Health Tech Nerds Radio

Kevin O'Leary, Martin Cech

Where we share our weekly news debriefs and discussions with industry experts. These are lo-fi recordings aimed at giving our readers more opportunities to engage with our analysis and a view into some of the conversations that shape it.

  1. A physician-turned-founder's take on making prior auth actually work | Jeremy Friese (Humata Health)

    1d ago

    A physician-turned-founder's take on making prior auth actually work | Jeremy Friese (Humata Health)

    Jeremy Friese spent a decade as a physician at Mayo Clinic navigating prior auth from the provider side. Now he runs Humata Health, which helps large health systems submit better prior auths to every plan in the country. Humata is a participant in CMMI's WISeR program, handling Oklahoma's fee-for-service Medicare prior auth, and six months in, providers are submitting almost exclusively through Humata's portal. Jeremy's view on fixing prior auth: use AI only to say yes, build real transparency into the rules, and let humans sort out the small fraction that actually requires a fight. Links referenced CBS article on WISeR rollout in Oklahoma: https://www.cbsnews.com/news/medicare-ai-program-wiser-prior-authorization-errors-delays/Substack on AI usage in prior auth: https://spinalcolumn.substack.com/p/the-algorithm-is-denying-your-authHumata Health: humatahealth.comJeremy Friese: jeremy@humatahealth.comFor more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

    18 min
  2. The Grand Roundup: Agentic voice AI wars, recent funding roundup, Cityblock acquires Homeward, UpDoc's FDA clearance, Humata's WISeR rollout, and more

    3d ago

    The Grand Roundup: Agentic voice AI wars, recent funding roundup, Cityblock acquires Homeward, UpDoc's FDA clearance, Humata's WISeR rollout, and more

    Kevin and Martin start with a discussion about a crowded week in healthcare AI funding. Prosper AI and Assort Health’s fundraising announcements were released on back-to-back days, with nearly identical customer quotes claiming each was "the only true platform." Kevin and Martin work through what that signals about the agentic voice AI space. They also cover Alan's €480M raise at a $6.3B valuation, Trase's $107M seed round, Cadence's RPM-to-chronic-care-management pivot, Hera's CCM play, Upside's Medicaid housing engagement numbers, the Cityblock-Homeward acquisition, and UpDoc's FDA 510K clearance. They close by explaining stop-loss lasering and what it means for insurability when the bag keeps getting passed. Then Jeremy Fries, CEO and founder of Humata Health, joins to talk through WISeR — the CMMI prior auth program now live in Oklahoma. Jeremy walks through how the program works (AI says yes instantly; humans adjudicate everything else), what the rollout has actually looked like on the ground, why provider adoption numbers are better than the headlines suggest, and why he thinks prior auth, done right, is one of the few places in healthcare where payers and providers can actually find common ground. Links referenced Bloomberg article on MyConnections: https://www.bloomberg.com/news/features/2019-11-05/unitedhealth-s-myconnections-houses-the-homeless-through-medicaidWSJ article on UpDoc: https://www.wsj.com/pro/venture-capital/updocs-ai-gets-fda-nod-to-act-as-concierge-doctor-between-visits-2b7fa41bMarsh McLennan report on lasering: https://view.ceros.com/marsh-mma-mid-atlantic/success-stories/p/19CBS article on WISeR rollout in Oklahoma: https://www.cbsnews.com/news/medicare-ai-program-wiser-prior-authorization-errors-delays/Substack on AI usage in prior auth: https://spinalcolumn.substack.com/p/the-algorithm-is-denying-your-authHumata Health: humatahealth.comJeremy Friese: jeremy@humatahealth.comFor more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

    1h 20m
  3. The liability gap holding clinical AI back — and who should solve it | JD Friedland (Cleveland Clinic)

    Jun 25

    The liability gap holding clinical AI back — and who should solve it | JD Friedland (Cleveland Clinic)

    JD Friedland is the executive director for ventures at Cleveland Clinic, where he evaluates and deploys emerging health technology across one of the country's largest and most research-intensive health systems. He walks through what Cleveland Clinic has actually built — some examples include: sepsis detection with Bayesian, clinical trial recruitment via Dyania, and surgical note generation through Theator's ambient video platform. He gets into why Cleveland Clinic's data is worth more today than it will be once the window to be an early contributor has closed, why OpenEvidence's pharma-advertising model gives him pause, and why the liability question, not the technology, determines the speed of clinical AI deployment. Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health this Wednesdsay, June 24 at 12pm ET to dive into specialty value-based care. Register to attend and receive the recording: luma.com/htn-ursa-atlas For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

    19 min
  4. The Grand Roundup: Anti-tiering contracts and the OhioHealth ruling, Thoreau/Ensemble update, 340B and Eli Lilly, OpenLoop's D2C play, Cleveland Clinic on AI trust, and more

    Jun 22

    The Grand Roundup: Anti-tiering contracts and the OhioHealth ruling, Thoreau/Ensemble update, 340B and Eli Lilly, OpenLoop's D2C play, Cleveland Clinic on AI trust, and more

    Kevin and Martin by discussing the OhioHealth DOJ settlement and what banning anti-tiering, anti-steering clauses in hospital contracts could mean for employer plan design, narrow networks, and upstart insurance models. They talk about the $12B Ensemble Health Partners deal: what it says about the RCM market's appetite for holistic versus point-solution approaches, and where it might fit into Matt Holt's broader Thoreau acquisition agenda. The Clover-Stars recalculation gets a full breakdown: what the judge sided with, what CMS did next, who won, and the uncertainty now rippling through payer teams, provider comp models, and the whole vendor ecosystem built around Star scores. Martin digs into the 340B program via Minnesota's annual state report, explaining Eli Lilly's decision to freeze discounts for non-compliant hospitals, the FQHC access problem at the center of it, and whether a rebate model actually helps or just punishes the safety net players the program was designed for. And Kevin walks through OpenLoop's Shopify-for-telehealth launch, what it would actually mean if anyone with an audience could create a D2C GLP-1 brand in hours, and why the economics of that model are an interesting question. Then JD Friedland, Executive Director for Ventures at Cleveland Clinic, joins to walk through how one of the country's flagship health systems is thinking about AI deployment. JD talks about what Cleveland Clinic has actually built with ambient listening, clinical trial enrollment via Dyania, and surgical documentation through Theator. He gets into the data consortium question—why your institution's data is most valuable when you’re an early contributor—and the liability and brand risk that makes health systems cautious about deploying forward-facing AI solutions they don't fully control. Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health this Wednesdsay, June 24 at 12pm ET to dive into specialty value-based care. Register to attend and receive the recording: luma.com/htn-ursa-atlas Links referenced OhioHealth / DOJ Settlement: https://www.justice.gov/opa/pr/justice-department-requires-ohiohealth-stop-using-anticompetitive-healthcare-contract-terms Minnesota 340B Report: https://www.health.state.mn.us/data/340b/docs/2025report.pdf For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

    1h 21m
  5. The tasks AI should take off doctors' plates — and the ones it shouldn't | Hashem Zikry (Counsel Health)

    Jun 17

    The tasks AI should take off doctors' plates — and the ones it shouldn't | Hashem Zikry (Counsel Health)

    Hashem Zikry is a practicing emergency physician at UCLA, a researcher focused on unnecessary ED utilization, and the medical director for clinical research and policy at Counsel Health — which, this week, began integrating Oura biometric data into clinical decision-making for the first time. That combination of roles gives him an unusual perspective on the question everyone is asking: what should AI actually be allowed to do in clinical care? He also speaks about regulation — the current state-by-state landscape ranges from Utah's live AI sandbox to New York and Colorado bills that would sharply limit patient-facing AI — and Zikry argues a federal floor would accelerate innovation rather than constrain it. On the Oura partnership, he pushes back on the concern that wearables drive unnecessary utilization, contending that access to a clinician at the point of data — not just the data itself — is what changes the demand curve. Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to dive into specialty value-based care. Register to attend and receive the recording: luma.com/htn-ursa-atlas Links referenced Hashem’s LA Times story: https://www.latimes.com/opinion/story/2026-04-25/ai-democratize-medicine-regulation Follow Hashem on LinkedIn: https://www.linkedin.com/in/hashem-e-z-87243529a/ For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

    16 min
  6. How Alignment Health gets health systems to come to them | John Kao (Alignment Health)

    Jun 16

    How Alignment Health gets health systems to come to them | John Kao (Alignment Health)

    Thirty-five years into Medicare Advantage, John Kao sees the V28 correction as a pricing reset, not a structural rupture. Plans that invested in clinical care delivery are emerging from it better positioned than those that leaned on coding and prior auth. He expects MA to capture 65–70% of the senior market within the next decade — and argues the current administration's push on program integrity is accelerating, not threatening, that trajectory. The second half of the conversation turns to health systems. Hospitals that are over capacity are coming to Alignment Health not out of ideological alignment on value-based care, but because reducing senior admissions frees up beds for commercial patients who reimburse at higher rates. Alignment's pitch is that it can deliver on that operationally — 142 acute admissions per thousand versus original Medicare's roughly 250 — while also moving market share into the system. The business case, he argues, makes the ideological one unnecessary. Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to dive into specialty value-based care. Register to attend and receive the recording: luma.com/htn-ursa-atlas Links referenced Follow John on LinkedIn: https://www.linkedin.com/in/johnkao1/ For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

    20 min
  7. The Grand Roundup: $12B Matt Holt/Ensemble deal, Hawaii's payvider bet unravels, PwC's highest commercial trend in 18 years, Clover Stars win, clinical AI regulation, and more

    Jun 15

    The Grand Roundup: $12B Matt Holt/Ensemble deal, Hawaii's payvider bet unravels, PwC's highest commercial trend in 18 years, Clover Stars win, clinical AI regulation, and more

    Kevin and Martin chat about Matt Holt's return with a reported $12 billion bid for Ensemble Healthcare Partners. They unpack what it means that Thoreau, Holt’s AI-forward play, is interested in a business whose CEO explicitly pitched a more human-centric approach to RCM. From there, they do a deep dive into what’s going on in Hawaii: HMSA's decade-long VBC experiment is unraveling, providers have done a complete 180 on whether they want it, and the state is now pushing a payvider merger that makes even less sense given the backdrop. Kevin traces it all back to the same payer-provider adversarial dynamic playing out across the country. Then they take a look at PwC's 2027 commercial trend report, which projects a 9% increase in medical costs, the highest in 18 years, with AI-driven billing optimization leading the charge, followed by behavioral health volume, GLP-1s, No Surprises Act fallout, and hospital services inflation. The politics aren't subtle: AI that helps providers bill more is innovation, while AI that helps payers deny more is bad. They also touch on recent stock moves for Clover and Alignment as signs that managed care is trending upward again. John Kao, chairman and CEO of Alignment Health, joins to explain why he always says not to bet against Medicare Advantage. He walks through what's made Alignment's California model work, why expanding outside the state is harder than it looks, and how health systems are increasingly coming to them — not the other way around — because keeping MA patients out of beds is good for all parties. Hashem Zikry from Counsel Health closes the show with a discussion on clinical AI regulation. He frames the current U.S. landscape as a laboratories-of-democracy experiment — Utah running a live sandbox, New York and Colorado pulling back — and argues the federal government should set a floor, not a ceiling. He also breaks down Counsel's new partnership with Oura, which this week begins integrating biometric data into clinical decision-making for the first time, and pushes back on the concern that wearables just generate more utilization. Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to dive into specialty value-based care. Register to attend and receive the recording: luma.com/htn-ursa-atlas Links referenced PwC report: https://www.pwc.com/us/en/industries/health-industries/library/behind-the-numbers.html Follow John on LinkedIn: https://www.linkedin.com/in/johnkao1/ Hashem’s LA Times story: https://www.latimes.com/opinion/story/2026-04-25/ai-democratize-medicine-regulation Follow Hashem on LinkedIn: https://www.linkedin.com/in/hashem-e-z-87243529a/ For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

    1h 38m
  8. The billing problem is actually an affordability problem | Seth Cohen (Cedar)

    Jun 10

    The billing problem is actually an affordability problem | Seth Cohen (Cedar)

    Seth Cohen runs Cedar, which sits inside the bill-pay workflow for health systems across the country, meaning he sees the patient collections reality that most hospitals are still processing. Most providers still sort patients into commercial, government, and self-pay, a taxonomy that made sense 15 years ago and doesn't anymore. ACA premium churn is quietly flipping commercial AR to self-pay retroactively, Medicaid redeterminations hit January 1st, and the average hospital is already collecting about 40 cents on every patient dollar owed. For a $5B system, that's $250M in net income lost annually. Seth argues that the billing problem has quietly become an affordability problem, and that the fix isn't better statements or more outreach—it's meeting people where they actually are. Brought to you by Ursa Health: Join HTN, Atlas Oncology Partners, and Ursa Health on June 24 at 12pm ET to learn what it takes to scale specialty value-based care. Register: luma.com/htn-ursa-atlas Links referenced Seth’s LinkedIn post on ACA premiums: https://www.linkedin.com/feed/update/urn:li:activity:7453134273911455744/ How to contact Seth: seth@cedar.com For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

    19 min
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About

Where we share our weekly news debriefs and discussions with industry experts. These are lo-fi recordings aimed at giving our readers more opportunities to engage with our analysis and a view into some of the conversations that shape it.

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    Kevin O'Leary, Martin Cech
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    © 2026 Kevin O'Leary, Martin Cech
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