The Grand Roundup: Debating the future of ESI, concierge medicine's $40K price tag, Elevance/SCAN sue over Stars, ACA rate hikes and death spiral fears, and more

The Grand Roundup: Debating the future of ESI, concierge medicine's $40K price tag, Elevance/SCAN sue over Stars, ACA rate hikes and death spiral fears, and more

Kevin and Martin open by discussing a question that recently surfaced in the Health Tech Nerds Slack community: is employer-sponsored insurance actually crumbling, or just showing its age? They then move into a conversation about Midi's CEO calling out a $40K/year concierge menopause practice on LinkedIn and a run of quick hits: Elevance and SCAN joining Clover in suing over Stars ratings, a Wall Street Journal piece flirting with "death spiral" language for the ACA, Alignment Health's accounting troubles, and Pearl Health's $110M raise stacked half on credit. Then Bryan Sivak and Sean Glass join to break down Evidenced, the venture fund they just launched with a $24 million raise. They explain the fund's core thesis — backing early-stage health tech and tech-enabled services companies where a specific regulatory or policy tailwind accelerates buying — and walk through portfolio examples like IMPaCT Care, the community health worker infrastructure company spun out of UPenn. Sam Melamed, CEO of NCD and self-described "Chief Insurance Nerd," closes things out. He walks through NCD's supplemental benefits business, then dives into forecasting enrollment in CMS's new Bridge program, discussing what full-page Eli Lilly ads in the New York Times signal about the money already flowing into that market, and lays out why he thinks standalone dental and vision plans keep gaining ground alongside Medicare Advantage. Links referenced Out of Pocket, Out of Reach: https://www.statnews.com/health-insurance-costs-out-of-pocket-out-of-reach-series/ [https://www.statnews.com/health-insurance-costs-out-of-pocket-out-of-reach-series/] The Billionaires’ Vagina Club: https://www.newyorker.com/magazine/2026/07/06/the-billionaires-vagina-club [https://www.newyorker.com/magazine/2026/07/06/the-billionaires-vagina-club] ACA rate increases: https://www.wsj.com/health/healthcare/obamacare-insurers-seek-big-rate-hikes-again-8a4bf9e4 [https://www.wsj.com/health/healthcare/obamacare-insurers-seek-big-rate-hikes-again-8a4bf9e4] Sean and Bryan (Evidenced): sean@evidenced.com [sean@evidenced.com], bryan@evidenced.com [bryan@evidenced.com] Sam Melamed (NCD): sam@ncd.com [sam@ncd.com] For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

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/ [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-auth [https://spinalcolumn.substack.com/p/the-algorithm-is-denying-your-auth] * Humata Health: humatahealth.com [http://humatahealth.com] * Jeremy Friese: jeremy@humatahealth.com [jeremy@humatahealth.com] For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

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-medicaid [https://www.bloomberg.com/news/features/2019-11-05/unitedhealth-s-myconnections-houses-the-homeless-through-medicaid] * WSJ article on UpDoc: https://www.wsj.com/pro/venture-capital/updocs-ai-gets-fda-nod-to-act-as-concierge-doctor-between-visits-2b7fa41b [https://www.wsj.com/pro/venture-capital/updocs-ai-gets-fda-nod-to-act-as-concierge-doctor-between-visits-2b7fa41b] * Marsh McLennan report on lasering: https://view.ceros.com/marsh-mma-mid-atlantic/success-stories/p/19 [https://view.ceros.com/marsh-mma-mid-atlantic/success-stories/p/19] * CBS article on WISeR rollout in Oklahoma: https://www.cbsnews.com/news/medicare-ai-program-wiser-prior-authorization-errors-delays/ [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-auth [https://spinalcolumn.substack.com/p/the-algorithm-is-denying-your-auth] * Humata Health: humatahealth.com [http://humatahealth.com] * Jeremy Friese: jeremy@humatahealth.com [jeremy@humatahealth.com] For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

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 [http://luma.com/htn-ursa-atlas] For more from Health Tech Nerds, subscribe to our weekly newsletters: https://www.healthtechnerds.com/subscribe

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 [http://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 [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 [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