1,300 Point Solutions Killed, CHF Admissions Halved, and the Mercy Playbook | Steve Mackin, Mercy CEO

VBC’s shift to performance, AI agents on the org chart, LEAD is a no-go, and why health systems should prep for mandatory risk models (with Tim Elliott, CEO of Navvis)

In this latest episode of Claims Denied, Blake sits down with Tim Elliott, CEO of Navvis, for one of the most clear-eyed conversations he's had on where value-based models are actually headed. Tim doesn't deal in buzzwords or wishful thinking. He deals in what's actually working, what operators are getting wrong, and where the puck is going — whether you're ready for it or not. Here were some gems from the discussion which makes the broader convo worth your time: * 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. * Tim is 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. * 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. * Stop leading with the comp model. Popular belief (that Blake 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. * 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. --- 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 [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/⁠⁠⁠ [https://hospitalogy.com/%E2%81%A0%E2%81%A0%E2%81%A0] Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ [https://hospitalogy.com/podcast/%E2%81%A0%E2%81%A0%E2%81%A0] 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/ [https://www.linkedin.com/in/tim-elliott-b246aa151/]  Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠ [https://www.linkedin.com/in/blakecmadden/%E2%81%A0%E2%81%A0%E2%81%A0%E2%81%A0%E2%81%A0]

How Lantern and Morgan Health Are Re-Wiring Employer Healthcare, And Why Narrow Networks Are Suddenly Worth a Second Look (with Dan Mendelson, CEO Morgan Health and John Zutter, CEO Lantern)

Blake Madden sits down with two of the people most responsible for re-wiring the employer side of healthcare right now: Dan Mendelson, CEO of Morgan Health — 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 serious ground: * How Lantern cracked the code on surgeons of excellence at a community level * Why Dan thinks traditional payer networks are failing * The $10M cell & gene therapy math nobody at the employer level wants to run * Whether AI finally makes narrow networks work this time around * Why specialty care, oncology, infusions, and specialty drugs represent ~60% of total employer healthcare spend — and are growing 1.5x to 3x faster than overall trend If you sell into employers, sit on a benefits committee, run a self-funded plan, or invest in this corner of the market, this one's worth blocking off the time for. --- 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 [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/⁠⁠⁠⁠⁠ [https://hospitalogy.com/] Like our podcast? Listen to previous episodes here: ⁠⁠⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠⁠⁠ [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/⁠⁠⁠⁠⁠⁠⁠⁠ [https://www.linkedin.com/in/blakecmadden/]  --- Follow Dan Mendelson on LinkedIn: https://www.linkedin.com/in/dnmendelson/ [https://www.linkedin.com/in/dnmendelson/]  Follow John Zutter on LinkedIn: https://www.linkedin.com/in/john-zutter-687000a/ [https://www.linkedin.com/in/john-zutter-687000a/]

From Multiplan Insider to Multiplan Disruptor: The Daffodil Health Story (with Navin Nagiah, CEO of Daffodil Health)

In this latest episode of Claims Denied, Blake Madden sits down with Navin Nagiah, co-founder and CEO of Daffodil Health. Navin spent nearly two years inside Multiplan trying to modernize their repricing model from the inside — went to the board three times, couldn't get alignment, and left to build the AI-native version himself. Blake and Navin get into the No Surprises Act arbitration imbalance (88% provider win rate), why the "percent of savings" model is built on a fake pricing anchor, and Daffodil's vision to evolve from OON repricing into a full smart plan platform. Plus, Navin shares why a 10-day silent meditation retreat is a founder development hack. --- 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 [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/⁠⁠⁠⁠ [https://hospitalogy.com/] Like our podcast? Listen to previous episodes here: ⁠⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠⁠ [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/⁠⁠⁠⁠⁠⁠⁠ [https://www.linkedin.com/in/blakecmadden/]  --- To learn more about Daffodil Health, check out their website: https://daffodilhealth.com/ [https://daffodilhealth.com/] Follow Navin Nagiah on LinkedIn: ⁠https://www.linkedin.com/in/navin-nagiah-8ab16⁠ [https://www.linkedin.com/in/navin-nagiah-8ab16]

MA is a Flat Circle, the Physician Subsidy Bear Case, and Why Density Beats Scale (with Jason Ross, EVP at Privia Health)

Hospitalogy's Blake Madden sits down with Jason Ross, EVP of Medical Groups at Privia Health, a guy who has worked basically every seat at the healthcare table. Jason is currently running the largest portion of Privia's single-TIN medical group footprint across a publicly traded enabler. Coming out of Privia's Q1 print, Blake and Jason leaned into on the stuff Wall Street keeps missing. * The MA down-cycle and whether VBC is actually broken or just on a familiar back-half-of-the-cycle slump. * Privia’s portfolio philosophy — why Privia runs 100+ FFS contracts alongside 100+ VBC contracts when half the market chased pure-play full-risk.  * The unsustainability of the health system physician subsidy model from somebody who lived it. * Density vs. scale. * The PE second-bite math falling apart in real time. * Privia is hitting singles and doubles (Not flashy, but Tony Gwynn never hit for power either...and he ended up in the Hall of Fame!) --- 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 [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/⁠⁠⁠ [https://hospitalogy.com/] Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ [https://hospitalogy.com/podcast/]  Be sure to leave us a review, and share our podcast with colleagues. Follow Jason Ross on LinkedIn: https://www.linkedin.com/in/jasonwross/ [https://www.linkedin.com/in/jasonwross/] Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠ [https://www.linkedin.com/in/blakecmadden/]

Insuring Against the Incumbents: Why Indigo Technologies' Jared Kaplan Is Betting MedMal Is Ripe for Disruption

You may think the insurance industry is dull, but not this conversation! For this episode, I sat down with Jared Kaplan, CEO and founder of Indigo Technologies, to talk about why medical malpractice insurance is one of the last bastions of healthcare that hasn't been touched by modern technology.  We also discussed how Indigo is using 1,500+ predictive attributes to blow up the 15-page application and individualize physician risk in a $13B market.  And we got into InsureTech 3.0, nuclear verdicts reshaping hospital balance sheets, why the best technology in the world means nothing without broker trust, and whether AI-enabled clinical care will eventually become a malpractice discount the way a burglar alarm lowers your homeowners’ premium.  --- Learn more about Indigo Technologies: https://www.getindigo.com/ [https://www.getindigo.com/] Follow Jared Kaplan on LinkedIn: https://www.linkedin.com/in/jared-kaplan-683412/ [https://www.linkedin.com/in/jared-kaplan-683412/] --- Follow Blake Madden on LinkedIn: ⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠ [https://www.linkedin.com/in/blakecmadden/]  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/⁠⁠ [https://hospitalogy.com/] Like our podcast? Listen to previous episodes here: ⁠⁠https://hospitalogy.com/podcast/⁠⁠ [https://hospitalogy.com/podcast/]  Be sure to leave us a review, and share our podcast with colleagues.