More AI point solutions won't solve healthcare's $200B administrative burden. Phare is healthcare's first Revenue Operating System, built on a foundation of Data Platform, Payer Atlas, and Phare Intelligence. The result: fewer denials and faster payments. See how it all works together in my latest article, written in collaboration with R1: @R1RCM

ICYMI: The CEO of a value-based enablement company just told me that "value-based care" is a dead term. Just 10 minutes into this episode, Tim Elliott, CEO of Navvis (@NavvisPopHealth) told me VBC as a term has run its course. We’re now entering a new categorical discussion more broadly around "performance" whether that’s commercial risk or full cap MA. Check out the episode: Apple: Spotify:

NEW ON THE POD: Here's a fun one: the CEO of a value-based enablement company just told me that "value-based care" is a dead term. Just 10 minutes into this episode, Tim Elliott, CEO of Navvis Healthcare @NavvisPopHealth told me VBC as a term has run its course. We’re now entering a new categorical discussion more broadly around "performance" whether that’s commercial risk or full cap MA. Here were some gems from the discussion which makes the broader convo worth your time: 1. 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. 2. He's 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. 3. 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. 4. Stop leading with the comp model. Popular belief (that I 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. 5. 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. I pushed back in a few spots and agreed in more. Either way it's the most clear-eyed conversation I've had on where these models are actually headed. Links below. Give it a listen and tell me where Tim's right and where more nuance matters. Apple: Spotify: 𝐓𝐈𝐌𝐄𝐒𝐓𝐀𝐌𝐏𝐒 • 09:10 — Tim retires "value-based care" on air (the term has run its course, and he'll tell you why) • 12:25 — The CHF bed that paid for itself — a value play with zero VBC contract attached • 24:00 — Lead with culture, not comp (the SSM sequencing call I pushed back on) • 41:00 — Why LEAD is a no for most of Navvis's book — spoiler: the settlement mechanics • 46:59 — Where the capital actually goes — ambulatory, and Ascension's AMSURG close as the tell • 49:36 — FTEs to FTAs: put your agents on the org chart — free idea, come get it

NEW ON THE POD: In this episode, I talk with two of the people most responsible for re-wiring the employer side of healthcare right now: Dan Mendelson @dnmendelson, CEO of @MorganHealth, JPMorgan Chase's $280M healthcare investment arm, and John Zutter, CEO of Lantern, a specialty care navigation platform now covering 12 million member lives. The conversation covers a lot of ground: how Lantern cracked the code on surgeons of excellence at a community level, why Dan thinks traditional payor networks are failing, the $10M cell & gene therapy math nobody at the employer level wants to run, and whether AI finally makes narrow networks work this time around. They get into the real cost drivers: specialty care, oncology, infusions, and specialty drugs represent about 60% of total employer healthcare spend — and they're all growing 1.5x to 3x faster than overall trend. John lays it out in numbers most CFOs don't see clearly enough. If you sell into employers, sit on a benefits committee, run a self-funded plan, or invest in this corner of the market, this is one I'd block off the time for. Drop me a note on what stuck. Apple: Spotify: TIMESTAMPS (00:00) From "fifth CEO in less than five years" to 12M lives: how Lantern actually turned around (and why "Centers of Excellence" had to die for "Surgeons of Excellence" to live) (11:39) Morgan Health rises from the ashes of Haven — Dan's favorite topic, allegedly (17:45) "Are you friend or foe?" — the call Dan got from a Big Five payer CEO right after Jamie went public (27:00) The 5% problem: John runs a clinic on where employer dollars actually go (mandatory listening — pull out a notepad) (40:00) $10M per dose, 12 months on payroll: the cell & gene therapy time-horizon problem nobody at the employer level wants to answer (50:30) HMO 2.0: why narrow networks plus AI might finally work, 30 years after the last attempt blew up

NEW ON THE POD: I tried something different this week. Instead of bringing on guests to interview, I pulled in two co-hosts — Teira Gunlock, CEO of First Stop Health, and Dr. Eric Bricker, CMO of AHealthcareZ — and we just… rumbled. Three topics, no script, healthcare's messiest debates. • AI regulation and whether EMRs need to be forced open (Eric made a compelling Steve Jobs / App Store analogy I can't stop thinking about). • First Stop Health hitting 5x productivity on their first fully AI-native dev cycle. • ICHRA vs. captives and why small/mid employers keep getting crushed on renewals. • Laser exclusions on stop-loss, the 80% renewal cycle, and why ICHRA's network problem is the real adoption blocker.  • Whether any of this is actually good for patients vs. just good for employers, the federal government, and everyone else trying to pass the healthcare cost hot potato (the “not it” dynamic). Also: Eric lost a chicken the day we were supposed to meet for lunch. So there's that. Apple: Spotify: 𝐓𝐈𝐌𝐄𝐒𝐓𝐀𝐌𝐏𝐒 00:00 — Co-hosts, not guests: trying a new format 01:05 — Tiera introduces First Stop Health (and her philosophy degree, which becomes relevant) 01:49 — Eric's origin story: Hopkins, Compass, YouTube, and accidentally becoming healthcare's finance explainer 07:23 — AI regulation: iterative governance vs. exponential tech (spoiler: they don't meet well) 10:48 — The liability question and why physicians are still on the hook for every AI decision 12:30 — Eric's App Store argument: why EMRs need to be forced open for agentic AI to matter 16:01 — "It's clinical workflow and billing software" — Tiera's correction that reframes the whole EMR conversation 17:11 — Is it malpractice NOT to use AI? (yes, eventually) 18:58 — First Stop Health's 5x dev cycle productivity gain (and what it means for clinical workflows) 22:44 — Radiology, AI, and the first real physician-specialty price war 28:09 — How to actually change the incentives (Tiera answers, Eric hides) 30:15 — The canary in the coal mine: HCA, Tenet, UHS will be first to layoff behind AI 32:05 — The "reskilling vs. swap-out" moral imperative (— free idea for every health system CHRO) 35:03 — AI primary care bots for rural patients: closing inequities or compounding them? 41:22 — Eric's "emotional labor is the next frontier" thesis (the best line of the pod) 46:04 — ICHRA explained: defined contribution, the 401k analogy, the Sally-will-quit problem 51:30 — Group captives: collective bargaining for stop-loss coverage 56:44 — Why exchange networks kill ICHRA adoption in the mid-market 01:00:47 — What IS the role of the employer in healthcare in 2026? 01:07:38 — Uwe Reinhardt, Donna Shalala, and why campaign finance reform is healthcare reform 01:12:51 — Keeping it in perspective: 1968 was worse. Also, Texas won the title in '69.

Can you believe it's been almost 4 months since the first episode of my Claims Denied podcast? That first episode featured Pete McCanna, CEO of Baylor Scott & White, who explained how legacy health systems are built like “castle walls” (supply-driven, organization-centric, and built to protect themselves), but this design fails customers who are outside the 4 walls. Check out this short clip to hear Pete's take on the need to transform health systems from supply-driven to demand-driven. Also during the episode, Pete discussed why: • 50%+ of encounters start at the wrong site of care. • Better routing is the real capacity unlock, not more hiring. • Baylor refuses to let anyone get between them and the customer (and “customer” isn’t semantics). • Epic can run the clinical backbone, but Baylor’s betting the winner is whoever owns orchestration, access, and the relationship. Listen to the full episode here: