Vital Signs with Jacob Effron and Nikhil Krishnan

Ep 68: Garner Health Founder on Measuring Doctor Quality, The AI Landscape & What Improves Healthcare

Nick Reber, CEO and founder of Garner Health, joins Jacob and Nikhil to walk through what is arguably one of the most structurally underrated problems in American healthcare: that the single biggest driver of cost and quality variation isn't which hospital system you use or whether your plan is value-based — it's which individual doctor you see. Nick traces the intellectual journey from his time at Oscar Health, where he first encountered 4x variation in complication rates across physicians at the same brand-name institutions, to building Garner's core infrastructure: a dataset of 320 million patients used to score every doctor in the country on quality-adjusted outcomes, layered on top of existing employer health plans with financial incentives to steer patients toward top performers. The episode drops alongside the announcement of Garner's Series E with Index Ventures, valuing the company at approximately $2.7 billion. The conversation covers the technical depth required to actually measure physician quality fairly (and why existing methodologies are fundamentally flawed), why value-based care has largely failed and what actually moves patient behavior, how AI will reshape the front door of healthcare, what it will take for AI health companies to build durable businesses beyond 2030, and why the solution to the US healthcare cost crisis may be as simple — and as politically hard — as treating it like a corporate expense policy.   (0:00) Intro (0:30) Garner's Origin Story (2:05) Doctor Choice Is the Biggest Lever (3:45) How Garner Works (5:43) Why Old Scoring Methods Failed (7:39) The Knee Pain Problem (11:58) Consumer UX, Incentives, and AI (33:44) How Much Spend Can AI Actually Touch? (36:00) Why Doctor Choice Needs Plan Integration (39:18) Build vs. Buy: Garner's AI Philosophy (41:38) The Unified Data Flywheel (43:01) What Actually Predicts Doctor Quality? (46:28) Enabling Independent Providers (51:37) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/

Ep 67: Abridge Leaders on AI-Native Healthcare, Doctors Who Code, and the Future of Clinical AI

A couple weeks ago, Michał Nedoszytko placed third globally at Anthropic's hackathon out of 13,000 participants. He was the head of cardiology at a hospital in Brussels at the time. Now he is Clinical Scientist at Abridge. On this episode of Vital Signs, Nikhil and I sat down with Abridge's CEO Shiv Rao and Michal to chat about how the hire came together, what changed with Opus 4.6 that let a cardiologist ship a working MVP in 40 minutes, and where they both think clinical AI goes next.   (0:00) Intro (0:19) Hackathon Fame (3:52) Shiv Recruits Mahal (6:30) Doctors Who Code (9:07) Prototypes vs Production (10:26) Regulation and Partnerships (13:00) Customization vs Reliability (15:59) AI Native Company Ops (19:29) Healthcare in 10 Years (21:08) Admin vs Clinical AI (24:47) Payers and Prior Auth (29:48) Training Doctors for AI (35:19) Context, Autonomy, and Demand (40:40) Pre-visit Workflows and Triage   Out-Of-Pocket: https://www.outofpocket.health/

Ep 66: Pete Shalek On The Future of Front Office Automation

Pete Shalek, founder of Valerie Health, is a multi-time healthcare entrepreneur who previously founded Joyable in 2013 (one of the earliest digital mental health platforms) and served as Chief Product Officer at AbleTo and Stellar Health. Pete discusses why AI in healthcare needs to move beyond selling software tools to actually doing the work for providers. He shares hard-won lessons from a decade in digital health, including why the shift to quality-based care in behavioral health has been surprisingly slow and why Joyable's therapist-free model was ahead of its time relative to payment models. The conversation covers Valerie's approach of building an AI front office that handles referrals, scheduling, and intake for independent medical practices without requiring them to learn new software, achieving 3-4 week implementations and 5-7% conversion lifts. Pete explains the technical challenges of structuring unstructured healthcare data with 100% accuracy, the strategic choice to own operations end-to-end rather than just provide tools, why referrals are the perfect wedge product as the most upstream data point, and his evolving views on how quickly AI will impact the gray area between administrative and clinical work. Throughout, he emphasizes the importance of meeting healthcare where it is (turning faxes into structured data rather than trying to force system-wide transformation) and building for today's payment models while working toward a bigger vision.   (0:00) Intro (0:52) Pete's Journey in Digital Health (1:45) Challenges in Behavioral Health (3:38) Valerie Health: An AI Front Office (4:47) Valerie's Unique Approach to Software (6:16) Customer-Centric Solutions (8:38) Data and AI in Healthcare (10:19) Building a Successful Health Tech Company (13:19) Future of AI in Healthcare (16:16) Operational Challenges and Solutions (28:57) Pricing and Value Delivery (30:12) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/ [https://www.outofpocket.health/]

Ep 65: CMMI Leaders on ACCESS Model Launch, Drug Pricing Strategy, and the Future of Technology Enabled Care

This episode announces the launch of CMS's ACCESS (Advancing Chronic Care with Effective, Scalable Solutions) model - a groundbreaking payment innovation that enables technology-enabled care organizations to treat Medicare fee-for-service patients with chronic conditions through outcome-aligned payments rather than traditional fee-for-service. Abe Sutton (Director of CMMI) and Jacob Shiff (Chief AI & Technology Officer at CMMI) explain how the model addresses a fundamental gap in healthcare: while commercial and Medicare Advantage patients have access to digital therapeutics and technology-enabled chronic disease management, original Medicare beneficiaries have been left behind. ACCESS changes this by paying providers monthly fees for managing conditions like diabetes, hypertension, obesity, behavioral health issues, and musculoskeletal pain - but only when patients achieve measurable clinical improvements. The model is designed to be deflationary rather than inflationary, encourages innovation by simplifying go-to-market for digital health startups, integrates with existing risk-bearing models like ACOs, and represents a broader CMMI strategy to shift from activity-based to outcome-based payments while leveraging new AI capabilities to democratize high-quality care.   (0:00) Intro (0:57) The ACCESS Model: Advancing Chronic Care (4:35) Outcome-Aligned Payments and Technology (7:40) Encouraging Innovation and Investment (09:23) Practical Implementation and Examples (24:28) Evaluating Success and Future Goals (26:18) Connecting the Dots: Broader CMMI Initiatives (28:40) Generous and Its Impact on Drug Pricing (30:11) Challenges and Benefits of Prior Authorization (35:19) The Role of Technology in Healthcare (37:59) AI and Technology-Enabled Care (40:26) Reflections on Value-Based Care Models (43:51) Encouraging Competition in the Healthcare Market (48:24) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/ [https://www.outofpocket.health/]

Ep 64: Sutter Health CEO & President Warner Thomas on Digital Transformation and the Future of Health Systems

The episode explores how Warner Thomas is transforming Sutter Health into a digitally-enabled, ambulatory-focused health system that can navigate major industry headwinds through growth rather than contraction. Thomas discusses Sutter's aggressive expansion of its physician network and ambulatory footprint, the system's push to dramatically improve consumer experience through technologies like online booking and ambient AI documentation, and their strategic pivot toward value-based care models as Medicare payment pressures intensify. Throughout the conversation, he emphasizes that successful health systems must embrace AI and digital tools not as futuristic concepts but as immediate operational necessities, while maintaining focus on integrated care delivery that keeps patients at the center—a philosophy shaped by his experience building integrated systems at Ochsner and now applied to reimagining Sutter's historically hospital-centric culture into one that blends physical and digital care delivery across the full continuum.   (0:00) Intro (1:01) Overview of Sutter Health (1:56) Comparing Sutter Health and Ochsner (4:08) Key Focus Areas for Sutter Health (6:49) Consumer Experience and Technology Integration (10:56) The Role of AI in Healthcare (18:03) Advice for Startups in Health Tech (21:19) Navigating Financial Challenges in Healthcare (24:23) Healthcare Policy and Advocacy (25:59) Competition and Differentiation in Healthcare (29:58) Value-Based Care and Medicare (34:03) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/