforms that are reshaping expectations around transparency, interoperability, prior authorization, and accountability. Medicare Advantage has become the front line for these shifts—exposing tensions between regulatory oversight, margin compression, and growing demands for better member and provider experiences. Against this backdrop, health plans are being asked to do more with less—while proving real value through measurable outcomes, trust, and access. In this episode, recorded in February at the ViVE digital health and healthcare innovation conference, Rae Woods moderates a conversation with payer and technology leaders on how AI and data are being used to reduce payer–provider friction, rethink prior authorization, and improve the member experience—without losing sight of accountability or return on investment. Panelists include: Ali Khan, MD, Chief Medical Officer, Medicare at Aetna (a CVS company) Kay Judge, MD, Chief Medical Officer, Medicare at Blue Shield of California Syed Mohiuddin, MD, Head of Healthcare, Anthropic We're here to help: Podcast | 276: The AI gold rush is changing how humans (and clinicians) make decisions Research | How to succeed using AI: Lessons from 4 leading organizations Expert Insight | Inside CMS' final rule changes for 2026 Learn more about the ViVE conference Register today for the 2026 Advisory Board Summit in Washington, D.C. Updating COVID-19 management protocols may help address long-term impacts A transcript of this episode as well as more information and resources can be found on RadioAdvisory.advisory.com.

Jefferson Health sues Aetna over a so-called Medicare Advantage "down coding" policy, CMS raises MA rates next year, and healthcare affordability tops domestic concerns, on today's episode of The Gist Healthcare Podcast. Hosted on Acast. See acast.com/privacy for more information.

This time on CodeWACK! Today, most people on Medicaid get their care through private insurers called Managed Care Organizations, or MCOs—like Aetna and UnitedHealthcare. Critics say these companies add layers of bureaucracy that make it harder for patients—most of them low-income—to get care. They discourage physicians from accepting Medicaid patients by making them jump through hoops to get treatment pre-authorizations, or even to get paid. Are Managed Care companies making health care more expensive, not less? How are some states reacting? Are legislators starting to wake up and see through the hype? Some are. All this and more is discussed in a recent report from Physicians for a National Health Program, Removing the Middlemen from Medicaid. To unpack it, we spoke with Dr. Alankrita Olson—a public health physician and PNHP board member who advocates for a single-payer healthcare system. This is the 2nd of a two-part series. Check out the Transcript and Show Notes for more! And please keep Code WACK! on the air with a tax-deductible donation at heal-ca.org/donate.

This time on CodeWACK! Today, most people on Medicaid get their care through private insurers called Managed Care Organizations, or MCOs—like Aetna and UnitedHealthcare. Critics say these companies add layers of bureaucracy that make it harder for patients—most of them low-income—to get care. They discourage physicians from accepting Medicaid patients by making them jump through hoops to get treatment pre-authorizations, or even to get paid. Are Managed Care companies making health care more expensive, not less? How are some states reacting? Are legislators starting to wake up and see through the hype?  Some are. All this and more is discussed in a recent report from Physicians for a National Health Program, Removing the Middlemen from Medicaid. To unpack it, we spoke with Dr. Alankrita Olson—a public health physician and PNHP board member who advocates for a single-payer healthcare system. This is the 2nd of a two-part series. Check out the Transcript and Show Notes for more! And please keep Code WACK! on the air with a tax-deductible donation at heal-ca.org/donate.

This time on CodeWACK! Today, most people on Medicaid get their care through private insurers called Managed Care Organizations, or MCOs—like Aetna and UnitedHealthcare. Critics say these companies add layers of bureaucracy that make it harder for patients—most of them low-income—to get care. They discourage physicians from accepting Medicaid patients by making them jump through hoops to get treatment pre-authorizations, or even to get paid. Are Managed Care companies making health care more expensive, not less? How are some states reacting? Are legislators starting to wake up and see through the hype? Some are. All this and more is discussed in a recent report from Physicians for a National Health Program, Removing the Middlemen from Medicaid. To unpack it, we spoke with Dr. Alankrita Olson, a public health physician and PNHP board member who advocates for a single-payer healthcare system. This is the 2nd of a two-part series. Check out the Transcript and Show Notes for more! And please keep Code WACK! on the air with a tax-deductible donation at heal-ca.org/donate.

To close out Medicare March, we're taking some time to look at the most popular Medicare program in the country: Medicare Advantage Plans (MAPs). Dr. Ali Khan, Chief Medical Officer, Medicare at Aetna, joins us to talk about the plans in general and dive into the specifics of the FSBP - Aetna Medicare Advantage Plan. Join us for a great conversation about the ins and outs of MAPs, how FSBP members can take advantage of savings and support opportunities, and for some general tips on care as we all age.  For more information on the FSBP - Aetna Medicare Advantage Plan, please visit www.fsbphealth.com/retiree. For more on how FSBP works with Medicare generally and other options available, please visit https://www.afspa.org/fsbp-and-medicare/. To learn more about our upcoming events, go to www.afspa.org/events.

In this episode of Content Amplified, host Ben Ard is joined by Justin Steinman, CMO of ModMed, for a masterclass on marketing organizational design and how it fuels a powerful content engine. Justin breaks down his philosophy of structuring marketing teams like a free market economy — aligning product marketers with product managers, specialty marketers with general managers, and demand gen managers with sales segments (even tying their bonuses to sales quota achievement). He explains the critical role of corporate marketing as the unifying brand voice and introduces his "steak and sizzle" framework: product marketing delivers the substance while the content team in corporate marketing adds the voice and consistency. Justin also dives into how AI is reshaping content demands, why press releases are back in vogue thanks to LLMs, and how he positions AI as an "intern" — an accelerant for his content team rather than a replacement.Guest Bio:Justin Steinman is the Chief Marketing Officer at ModMed, the leading provider of electronic medical records, practice management, and revenue cycle software for specialty physicians. A seasoned B2B marketing executive with over 20 years of experience in healthcare IT, Justin previously served as CMO of Insora Health and Definitive Healthcare (where he helped take the company public on NASDAQ). His earlier career includes roles at Aetna, GE Healthcare IT, and Novell. Justin holds an English degree and is passionate about organizational design, content strategy, and building marketing teams that make everyone around them better.Text us what you think about this episode!

Preferred pharmacies can play a massive role in the affordability of a PDP or MAPD plan for your clients. Do you know what they are and how they can change the essential math for your clients?   Read the text version   Selling Medicare Part D The Complete Guide on How to Sell Prescription Drug Plans   Get Connected:

Aetna is just the latest in a long list of healthcare entities to settle False Claims Act (FCA) allegations with a massive settlement.The insurer, one of the nation's largest, recently agreed to pay $117.7 million to resolve a case involving purportedly inaccurate and untruthful diagnosis codes to increase payments. That and other recent U.S. Department of Justice (DOJ) actions will take center stage during the next edition of Monitor Mondays, when featured speakers will weigh in on striking recent trends related to such developments. Settlements and judgments under the FCA totaled $6.8 billion in the most recent full fiscal yar, an all-time record, with 84 percent of the recoveries related to matters involving the healthcare industry. Broadcast segments will also include these instantly recognizable features:•Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. •The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. •Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.•Legislative Update: Matthew Albright, chief legislative affairs liaison for Zelis, will report on current healthcare legislation.

Hosts Jonathan Owens, Ardis Watkins, and Suzanne Beasley discuss Governor Josh Stein's proposed critical needs budget and its impact on state employees and retirees; the sustainability and transparency issues facing the State Health Plan; debates over Aetna and Lantern's surgery network; and rising prescription costs. They also cover upcoming veto override votes, primary election recounts, and what to expect in the short legislative session.

In this episode of The Learning & Development Podcast, David James is joined by Brian Jarvis to explore what it takes to lead an L&D transformation inside a long-established organisation. Brian reflects on stepping into WM, the early signals that learning wasn't supporting the business in the way it needed and the first moves he made to begin changing direction. He discusses building credibility with stakeholders, evolving ways of working within his team and how L&D has shifted from a reactive, request-led function to one that's having a more meaningful impact on the organisation. Take your L&D to the next level Take advantage of thousands of hours of analysis. Hundreds of conversations with industry innovators and 25+ years of hands-on global L&D leadership. It's all distilled into one framework to help you level up L&D. Access the L&D Maturity Model here - https://360learning.com/maturity-model KEY TAKEAWAYS Make their problem your problem. Speak the language of stakeholders, take ownership of their goals and risks, and provide impactful and measurable solutions. Target where the business is hurting most, prove revenue and performance impact. Then, expand from there.   Play the long game: build trust, feedback loops, and champions.  Be ready to wow someone - you need stakeholders who advocate for L&D.  Measure time‑to‑proficiency, readiness, and confidence, not just completion of courses or content delivered.   Evolve your practice with design thinking, leverage AI, and technology. Put in place solid best practice to scale the impact of L&D without needing a bigger team. BEST MOMENTS “Every programme … is evolving and changing as they (the learners) grow into another year.” “Make their problem your problem.” “The management of the stakeholders is the most important piece.” “We either use smart tools to do dumb things, or we use smart tools to do the right things.” Brian Jarvis Bio Brian Jarvis is a strategic Learning & Development leader with more than 13 years' experience leading enterprise-scale initiatives across large, complex organisations. He is currently responsible for Learning and Leadership Development for National Accounts at WM, supporting teams across North America, Canada, and India. In this role, Brian has modernised onboarding and upskilling for customer experience, billing, and sales functions—reducing time to proficiency, improving frontline readiness, and increasing retention while supporting significant business growth and transformation. Previously, he led large-scale learning strategies at CVS Health, Aetna, and United Bank, delivering data-driven, digital-first learning approaches that improved performance, strengthened capability at scale, and delivered measurable commercial impact. VALUABLE RESOURCES The Learning And Development Podcast - https://podcasts.apple.com/gb/podcast/the-learning-development-podcast/id1466927523 L&D Master Class Series: https://360learning.com/blog/l-and-d-masterclass-home ABOUT THE HOST David James  David has been a People Development professional for more than 20 years, most notably as Director of Talent, Learning & OD for The Walt Disney Company across Europe, the Middle East & Africa.  As well as being the Chief Learning Officer at 360Learning, David is a prominent writer and speaker on topics around modern and digital L&D.  CONTACT METHOD  Twitter:  https://twitter.com/davidinlearning LinkedIn: https://www.linkedin.com/in/davidjameslinkedin L&D Collective: https://360learning.com/the-l-and-d-collective Blog: https://360learning.com/blog L&D Master Class Series: https://360learning.com/blog/l-and-d-masterclass-home This Podcast has been brought to you by Disruptive Media. https://disruptivemedia.co.uk/

From WEDI's 2026 Winter Forum, Michael concludes this 2-part episode on how access APIs are improving the patient experience by making data easier to access, use, and share across care journeys. Tom Loomis, Enterprise Architecture- Interoperability, Evernorth Nancy Bevin, Director, Provider Connectivity, Medica Ron Wampler, Executive Director, Interoperability, Aetna, a CVS Health Company

Dr. Khan explains why preventive care is critical for seniors. He breaks down the big three you should be getting checked that seniors should be doing to live a healthier and happier life.

From WEDI's 2026 Winter Forum, Michael chats with three payer representatives who discuss how access APIs are improving the patient experience by making data easier to access, use, and share across care journeys. Tom Loomis, Enterprise Architecture- Interoperability, Evernorth Nancy Bevin, Director, Provider Connectivity, Medica Ron Wampler, Executive Director, Interoperability, Aetna, a CVS Health Company

MEDICARE ADVANTAGE MINUTE:                                                                     CMS (THE GOVERNMENT) TAKES AIM AT MEDICARE ADVANTAGE FRAUD Correspondence: Client Mike writes to ask me to find his wife a Plan G Medicare supplement with a better price. Her current Aetna plan has scheduled a $60+ monthly rate increase so Mike asked me to look for a better deal.  Once again I explained the advantages of High Deductible Plan G (HDG) but Mrs. Mike is very risk averse and wants to stay with regular (expensive) Plan G. A few weeks after, Mike contacted me again to announce that he plans to switch to HDG when his state mandated Birthday Rule period came around. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+)                   Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2026; SIMPLEST & EASIEST GUIDE EVER!" "MEDICARE ENROLLMENT GUIDE!" (Free download from site below) "MEDICARE DRUG PLANS: A SIMPLE D-I-Y GUIDE" For sale on Amazon.com. After enjoying the books, please consider returning to leave a short customer review to  help future readers. Official website: https://www.MedicareForTheLazyMan.com.

In this episode, Melanie Fernando, President and CEO of Aetna Better Health of Illinois, discusses launching a virtual menopause partnership to close gaps in Medicaid women's health, improve member engagement, and drive better outcomes through tailored, community based solutions.

In a January 28 article, Dr. Ronald Hirsch verified that the Centers for Medicare and Medicaid Services (CMS) “has no problem” with the Aetna Severity Payment policy because it “meets the Two-Midnight Rule.” However, there is more to consider than compliance with 42 CFR 412.3. Federal regulations also state Medicare Advantage organizations must comply with Traditional Medicare laws including payment criteria for inpatient admissions at 42 CFR 422.101(b)(2). So the burning question remains: Is CMS disregarding pertinent regulations that could nullify Aetna's policy?During the next live edition of the venerable Monitor Monday, the Internet broadcast, Cheryl Ericson, senior director of clinical policy and education for the Brundage Group, will address this apparent contradiction.Broadcast segments will also include these instantly recognizable features:·      Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds. ·      The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Nelson Mullins, will report the latest news about auditors. ·      Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Byron, will join the broadcast with his trademark segment.·      Legislative Update: Adam Brenman, legislative affairs liaison for Zelis, will report on current healthcare legislation.

In this episode, Melanie Fernando, President and CEO of Aetna Better Health of Illinois, discusses launching a virtual menopause partnership to close gaps in Medicaid women's health, improve member engagement, and drive better outcomes through tailored, community based solutions.

Medicare for all. Not socialized medicine, just a single, government-run system that provides healthcare.  Is it possible? Or even viable? Our guest this week on the Creating a New Healthcare podcast believes so. In fact, he sees it as the only way to ultimately address the affordability problem with healthcare, particularly for high cost conditions like cancer. In today's episode, we talk with Dr. Troy Brennan about his book, The Transformation of American Health Insurance: On the Path to Medicare for All, and why a single payer, government system is needed, and how the changes the current administration has made to our public health systems is taking us backwards, not forward. Troyen Brennan is an Adjunct Professor at Harvard Chan School of Public Health.  He was formerly the Executive Vice President and Chief Medical Officer for CVS Health and Aetna. Before that, he was the President of the Brigham and Women's Physician Organization and Professor of Medicine at Harvard Medical School.  He was also Professor of Law and Public Health at the Harvard Chan School of Public Health.  Brennan was formerly the Chair of the American Board of Internal Medicine and is a member of the National Academy of Medicine. He has published six books and over 600 articles. 

When communities lead, care works: culturally grounded support, early intervention, and multiple doors to emotional wellness. In this episode, host Sharlee Dixon sits down with Dr. Cara McNulty, CEO of Vibrant Emotional Health, the national organization behind the 988 Suicide & Crisis Lifeline, serving more than five million people each year. A population health scientist and nationally recognized leader, Cara is committed to breaking down stigma and democratizing access to mental health care across the country. Before joining Vibrant, she served as President of Behavioral Health and Mental Well-being at CVS Health, where she launched bold, data-driven initiatives, including a strategy to reduce suicide attempts by 20% among Aetna members, and helped spearhead Minnesota's transformational population health legislation. With a doctorate in public administration and decades of experience translating evidence-based science into scalable solutions, Cara is passionate about building a society where emotional wellness is accessible to all. Together, Sharlee and Cara explore how community-driven peer support, led by people with lived experience, is reshaping youth mental health. They discuss how families can better navigate complex systems, access culturally competent care, recognize early warning signs, and create identity-affirming spaces where teens feel seen, supported, and empowered to thrive. The conversation also looks at the systemic changes needed to ensure emotional wellness isn't a privilege, but a possibility for every young person.   For more information about Vibrant Emotional Health, please visit: https://www.vibrant.org/ For more information about Vibrant Emotional Health's Community Programs, please visit: https://www.vibrant.org/what-we-do/community-programs/ For more information about 988 Suicide and Crisis Lifeline, please visit: https://988lifeline.org If you're interested in supporting Vibrant Emotional Health through donation, please visit: https://www.vibrant.org/donate/ Connect with Vibrant Emotional Health on social media: on Facebook: https://www.facebook.com/vibrantforall/ on Instagram: https://www.instagram.com/vibrantforall/ on Linkedin: https://www.linkedin.com/company/vibrantforall on YouTube: https://www.youtube.com/VibrantForAll on TikTok: https://www.tiktok.com/@vibrantforall on X: https://x.com/vibrantforall

"One of our most unique and precious things we can use is our own voice." -Tina Dietz   Tina Dietz is an award-winning vocal leadership expert and founder and CEO of Twin Flames Studios, a premier audio publishing company helping entrepreneurs and experts turn their voices into powerful audiobooks and professionally published books. A pioneer in voice-powered publishing, she led the industry's first fully guided remote audiobook recording experience and is known for transforming podcast content into lasting authority and revenue-generating assets. With over 20 years of experience across 30+ industries and eight countries, Tina has worked with global brands including Johnson & Johnson, GE, Aetna, and UGG. Recognized by Forbes and Inc., and a founding member of the Forbes Coaches Council, she is a trusted voice shaping the future of audio publishing. Website: https://twinflamesstudios.com  LinkedIn: https://www.linkedin.com/in/tinadietz/  YouTube: https://www.youtube.com/@TwinFlamesStudios  Instagram: https://www.instagram.com/twinflamesstudios/  Facebook: https://www.facebook.com/TwinFlamesStudiosLeadership/    Zachary Bernard is the founder of We Feature You PR, a public relations company that helps individuals and businesses establish themselves as thought leaders through podcasts and press.  Since its inception, We Feature You PR has worked with 350+ clients, from solopreneurs to publicly traded companies, securing features in major publications like Forbes, Entrepreneur, and USA Today, and booking over a 1,000 podcast appearances. Website: https://wefeatureyou.com LinkedIn: https://www.linkedin.com/in/itszachb/ YouTube: https://www.youtube.com/@itszachb_ Instagram: https://www.instagram.com/itszachb_   In this episode, we explore leadership, podcast marketing, audiobook creation, and authentic AI strategies with Tina and Zach.    Apply to join our marketing mastermind group: https://notypicalmoments.typeform.com/to/hWLDNgjz   Follow No Typical Moments at: Website: https://notypicalmoments.com/ LinkedIn: https://www.linkedin.com/company/no-typical-moments-llc/ YouTube: https://www.youtube.com/channel/UC4G7csw9j7zpjdASvpMzqUA Instagram: https://www.instagram.com/notypicalmoments Facebook: https://www.facebook.com/NTMoments  

"One of our most unique and precious things we can use is our own voice." -Tina Dietz   Tina Dietz is an award-winning vocal leadership expert and founder and CEO of Twin Flames Studios, a premier audio publishing company helping entrepreneurs and experts turn their voices into powerful audiobooks and professionally published books. A pioneer in voice-powered publishing, she led the industry's first fully guided remote audiobook recording experience and is known for transforming podcast content into lasting authority and revenue-generating assets. With over 20 years of experience across 30+ industries and eight countries, Tina has worked with global brands including Johnson & Johnson, GE, Aetna, and UGG. Recognized by Forbes and Inc., and a founding member of the Forbes Coaches Council, she is a trusted voice shaping the future of audio publishing. Website: https://twinflamesstudios.com  LinkedIn: https://www.linkedin.com/in/tinadietz/  YouTube: https://www.youtube.com/@TwinFlamesStudios  Instagram: https://www.instagram.com/twinflamesstudios/  Facebook: https://www.facebook.com/TwinFlamesStudiosLeadership/    Zachary Bernard is the founder of We Feature You PR, a public relations company that helps individuals and businesses establish themselves as thought leaders through podcasts and press.  Since its inception, We Feature You PR has worked with 350+ clients, from solopreneurs to publicly traded companies, securing features in major publications like Forbes, Entrepreneur, and USA Today, and booking over a 1,000 podcast appearances. Website: https://wefeatureyou.com LinkedIn: https://www.linkedin.com/in/itszachb/ YouTube: https://www.youtube.com/@itszachb_ Instagram: https://www.instagram.com/itszachb_   In this episode, we explore leadership, podcast marketing, audiobook creation, and authentic AI strategies with Tina and Zach.    Apply to join our marketing mastermind group: https://notypicalmoments.typeform.com/to/hWLDNgjz   Follow No Typical Moments at: Website: https://notypicalmoments.com/ LinkedIn: https://www.linkedin.com/company/no-typical-moments-llc/ YouTube: https://www.youtube.com/channel/UC4G7csw9j7zpjdASvpMzqUA Instagram: https://www.instagram.com/notypicalmoments Facebook: https://www.facebook.com/NTMoments  

If you enjoy this episode, we're sure you will enjoy more content like this on The Occult Rejects.  In fact, we have curated playlists on occult topics like grimoires, esoteric concepts and phenomena, occult history, analyzing true crime and cults with an occult lens, Para politics, and occultism in music. Whether you enjoy consuming your content visually or via audio, we've got you covered - and it will always be provided free of charge.  So, if you enjoy what we do and want to support our work of providing accessible, free content on various platforms, please consider making a donation to the links provided below.  Thank you and enjoy the episode!Links For The Occult Rejects and The Spiritual Gangsters https://linktr.ee/theoccultrejectsOccult Research Institutehttps://www.occultresearchinstitute.org/Cash Apphttps://cash.app/$theoccultrejectsVenmo@TheOccultRejectsBuy Me A Coffeebuymeacoffee.com/TheOccultRejectsPatreonhttps://www.patreon.com/TheOccultRejects

On this episode of Managed Care Cast, The American Journal of Managed Care® spoke with David Muhlstein, PhD, JD, founder and CEO of Simple Healthcare, about his recent articles highlighting Transparency in Coverage (TIC) files and ghost rates from 119 insurers, including 3 national commercial payers. Aetna, Cigna, and United Healthcare TIC files were more than 90% ghost rates—billing codes for procedures that would never be performed by a specific physician. For example, there were billing codes for heart surgery performed by a psychiatrist, Muhlstein said. These ghost rates increase the size of TIC files, making them difficult to evaluate for consumers, researchers, and analysts. Data files of this size muddle the true aim of the TIC files to provide actual transparency that would allow consumers to compare the prices of health care services and choose more affordable options.

INTERVIEW: Fresno Teachers Association President Manuel Bonilla gives an update on Fresno Unified retirees disrupted healthcare access. The district’s Joint Health Management Board has approved a new option allowing retirees to enroll in traditional Medicare with a district‑provided PPO supplemental plan, beginning January 1, 2027. This comes after more than 6,000 retirees lost in‑network coverage on January 1 due to a contract breakdown between Aetna and Community Medical Centers. Community Medical Centers says retirees can now make appointments but appointments are still out of network. Please Like, Comment and Follow 'Broeske & Musson' on all platforms: --- The ‘Broeske & Musson Podcast’ is available on the KMJNOW app, Apple Podcasts, Spotify or wherever else you listen to podcasts. --- ‘Broeske & Musson' Weekdays 9-11 AM Pacific on News/Talk 580 AM & 105.9 FM KMJ | Facebook | Podcast| X | - Everything KMJ KMJNOW App | Podcasts | Facebook | X | Instagram See omnystudio.com/listener for privacy information.

Over 6,000 Fresno Unified retirees have gone without in-network healthcare coverage since the start of the year as negotiations stalled between Community Medical Centers and insurance company Aetna. Janica Mendenhall's daughter, who initially showed flu-like symptoms in December, quickly worsened and is now on life support. Doctors discovered "pockets," or holes, in the teenager's lungs, attributed to vaping. Please Like, Comment and Follow 'Philip Teresi on KMJ' on all platforms: --- Philip Teresi on KMJ is available on the KMJNOW app, Apple Podcasts, Spotify, YouTube or wherever else you listen to podcasts. -- Philip Teresi on KMJ Weekdays 2-6 PM Pacific on News/Talk 580 AM & 105.9 FM KMJ | Website | Facebook | Instagram | X | Podcast | Amazon | - Everything KMJ KMJNOW App | Podcasts | Facebook | X | Instagram See omnystudio.com/listener for privacy information.

Fresno Unified leadership contacted Community Medical Centers leadership and scheduled a meeting for this morning. District and FTA leadership met to discuss the negative impact the stalled negotiations between Community and Aetna is having on retirees. Please Like, Comment and Follow 'Philip Teresi on KMJ' on all platforms: --- Philip Teresi on KMJ is available on the KMJNOW app, Apple Podcasts, Spotify, YouTube or wherever else you listen to podcasts. -- Philip Teresi on KMJ Weekdays 2-6 PM Pacific on News/Talk 580 AM & 105.9 FM KMJ | Website | Facebook | Instagram | X | Podcast | Amazon | - Everything KMJ KMJNOW App | Podcasts | Facebook | X | Instagram See omnystudio.com/listener for privacy information.

INTERVIEW: Manuel Bonilla, Fresno Teachers Association & Patrick Jensen, CFO Fresno Unified discuss the thousands of Fresno Unified retirees who abruptly lost access to Community Medical Centers after Aetna and the hospital network failed to reach a contract agreement by December 31. About 6,200 retirees are affected, many struggling to secure care. The district says emergency treatment remains available while long‑term solutions are explored. Please Like, Comment and Follow 'Broeske & Musson' on all platforms: --- The ‘Broeske & Musson Podcast’ is available on the KMJNOW app, Apple Podcasts, Spotify or wherever else you listen to podcasts. --- ‘Broeske & Musson' Weekdays 9-11 AM Pacific on News/Talk 580 AM & 105.9 FM KMJ | Facebook | Podcast| X | - Everything KMJ KMJNOW App | Podcasts | Facebook | X | Instagram See omnystudio.com/listener for privacy information.

A conversation with Dr. Troyen BrennanOur primary care sector is dysfunctional.Enter Dr. Troyen Brennan: author, adjunct professor at Harvard, former CMO for CVS Health and Aetna, and a national voice on the issues facing our healthcare system.He explains how the primary care/specialty care balance led America to adopt a profit-driven model, highlighting the repercussions this has had for primary care access across the country.The current projections are stark, so we need to push for fundamental change.—We spoke about the contrast between the Affordable Care Act and a single-payer system, the importance of primary care as a foundation for a functional healthcare system, the viability of value-based care models, and the potential pathways to achieve equitable access to primary care in spite of current political and financial challenges.Follow me on Instagram and Facebook @ericfethkemd and checkout my website at www.EricFethkeMD.com. My brand new book, The Privilege of Caring, is out now on Amazon! https://www.amazon.com/dp/B0CP6H6QN4

The SEANC View podcast addresses listener questions on state employee and retiree concerns, including the absent budget, the loss of retirement health insurance for hires after 2021, early December pay changes, and the $3.3 billion surplus. We discuss staffing and retention issues, why COLAs aren't being issued despite strong investment returns, the role of EMPAC endorsements, Aetna vs. Blue Cross transitions, and potential future coverage for GLP-1 drugs. Plus: a light-hearted round on favorite Christmas songs.

In this episode of Healing Powers Podcast, angel investor Jeff Stock shares his journey from being a highly analytical skeptic to receiving undeniable synchronicities—goosebumps, repeating signs, psychic validations, and uncanny moments of divine timing that shaped his life and investments.Jeff opens up about the pivotal moments that shifted his worldview, including powerful angel signs, dream messages, and statistically impossible coincidences that challenged his logical framework. Reach out to jeff@stockalternatives.com if you want to share any of your stories with him.Bio:Jeff Stock brings over a decade of hands-on experience in actuarial risk management and financial analytics to the world of real estate and private credit. He holds an actuarial degree from the University of Connecticut, where he was part of the student-managed fund, and began his career in Aetna's investment management division overseeing $7 billion in assets, including private investments. This blend of analytical training and real-world investing gives Jeff a grounded, thoughtful perspective on evaluating opportunities and managing risk. He enjoys helping investors understand their options and choose real estate and private credit strategies that feel aligned, sustainable, and supportive of their long-term goals.Laura is a Celebrity Psychic who has been featured by Buzzfeed, The Weakest Link, Beast Games, NBC, ABC, CBS, FOX, the CW, Motherboard by Vice Magazine and the #1” Ron Burgundy Podcast” with Will Ferrell. Laura Powers is a clairvoyant, psychic medium, writer, actress, producer, writer, and speaker who helps other receive guidance and communicate with loved ones. Laura travels nationally and internationally for clients, events, television appearances, and speaking engagements. She is also the author of 7 books on the psychic realm and 1 book on podcasting. Laura also works as a psychic, entertainer, and creative entrepreneur.For more information about Laura and her work, you can go to her website www.healingpowers.net or find her on X @thatlaurapowers, on Facebook at @realhealingpowers and @mllelaura, and on Instagram, TikTok and Insight Timer @laurapowers44.

Welcome back to Your World of Creativity, where we explore how creative professionals and business innovators bring ideas to life. Today we'll learn how presence, communication, and neuroscience can fuel your creativity, alignment, and even transformation.We're joined by two powerhouse thought leaders in leadership and communication—Meaghan Benjamin and Phyllis Dealy. They're the co-founders of Studio Reinvent and the creators behind the groundbreaking leadership frameworks and services.Phyllis's Website 1. Presence seems to be a cornerstone of your work...You teach presence not as performance but as a way of being. What does presence look and feel like in a high-stakes leadership setting—or even on a global stage? How can leaders begin cultivating this sense of presence in everyday communication? They've coached teams from PepsiCo, Aetna, and Susan G. Komen.2. You both emphasize the science of communication...Meaghan, with your background in neuroscience and psychology, how do tools like brain-coupling and conscious listening elevate communication? (Phyllis): How do you incorporate systems thinking and storytelling to turn communication into a competitive edge? You've described The Awareness Factor® as a leadership framework that brings alignment, momentum, and measurable results. What inspired its creation—and how does it differ from other leadership models we hear about today? How have executive teams responded when first introduced to this model?3. Many of our listeners are creatives and entrepreneurs...What are some of the most common communication pitfalls you see in founders and creatives—and how can they improve clarity and confidence in pitching, leading, or collaborating?4. Let's talk reinvention...Your work is all about reinvention—whether it's personal leadership or brand transformation. What does it take for a company—or a person—to truly reinvent themselves today?Such rich insights today from Meaghan and Phyllis—thank you both for helping us see communication, leadership, and reinvention through a creative and scientific lens. Listeners, you can learn more about their work at StudioReinvent.com and keep an eye out for their upcoming book, The Awareness Factor®.Sponsor Message:This episode was brought to you by White Cloud Coffee Roasters—where great ideas begin with great coffee. Visit WhiteCloudCoffee.com and use the code CREATIVITY for 10% off your first order.Be sure to subscribe, rate, and review Your World of Creativity on your favorite podcast app—and come back next time as we continue our journey to ignite creative thinking and innovation around the world.