Claims Denied: A Hospitalogy Podcast

Blake Madden
  • 5.0 (7)
  • 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. 2d ago

    Inpatient AI, Payor Win-Wins, and Token Costs (with Dr. Shiv Rao, co-founder and CEO of Abridge)

    Hospitalogy’s Blake Madden sits down with Dr. Shiv Rao, CEO and co-founder of Abridge, two hours before Rao was going on call at the hospital.  They talk about how Abridge has taken its playbook from ambulatory to the ER and now inpatient, and what’s different about engineering for that setting, why AI should rethink the claims process rather than be sprinkled on it, and how Abridge is working to help health systems avoid unpredictable token costs.  Also in this episode: What happens to a claim after a doctor types “shortness of breath” into a note? Rao says the whole loop adds up to roughly $300 billion of waste. What separates real products from “party trick” prototypes? A University of Vermont case shows the value-add of context engineering, guardrails, and knowing what good looks like. One payor told Abridge it approves well over 90% of the prior auths it initially denies and would welcome automation. Rao says scale earned Abridge a seat with payors, and he wants to avoid a future of “agents fighting agents.” --- Assort Health’s AI agents complete the work that turns patient demand into care, including scheduling, intake, referrals, forms, medication refills, and payments. Customers have increased appointment volume by 5%, expanded staff capacity by 115%, and captured up to $4.3 million in new annual revenue per 100 providers. To learn more, check them out today at ⁠⁠https://www.assorthealth.com/hospitalogy⁠⁠ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 80K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Like our podcast? Listen to 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/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

    Inpatient AI, Payor Win-Wins, and Token Costs (with Dr. Shiv Rao, co-founder and CEO of Abridge)

  2. Oct 13

    Standard as Possible, Different as Necessary: Inside Jefferson Health’s Payvider Bet and LVHN Integration (with Dr. Baligh Yehia, President of Jefferson Health)

    Which model won after Jefferson Health and Lehigh Valley Health Network merged? Dr. Baligh Yehia says that’s not the question Jefferson asks. Blake sits down with Dr. Yehia, President of Jefferson Health, to talk about running a 33-hospital system that wants to be an operating company, not a collection of hospitals. He breaks down how Jefferson is integrating LVHN, why the team lets AI-era rebuilds replace the usual model bake-off, and what it takes to align incentives when a payvider only covers part of your patients. In this episode: Why “standard as possible, different as necessary” is the default Jefferson is building around, and why quality came before back office in the LVHN integration Why payviders are one of the few models that can truly align incentives, even with no commercial book (Medicaid, Medicare Advantage, and ACA only), and how Jefferson still removes friction, like skipping prior auth for plan members moving to the next site of care The goal of handing 10 million hours back to clinicians in 3 years “Nursing out loud”: ambient for nurses is in 3 pilots, and the early wins are nurses eating lunch and clocking out on time Why AI won’t fix misaligned payment models, and will just run automated denials and automated appeals at machine speed --- Assort Health’s AI agents complete the work that turns patient demand into care, including scheduling, intake, referrals, forms, medication refills, and payments. Customers have increased appointment volume by 5%, expanded staff capacity by 115%, and captured up to $4.3 million in new annual revenue per 100 providers. To learn more, check them out today at ⁠https://www.assorthealth.com/hospitalogy⁠ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 80K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠ Like our podcast? Listen to 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/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

    Standard as Possible, Different as Necessary: Inside Jefferson Health’s Payvider Bet and LVHN Integration (with Dr. Baligh Yehia, President of Jefferson Health)

  3. Oct 6

    Members Leave Carriers, Not Brokers (with Will Johnson, Co-founder and CEO of Gyde)

    Claims Denied is back for a new season, and Blake kicks it off by driving down from Dallas to Austin, and sits in-studio with Will Johnson, co-founder and CEO of AI startup Gyde (http://gydehealth.ai/). Will is 17 months post-incorporation with a decade at Oscar behind him, and he brought a thesis Blake hadn't heard anyone articulate this cleanly: Healthcare's real front door isn't the carrier or the PCP. It's the broker, and there are fewer of them every year while the job gets harder every year. They get into why Will thinks commission rates stay flat while ACA premiums rip 14%, why an AI founder calls himself "a huge software bear," why roll-up is a banned word inside his own M&A shop, and the Capstone deal he thought was dead until a February coffee in Austin. Healthcare keeps trying to go around the broker. This episode makes the case for going through them. --- Assort Health’s AI agents complete the work that turns patient demand into care, including scheduling, intake, referrals, forms, medication refills, and payments. Customers have increased appointment volume by 5%, expanded staff capacity by 115%, and captured up to $4.3 million in new annual revenue per 100 providers. To learn more, check them out today at https://www.assorthealth.com/hospitalogy --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 80K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠⁠⁠⁠⁠ Like our podcast? Listen to 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/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠

    Members Leave Carriers, Not Brokers (with Will Johnson, Co-founder and CEO of Gyde)

  4. Sep 22

    CMS Isn't Asking Anymore: Inside the Mandatory Bundle Era (with Tim Elliott, CEO of Navvis)

    Second time's the charm! Blake welcomes back Navvis CEO, Tim Elliott, for a new conversation that goes deeper than round one. Blake and Tim get into why CMS finally ditched its "voluntary" posture on value-based care, what actually happens in the first 60 days when a mandatory bundle lands on a health system, and why specialists, not just primary care, are now squarely in CMS's crosshairs. They also cover physician enterprise 2.0, where AI is actually moving the needle on burnout (spoiler: it's not just ambient scribes), and Tim's read on what health systems get wrong heading into 2027. Genuinely one of Blake's favorite VBC conversations this season. And if you missed Tim's first appearance on Claims Denied from June 2026, be sure to check out that episode here. --- 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 Tim Elliott on LinkedIn: https://www.linkedin.com/in/tim-elliott-b246aa151/ Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠⁠⁠⁠

    CMS Isn't Asking Anymore: Inside the Mandatory Bundle Era (with Tim Elliott, CEO of Navvis)

  5. Sep 15

    Mentorship, Physician Entrepreneurship, and Owning the Pipes: Dr. Ramon Lizardo's Journey Through Scaling Tele911

    Blake sits down with Dr. Ramon Lizardo, ER doc turned three-time operator turned investor, and former CEO of Tele911. This one goes places Blake didn't plan for. Ramon shares his impressive journey: Getting into medical school on a single borrowed application he found in his backpack a month later. He left a $300K+ clinical job for $40K base and a $25K bonus, with debt. Then he built a company that turned Baltimore, Fort Worth, and San Francisco into cities where calling 911 puts a physician on your screen in 37 seconds. When the Key Bridge collapsed, the city called him at 3 a.m. and asked him to go live early. Blake pushed him on the physician hierarchy, on why nobody teaches doctors how money works, and on the digital health profitability problem. He also told Blake, on the record and before anyone else, where he's going next. Ramon even suggested a working title for the episode: "Health Tech Physician-founder Can't Control His Children" (His five-year-old and eight-year-old were negotiating a treaty in the next room the whole time.) This is the best kind of episode. Genuine, honest, and one not to miss! --- 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 Ramon Lizardo on LinkedIn: https://www.linkedin.com/in/ramonlizardomd Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠⁠⁠⁠

    Mentorship, Physician Entrepreneurship, and Owning the Pipes: Dr. Ramon Lizardo's Journey Through Scaling Tele911

  6. Sep 8

    Primary Care's Choke Point Was Never Knowledge (with Matic and Catalyst Health Group)

    We're doing something special with this latest episode of Claims Denied. Blake packed up and drove out to Plano, TX on a 100 degree August morning to record this one live on site, and the location is half the story: Matic's team works out of a suite inside Catalyst Health Group's headquarters. That's not a real estate footnote. That's the business model. Blake sits down with Calvin Carter, CEO and co-founder of Matic (https://maticinside.ai/), and Dr. Chris Crow, CEO and co-founder of Catalyst Health Group (https://www.catalysthealthgroup.net/). Calvin spent 15 years at Bottle Rocket building consumer apps for Chick-fil-A, Southwest, and half the news networks in America before an algorithmic trading side project put him next to Dr. Alex Shepherd, an engineer with a PhD in adversarial training for hallucinations who decided to go to medical school because "finance is a zero-sum game." The group gets into why Dr. Crow thinks every lab-built AI product is just the EMR story repeating, why he called direct primary care a cottage industry born of burnout rather than a model worth scaling, and what happens to a physician's panel when you stop making them the bottleneck. Dr. Crow also went on record with "Natty or bust" for the Texas Longhorns, and Blake is ready to hold him to it! --- 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 Calvin Carter on LinkedIn: https://www.linkedin.com/in/calvincarter/ Follow Dr. Chris Crow on LinkedIn: https://www.linkedin.com/in/drcrow/ Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠

  7. Sep 1

    Handl Health and the Death of Cost Shifting (with Ahmed Marmoush, Co-founder and CEO of Handl Health)

    Blake sits down with Ahmed Marmoush, CEO and co-founder of Handl Health, fresh off their Series A funding, and this one covers the full arc of where employer-sponsored insurance is heading. Ahmed's path is unlike any guest we've seen on Claims Denied: From a clinical pharmacist in New Zealand's single-payer system, to a consultant alongside the country's former Director General of Health, to an $800 bill for a routine physical in LA that turned into a company. (They offered him 50% off if he paid within a few days. He compared it to haggling in an Egyptian street market. He's not wrong.) They get into why cost shifting is dead, how variable copay plans really work, what's inside Handl's value index, and why Ahmed is betting on being the enablement layer between brokers and carriers instead of building yet another health plan. If you touch benefits strategy, brokerage, or health plan ops, this one's worth the commute. --- 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 Ahmed on LinkedIn: https://www.linkedin.com/in/ahmed-marmoush-25169961/ Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠⁠⁠

    Handl Health and the Death of Cost Shifting (with Ahmed Marmoush, Co-founder and CEO of Handl Health)

  8. Aug 18

    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)
See All (36)

Trailer

Ratings & Reviews

5
out of 5
7 Ratings

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
    36

You Might Also Like