Health Tech Nerds Radio

How Gyde is enabling the shift from MA broker to trusted advisor | Will Johnson (Gyde)

Will Johnson, CEO and Co-Founder of Gyde, joins on the day Gyde announces the acquisition of We Know Medicare to discuss the MA brokerage market and where it's headed. Will walks through Gyde's acquisition model: buying quality MA brokerages and equipping them with a platform and support to drive organic growth post-acquisition. He contrasts this what agencies historically experienced in M&A: minimal resources post-transaction, team reorgs, and increased admin burdens. Gyde instead pitches itself as a long-term partner rather than a financial buyer. The conversation shifts to the strategic value of the broker as carriers grapple with acquisition and retention. Will's view: the best brokers are already acting as trusted advisors beyond enrollment — helping members navigate pharmaceutical issues, find physicians, and manage the broader healthcare experience. He sees that role growing as MA benefits rationalize and get more complex to navigate independently. The episode closes on his insurance unbundling thesis: as MA benefits become more focused on major medical expenses and supplemental coverage gets individualized, Will sees consumers needing comprehensive guidance across insurance, health, and wealth decisions — with Medicare as the entry point into a much broader relationship. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe Brought to you by: Ursa Health: Helping value-based care organizations unlock the full value of their data. Learn more at ursahealth.com   Nashville Healthcare Sessions: join HTN and 1,400 execs from across the ecosystem Sep 13-15 in Nashville. Register at nashvillehealthcaresessions.com/register/ Referenced: Gyde Health acquisition: https://www.gydehealth.ai/resources/gyde-acquires-we-know-medicare Gyde Health: https://www.gydehealth.ai/ Will Johnson: will@guidehealth.ai

How the No Surprises Act solved balance billing but created a pricing problem | Loren Adler (Brookings Institution)

Loren Adler, Fellow and Associate Director at the Brookings Institution, joins to assess the No Surprises Act four years in after recent coverage in NYT sparked discussion. The good news: patients have largely been removed from balance billing. The harder news: the IDR arbitration process that replaced rate-setting has pushed prices to nearly 4x historical in-network rates in radiology, with those costs flowing to employers and likely eventually back to patients through higher premiums. Arbitration was always risky — it's opaque, and human arbitrators tend to be more sympathetic to physicians than insurers. Loren walks through what may have been a cleaner approach: a benchmark price tying out-of-network payments to a percentage of Medicare, or regulating contract design directly by making it illegal for anesthesia and surgical groups to hold discordant network status from the hospitals they work in. Both solutions had appeal but neither got far in Congress. On the near-term outlook, Loren is candid: no big picture changes are likely because the winners are concentrated — a handful of PE-backed emergency medicine and anesthesia groups dominating the IDR process — and the losers are diffuse. This dynamic makes congressional action very unlikely in the near term. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe Brought to you by: Ursa Health: Helping value-based care organizations unlock the full value of their data. Learn more at ursahealth.com   Nashville Healthcare Sessions: join HTN and 1,400 execs from across the ecosystem Sep 13-15 in Nashville. Register at nashvillehealthcaresessions.com/register/ Referenced: No Surprises Act: https://www.brookings.edu/articles/no-surprises-act-arbitration-databook/ Loren Adler, Brookings: https://www.brookings.edu/people/loren-adler/ Loren Adler on X: https://x.com/LorenAdler

The Grand Roundup: Mass General Brigham's AI PCP backlash, Hinge Health pushback on CMMI ACCESS, No Surprises Act increasing costs, US drug access & TAMs, AI market signals, and more

News & Analysis from Health Tech Nerds Mass General Brigham faced pushback from two directions in two weeks — the state flagging the MinuteClinic partnership for increasing costs, and its own primary care docs criticizing the K Health AI partnership. Kevin's take: MGB has the highest primary care rates in Massachusetts with PCPs talking about unionizing, raising the question of whether an academic medical center should be in the primary care business at all. Digital health continued pushing back on CMMI ACCESS rates, with Hinge Health CEO Daniel Perez issuing the most direct public rebuke yet. Kevin's read: CMMI set rates deliberately low to force a ground-up rebuild, publicly traded digital health companies are structurally ill-suited to participate, and the opportunity is best fit for companies building from a fundamentally different cost structure. Kevin and Martin discuss the mixed signals emerging around healthcare AI adoption: OpenEvidence showing explosive clinician usage growth while Doximity and Health Catalyst struggle through the transition, alongside OpenAI and Anthropic launching consulting arms and Hippocratic AI publicly defending its traction amid growing scrutiny. The US reimburses 88% of approved drug indications versus 30-40% in peer economies, illustrating the tradeoffs with healthcare costs in our country. Meanwhile, drug development TAMs are massive, exceeding that of even OpenAI. Kevin’s observation: we can and should be innovating here, but the healthcare cost debate must acknowledge that innovation comes with costs. Guest: Loren Adler (Brookings Institution) The No Surprises Act eliminated surprise bills, but the IDR arbitration process that replaced rate-setting has pushed prices to nearly 4x historical in-network rates — with those costs flowing to employers and eventually premiums. Loren's assessment: a benchmark price would have been cleaner, and a near-term fix is unlikely. Guest: Will Johnson (Gyde) Will, CEO of Gyde, joins to discuss Gyde’s growth via acquisitions of other MA brokerage agencies and how they integrate and support partners. He shares how they are incorporating AI, his perspective on the journey of the broker market, and the opportunity to go enrollment. Guest: Jenny Schneider (Homeward) Jenny Schneider from Homeward joins to discuss the $50B Rural Health Transformation Program and the challenges facing rural healthcare. The conversation covers the operational challenges states face in deploying funds, the $137B in projected rural cuts that exceed the investment, and why provider retention is the more pressing and underaddressed challenge. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe Brought to you by: Ursa Health: Helping value-based care organizations unlock the full value of their data. Learn more at ursahealth.com   Nashville Healthcare Sessions: join HTN and 1,400 execs from across the ecosystem Sep 13-15 in Nashville. Register at nashvillehealthcaresessions.com/register/ Referenced: MGB PCP backlash: https://www.bostonglobe.com/2026/05/09/business/mass-general-brigham-primary/ ACCESS pushback: https://www.statnews.com/2026/05/14/medicare-chronic-care-pilot-access-digital-health-tech/ No Surprises Act: https://www.brookings.edu/articles/no-surprises-act-arbitration-databook/ Loren Adler, Brookings: https://www.brookings.edu/people/loren-adler/ Loren Adler on X: https://x.com/LorenAdler PhRMA report: https://cdn.aglty.io/phrma/Attachments/NewItems/PhRMA_OnePager_AccessToNewMedicinesReport_8.5x11_v3.2_Print%20(2)_20260512113247.pdf Gyde Health acquisition: https://www.gydehealth.ai/resources/gyde-acquires-we-know-medicare Gyde Health: https://www.gydehealth.ai/ Will Johnson: will@guidehealth.ai OpenEvidence adoption: https://www.nbcnews.com/tech/tech-news/openevidence-ai-doctor-medical-physician-login-app-what-npi-uptodate-rcna341064 Homeward Health: https://www.homewardhealth.com/ Jenny Schneider: jschneider@homewardhealth.com

Why Photon Health is doubling down on the pharmacy patient experience | Otto Sipe (Photon Health)

Otto Sipe, founder and CEO of Photon Health, joins following the company’s $16M Series A to discuss why prescribing infrastructure remains surprisingly antiquated, and why Photon believes the real opportunity is not transmitting prescriptions, but helping patients obtain them. Otto explains how Photon evolved from an e-prescribing network into a consumer-oriented prescribing marketplace focused on transparency, fulfillment, and patient navigation. The conversation explores the broader prescribing ecosystem, including the limitations of legacy infrastructure, why “sending the XML document” is effectively a commodity, and how Photon is repositioning prescribing around the patient experience. Otto argues the real challenge begins after the prescription is written: pharmacy selection, insurance pricing, inventory availability, prior auth, and fulfillment. Otto also discusses Photon’s go-to-market pivot toward health systems, where the company found stronger demand for pharmacy transparency and patient navigation. The discussion closes on why health systems increasingly operate around pharmacy economics, why pharmacy may become one of the most important patient engagement surfaces in healthcare, and how AI may further shift health systems toward medication-centered care models. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

The case for underwriting as the new defensible moat in healthcare | Sean Doolan & Emre Karatas (Virtue VC)

Sean Doolan and Emre Karatas from Virtue VC join to discuss their thesis that a new actuarial infrastructure layer is emerging in healthcare and why they're investing behind it. The starting point is a simple observation: most healthcare risk is either mispriced or unpriced, and the incumbents who could theoretically fix it are structurally prevented from doing so because their business models depend on the mispricing. That creates an opening for a new category of companies that can quote a number, bear the risk, and stand behind their math. Sean and Emre walk through how they think about this infrastructure layer, with dashboards and workflow tools on top and underwriting as the chassis underneath. RightWise, a portfolio company repricing pharmacy claims at the individual drug level for self-insured SMB employers, serves as a concrete illustration of their thesis. The conversation also covers where else the thesis applies: ACOs, medical malpractice, surgical centers of excellence, and site of care arbitrage. On go-to-market, Sean and Emre explain why pharmacy is a cleaner starting point than medical, why SMBs are the right initial customer, and why focused execution beats trying to serve the whole market at once. Sean and Emre wrap by underscoring that actuarial infrastructure is one of the more defensible investment categories in an AI world and what kind of founders Virtue wants to hear from. For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe