Claims Denied: A Hospitalogy Podcast

Blake Madden
  • 5.0 (5)
  • Business
  • Updated Weekly

Join one man’s quest to learn everything there is to know about the business of healthcare. Blake Madden and friends cut through the fluff to talk shop with influential healthcare leaders across innovation, strategy, finance, policy, and more. Learn about disruptive health tech startups, hear war stories, stay up to date on emerging health system transformation strategies, and listen in to scalding hot takes on pressing topics and the future of the industry. New episodes drop Mondays. Subscribe to get the latest!

  1. 3d ago

    The End of Managed Care? How Northwell Built a $2.5B Direct Contracting Machine (with Nick Stefanizzi, CEO Northwell Direct)

    Blake sits down with Nick Stefanizzi, CEO of Northwell Direct (https://northwelldirect.northwell.edu/) — the man running the most ambitious direct-to-employer play in the country. Since going live in 2022, his team has built a platform serving 70+ employers and unions, 300K members, and $2.5B in medical spend, with 97% retention. Then they landed 32BJ: 20% validated savings, $46M in year one, live as of April. Blake and Nick get into all of it — why Northwell runs Direct as a standalone company (Nick literally negotiates rates against his own parent system), what they rented instead of built, how the 32BJ deal came together in 10 weeks, and what happens to managed care when health systems stop asking permission. If you're a health system exec, benefits leader, or union fund trustee, this one's required listening. --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. ⁠⁠https://navvishealthcare.com/vbc⁠⁠ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠⁠ Like our podcast? Check our previous episodes of Claims Denied here: ⁠⁠⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. --- Follow Nick on LinkedIn: https://www.linkedin.com/in/nickstefanizzi/ Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠⁠

    The End of Managed Care? How Northwell Built a $2.5B Direct Contracting Machine (with Nick Stefanizzi, CEO Northwell Direct)

  2. Aug 11

    Insurance Is the Inflation: Your Health Plan Costs the Same as a Tesla Model Y, and What Collective Health is Doing to Fix it

    This episode hits the affordability crisis head-on, as Blake sits down with Ali Diab, CEO and co-founder of Collective Health (https://collectivehealth.com/). Ali started the company after his own hospital claim got denied, and has spent the decade since building what he calls the “Stripe” of healthcare benefits — for employers today, and potentially insurers and health systems tomorrow. In this episode, Ali makes the case that health insurance itself is the real inflationary catalyst in American healthcare.  Ali doesn't do the polite version. He calls the MLR a cost-plus contract, compares network "discounts" to markdowns off the Neiman Marcus price, and told me about the time he was charged $340 in coinsurance for a $125 knee brace on his own company's plan.  We dig into why self-insurance and direct contracting are eating the fully-insured market alive, why small employers are legally boxed out of self-funding, and why he thinks healthcare pricing needs an SEC. Also: World Cup takes. Ali's a winger-turned-number-nine and I broke two leg bones playing this sport, so we earned the tangent. Follow Ali Diab on LinkedIn: https://www.linkedin.com/in/alidiab/ Follows Collective Health on LinkedIn: https://www.linkedin.com/company/collectivehealth/home/ --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. ⁠https://navvishealthcare.com/vbc⁠ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠ Like our podcast? Check our previous episodes of Claims Denied here: ⁠⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠

    Insurance Is the Inflation: Your Health Plan Costs the Same as a Tesla Model Y, and What Collective Health is Doing to Fix it

  3. Aug 4

    25K Patients Deep and Zero Physician Equity: Inside MGB and Regent's Site-of-Service Bet, and their New ASC Ownership Playbook

    For this week's episode, Hospitalogy's Blake Madden puts two people on opposite ends of the same handshake into one virtual room: Travis Messina, CEO of Regent Surgical, and Niyum Gandhi, CFO of Mass General Brigham (MGB), who runs one of the most-watched integrated systems in the country. Nominally, this episode is about ASCs. Really, it's about what a system does when it could build anything itself — and chooses to partner instead. Blake walked in carrying a grudge from his valuation days, when every ASC cap table he cracked open had physician ownership baked in like it was law. Niyum spent 20 minutes calmly arguing the opposite. They also get into MGB's $3B insurance arm (don't call it a provider-sponsored plan to his face), a 25,000-patient endoscopy wait list, robots doing oncology, and the best AI adoption framework Blake's heard a CFO articulate. Travis also reminded Blake that his Geogia Bulldogs bounced Blake's Texas Longhorns during the College World Series — which Blake is choosing to forgive. Follow Travis Messina on LinkedIn: https://www.linkedin.com/in/travis-messina-4460565/ Follow Niyum Gandhi on LinkedIn: https://www.linkedin.com/in/niyum-gandhi/ Follow Mass General Brigham on LinkedIn: https://www.linkedin.com/company/mass-general-brigham/ Follow Regent Surgical on LinkedIn: https://www.linkedin.com/company/regent-surgical/ Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. ⁠https://navvishealthcare.com/vbc⁠ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠

    25K Patients Deep and Zero Physician Equity: Inside MGB and Regent's Site-of-Service Bet, and their New ASC Ownership Playbook

  4. Jul 28

    Addiction Treatment and Why Your Claims Data Is Lying About Gambling Disorder

    Featuring: Elliott Rapaport (Founder of Birches Health) and Dr. Doug Nemecek (Senior advisor with Birches Health and former Cigna/Evernorth CMO) --- This episode with two experts in the mental health space (Elliott Rapaport, Founder of Birches Health, and Dr. Doug Nemecek, a senior advisor with Birches Health and former Cigna/Evernorth CMO for behavioral health) was one of the more eye-opening conversations Hospitalogy’s Blake Madden has had on payor behavioral spend. Think about this: 39 states + DC have legalized online gambling, FanDuel and DraftKings are sponsoring everything that moves, and yet payors will tell you they don't "see" the gambling disorder volume in their claims data. That's because it's getting coded as depression or anxiety. F63.0 never makes it to the bill. Blake, Doug, and Elliott get into the real prevalence numbers (a recent Pennsylvania study puts roughly a third of the state somewhere on the gambling-risk spectrum), why specialty networks for behavioral process addictions are about to follow the same pattern Equip ran in eating disorders, and what AI actually does in this model (spoiler: it's not replacing the therapist). Blake also pushed Elliott on the "anti-capitalism" of building a clinical model that explicitly wants patients to use you less over time. Elliott’s answer was sharp. Follow Birches Health on LinkedIn: ⁠https://www.linkedin.com/company/bircheshealth/⁠ Follow Doug on LinkedIn: https://www.linkedin.com/in/douglasnemecek/ Follow Elliott on LinkedIn: https://www.linkedin.com/in/er1/ --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. https://navvishealthcare.com/vbc --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠https://hospitalogy.com/⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠

    Addiction Treatment and Why Your Claims Data Is Lying About Gambling Disorder

  5. Jul 21

    AvoMD’s Series A and the Bet That Epic Doesn't Eat Everything (with Yair Saperstein, MD MPH)

    Hospitalogy's Blake Madden sits down with Yair Saperstein, MD MPH — co-founder and CEO of AvoMD — fresh off the company's Series A close in Q1. Yair makes the case that the real prize in clinical AI isn't the AI scribe, it's the operating system living inside the EHR itself, and why he thinks most of primary care ultimately gets replaced by AI voice chatbots, at-home labs, and wearables. Blake also pushes Yair on the Open Evidence valuation question (politely sidestepped), how AvoMD sells differently to academic systems versus rural hospitals, and the "avoid the 800-pound gorilla" go-to-market strategy against Epic. Plus: what Dr. Oz told a ViVE crowd about agentic AI being in front of every patient by 2028 — and a closing piece of life advice that somehow involves Frogger. --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. https://navvishealthcare.com/vbc --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠https://hospitalogy.com/⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. --- Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠

    AvoMD’s Series A and the Bet That Epic Doesn't Eat Everything (with Yair Saperstein, MD MPH)

  6. Jul 14

    Inside US Heart and Vascular: Cardiology's Independent Integration Play and When Private Equity Works

    Featuring: Emily Rash (COO) and Dr. Neil Gheewala (CMO of Value-Based Care), US Heart and Vascular --- Is 3-6 weeks really how long patients should have to wait to see a cardiologist? That's the national average — and it's the exact inefficiency Emily Rash (COO) and Dr. Neil Gheewala (CMO of Value-Based Care) at US Heart and Vascular are betting they can fix. Blake Madden sat down with them for a refreshingly candid conversation about what actually separates an integrated cardiology platform from a bunch of practices bolted onto a cap table. In this episode: The Ares + Rubicon Founders dual capital structure — arguably the sharpest specialty-VBC sponsor pairing out there The "AIR" framework (autonomy, independence, representative governance), and why the third leg is the one most rollups get wrong Why cardiology might be the cleanest specialty fit for value-based care, full stop (no structural fee-for-service conflict the way a hospital has) Neil's actual pitch to RFK Jr. for a "Level 6" reimbursement category for ambulatory IV diuretics (CMMI, this one's free) Where cardiology bifurcates in the next five years: outpatient access groups vs. hospital-based acute care If specialty VBC, physician governance, or the cardiology rollup wave are anywhere on your radar, this one's worth the listen. --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. https://navvishealthcare.com/vbc --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠https://hospitalogy.com/⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠

    Inside US Heart and Vascular: Cardiology's Independent Integration Play and When Private Equity Works

  7. Jul 7

    Whoop for Your Poop: Inside Throne Science's Bet on the Smart Toilet (with Scott Hickle, Co-Founder, Throne Science)

    This episode covers something Claims Denied hasn't touched before: the world's first passive gut health monitoring device. Blake sits down with Scott Hickle, co-founder of Throne Science, for a deep dive into the tech behind hands-free gut health, hydration, and urinary health monitoring — and yes, that means talking about poop for an hour. It turns out to be one of the most fascinating conversations on the pod yet, covering real technology, wild behavior-change data, and a long-term vision for cancer screening. Listen to hear: How Throne's monitor clips onto your toilet, identifies users via Bluetooth, and runs entirely in the background with no sample collection and no manual logging How Whoop's former CTO ended up joining the team after a hospital stay with ulcerative colitis What three years of obsessive product development looks like when building a camera for the most intimate room in someone's home What longitudinal gut health data reveals that elimination diets and manual stool logs can't How Oura Ring's decade-long arc — from 2,400 Kickstarter units to an $11 billion valuation — shapes Throne's own go-to-market patience The roadmap toward detecting microscopic blood in stool, and why that could make Throne a smoke detector for colon cancer, bladder cancer, and more Follow Scott Hickle on LinkedIn: https://www.linkedin.com/in/scotthickle/ Follow Throne Science on LinkedIn: https://www.linkedin.com/company/thronescience/ --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. https://navvishealthcare.com/vbc For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠https://hospitalogy.com/⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠

    Whoop for Your Poop: Inside Throne Science's Bet on the Smart Toilet (with Scott Hickle, Co-Founder, Throne Science)

  8. Jun 23

    VBC’s shift to performance, AI agents on the org chart, LEAD is a no-go, and why health systems should prep for mandatory risk models (with Tim Elliott, CEO of Navvis)

    In this latest episode of Claims Denied, Blake sits down with Tim Elliott, CEO of Navvis, for one of the most clear-eyed conversations he's had on where value-based models are actually headed. Tim doesn't deal in buzzwords or wishful thinking. He deals in what's actually working, what operators are getting wrong, and where the puck is going — whether you're ready for it or not. Here were some gems from the discussion which makes the broader convo worth your time: Payment innovation will always come out of the government. Tim's conviction is that DRGs came from CMS, and the next durable models, commercial and governmental alike, will too. Not the private market. Tim is a fan of moving more into mandatory risk models. While most operators are bracing against mandatory, Tim thinks the mandatory direction is exactly where we need to go and would tell CMMI to keep pushing. LEAD is a no-go right now for most systems. Navvis' analysis with their partners anticipates very few of them will move to LEAD as it stands today. Benchmarking and settlement math doesn't pencil yet, so it's enhanced-track MSSP until they get a few more reps. Stop leading with the comp model. Popular belief (that Blake asked Tim about) is that nothing changes in healthcare until physician comp changes. Tim pushed back on this notion hard. At SSM Health, he led with culture first and comp later, and argued you can get pretty darn far before you ever touch the RVU. FTEs are becoming FTAs, meaning full-time equivalent agents. His advice was to start drawing your org chart with agents on it. Pretty interesting mental model and paradigm shift. --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. https://navvishealthcare.com/vbc --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠https://hospitalogy.com/⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Tim Elliott on LinkedIn: https://www.linkedin.com/in/tim-elliott-b246aa151/  Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠

    VBC’s shift to performance, AI agents on the org chart, LEAD is a no-go, and why health systems should prep for mandatory risk models (with Tim Elliott, CEO of Navvis)
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About

Join one man’s quest to learn everything there is to know about the business of healthcare. Blake Madden and friends cut through the fluff to talk shop with influential healthcare leaders across innovation, strategy, finance, policy, and more. Learn about disruptive health tech startups, hear war stories, stay up to date on emerging health system transformation strategies, and listen in to scalding hot takes on pressing topics and the future of the industry. New episodes drop Mondays. Subscribe to get the latest!

Information

  • Creator
    Blake Madden
  • Years Active
    2025 - 2026
  • Episodes
    29

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