NerdMDs StackBytes #6

NerdMDs StackBytes #8

🎧 StackByte Episode Summary (Ep #8 – “How Much of Medicine Is Actually an Algorithm? What technologists miss when they try to systematize care.”)🎧 StackByte Episode Summary:In this episode of NerdMDs StackBytes, Dr. Adam Carewe tackles a deceptively simple question: How much of medicine is actually an algorithm? Through sharp reflection and clinical insight, he explores the structured side of medicine—where protocols and decision trees save lives—while powerfully asserting that the heart of care lies in the gray zones algorithms can’t reach. It’s a compelling call to technologists: true innovation in healthcare requires humility, respect for clinical nuance, and partnership with the humans who carry the burden of care.🔗 Read the full Substack post [https://rewskidotcom.substack.com/p/how-much-of-medicine-is-actually] 🔹 00:00 – Framing the Big QuestionDr. Adam Carewe opens with a provocative inquiry: Is medicine just a set of algorithms? He lays out why this question matters now, especially for those building healthcare technologies. The episode promises to untangle what tech can and can’t replicate in medicine. 🔹 01:52 – Where Algorithms ShineDr. Carewe highlights the clinical scenarios where algorithms thrive—emergency settings, sepsis bundles, stroke codes. These tools bring life-saving structure and speed to chaotic moments. “In emergency medicine and the ICU, algorithms bring order to chaos.” 🔹 04:31 – When the Guidelines Run OutAs the conversation moves into the real-world messiness of medicine, Dr. Carewe underscores how most patients don’t fit cleanly into protocols. This is where clinical judgment, not code, takes the lead. “Medicine isn’t just executing a flowchart. It’s holding responsibility in uncertainty.” 🔹 07:45 – The Enduring ‘Art’ of MedicineWith historical nods to Hippocrates and Galen, Dr. Carewe reflects on the philosophical and human aspects of medicine—listening, presence, gut instinct, and the courage to act (or not) amid uncertainty. 🔹 10:18 – Why Tech Keeps Missing the PointHere, Dr. Carewe critiques the common mindset among health tech founders: seeing medicine as a system to be optimized. He warns that without understanding the emotional and ethical labor of clinicians, even the best tools will miss the mark. “Until you’ve stood at the bedside at 3 a.m., with a crashing patient and no clear guideline, you won’t grasp the weight of what medicine requires.” 🔹 13:02 – The Real Future: Collaboration, Not ReplacementDr. Carewe concludes with a hopeful challenge: the future of healthcare isn’t in replacing doctors—it’s in building tools that amplify what humans do best. He calls for a tech-clinician partnership rooted in respect and realism. If you’re a technologist, clinician, or anyone curious about where medicine meets innovation, this episode is essential listening. For the full essay, visit Dr. Carewe’s Substack [https://rewskidotcom.substack.com/p/how-much-of-medicine-is-actually]. Get full access to Rewskidotcom by Adam Carewe MD at rewskidotcom.substack.com/subscribe [https://rewskidotcom.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4]

NerdMDs StackBytes #7

🎧 StackByte Episode Summary (Ep #7 – “Confessions of a Former CMIO: I Was Wrong About Integration”)In this episode of StackByte, host Adam Carewe, a former Chief Medical Information Officer, candidly reflects on a major shift in his thinking about health IT. Once a staunch advocate for EHR integration, Adam shares why he now believes the future belongs to tools that are intelligent, not just integrated. He explores how generative AI is enabling standalone solutions that deliver real clinical value, sparking a move from traditional ambient documentation to intelligent clinical companions. Packed with hard-won insights and real-world examples, this episode challenges healthcare leaders to rethink their tech priorities. Dive deeper into the topic in the original Substack post: Confessions of a Former CMIO: I Was Wrong About Integration. [https://open.substack.com/pub/rewskidotcom/p/confessions-of-a-former-cmio-i-was?r=1n0gtg&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true] 🔹 00:00 – Intro & SetupAdam introduces the theme of the episode—why he now questions the long-held belief that “integration is king” in healthcare tech. He sets up the context for his confession, rooted in his own leadership experience at Kaiser. “For most of my career I believed it with religious conviction… But here's the confession—I think I was wrong.” 🔹 01:20 – The Old Rule: No Integration, No DealReflecting on his time at Kaiser, Adam recounts how he rejected tools that didn’t directly integrate with Epic, even if they showed promise. Back then, integration equaled usability and adoption. 🔹 03:00 – Enter Generative AI: A Game-ChangerThe rise of generative AI has changed the equation. Tools like OpenEvidence now deliver high clinical value without being embedded in the EHR. He explains how this shift reshapes what's possible in digital health. “We’ve entered an era where a tool doesn’t need to be hard-wired into the EHR to deliver value.” 🔹 05:25 – The Problem with Integrated ToolsAdam shares his experience trialing ambient note tools that were seamlessly integrated—but underwhelming. Though technically elegant, they flattened clinical reasoning and buried key insights. 🔹 07:15 – The Rise of Intelligent Clinical CompanionsHe introduces the idea of tools that go beyond documentation—tools that listen, guide, generate notes, and offer decision support. At General Medicine, his team has already shifted to using raw transcripts and building intelligence in-house. “An intelligent clinical companion doesn’t just document, it guides.” 🔹 09:45 – Rethinking the PlaybookAdam warns that many healthcare leaders are stuck in a 2018 mindset, still prioritizing integration above all else. But the grassroots adoption of non-integrated AI tools by clinicians tells a different story—one of unmet needs and innovation. 🔹 11:40 – Final Thoughts & The Real QuestionHe wraps up by encouraging leaders to ask not only does it integrate? but does it deliver outsized value even without integration? The next wave, he argues, will be defined by intelligence, not connectivity. “The tools that win physician loyalty won’t be the ones that integrate first. They’ll be the ones that act as true intelligent clinical companions.” Get full access to Rewskidotcom by Adam Carewe MD at rewskidotcom.substack.com/subscribe [https://rewskidotcom.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4]

NerdMDs StackBytes #5

🎧 StackByte Episode Summary (Ep #5 – “Health Delivery 2.0”) Drs. Adam Carewe and Dale Gold distill Carewe’s recent Substack essay on rebuilding U.S. health-care economics from “sick-care” to true health delivery. Citing Medicare fee-schedule cuts, exploding costs, and tech tailwinds, they argue that incremental margin hacks are dead; only a wholesale redesign of the payment-and-care stack can keep providers solvent and patients healthy. Carewe lays out six structural “moves” — from killing fee-for-service to making data liquid and shifting hospital-level care into the living-room — and closes with three 90-day action items any operator can start today. (Read the full essay on the NerdMDs Substack [https://open.substack.com/pub/rewskidotcom/p/health-delivery-20-demolish-and-rebuild?r=1n0gtg&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true]). 🔹 00:00 – Welcome & Why This Matters The hosts frame the chat as a “10-minute power session” translating Carewe’s Substack into audio, warning that the current system is on a financial “burning platform.” 🔹 01:22 – From Sick-Care to Health Delivery Carewe stresses that keeping people well is now an urgent necessity for survival, not a nice-to-have. A fresh 2.9 % CMS fee-schedule cut against CPI + 5 % cost inflation shows why tweaks won’t cut it. 🔹 02:48 – The Six Moves Overview He introduces six radical moves and warns: “Your margin … won’t save you. Your model will.” 1️⃣ Kill Fee-for-Service (02:48) Volume is “officially on hospice.” Providers must swap RVUs for population-health upside payments. 2️⃣ Pay for Risk, Not Visits (04:03) Capitation already touches 14 % of U.S. spend — double four years ago — and mastering RAF coding plus prevention is now table stakes. 3️⃣ Make Data Liquid (05:33) The January 2025 TEFCA rule imposes $1 M fines per blocked record, forcing open FHIR APIs and edge-analytics at the bedside. 4️⃣ Regulated Code Speed (07:14) New FDA “living-algorithm” guidance lets adaptive AI into care if every weight update is version-controlled and explainable—“transparency equals clearance; opacity equals 483-letter hell.” 5️⃣ Shift Care Home-First (08:41) Remote sensors + 24/7 command centers turn the couch into the new ward, with hospital-at-home DRGs capturing full reimbursement. 6️⃣ Retail Keeps Us Honest (10:10) Amazon-style “one-click, same-day, transparent-price” expectations mean health systems must match retail convenience or be replaced. 🔹 11:19 – Three Immediate Plays Plot your risk runway (how many PMPM lives can you manage in 12 months). Open the pipes: map every data silo and unblock within 90 days. Restage site-of-care: move one DRG home this quarter, three next. 🔹 12:24 – Closing Reflection The episode ends urging listeners to ask what “studs are showing” in their own organizations that signal it’s time to smash, sweep, and rebuild toward a system that actually pays for health. Notable Quote: “Transparency equals clearance; opacity equals 483-letter hell.” Get full access to Rewskidotcom by Adam Carewe MD at rewskidotcom.substack.com/subscribe [https://rewskidotcom.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4]

NerdMDs StackBytes #6

🎧 StackByte Episode Summary (Ep #5 – “Health Delivery 2.0”) Drs. Adam Carewe and Dale Gold distill Carewe’s recent Substack essay on rebuilding U.S. health-care economics from “sick-care” to true health delivery. Citing Medicare fee-schedule cuts, exploding costs, and tech tailwinds, they argue that incremental margin hacks are dead; only a wholesale redesign of the payment-and-care stack can keep providers solvent and patients healthy. Carewe lays out six structural “moves” — from killing fee-for-service to making data liquid and shifting hospital-level care into the living-room — and closes with three 90-day action items any operator can start today. (Read the full essay on the NerdMDs Substack [https://open.substack.com/pub/rewskidotcom/p/health-delivery-20-demolish-and-rebuild?r=1n0gtg&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true]). 🔹 00:00 – Welcome & Why This Matters The hosts frame the chat as a “10-minute power session” translating Carewe’s Substack into audio, warning that the current system is on a financial “burning platform.” 🔹 01:22 – From Sick-Care to Health Delivery Carewe stresses that keeping people well is now an urgent necessity for survival, not a nice-to-have. A fresh 2.9 % CMS fee-schedule cut against CPI + 5 % cost inflation shows why tweaks won’t cut it. 🔹 02:48 – The Six Moves Overview He introduces six radical moves and warns: “Your margin … won’t save you. Your model will.” 1️⃣ Kill Fee-for-Service (02:48) Volume is “officially on hospice.” Providers must swap RVUs for population-health upside payments. 2️⃣ Pay for Risk, Not Visits (04:03) Capitation already touches 14 % of U.S. spend — double four years ago — and mastering RAF coding plus prevention is now table stakes. 3️⃣ Make Data Liquid (05:33) The January 2025 TEFCA rule imposes $1 M fines per blocked record, forcing open FHIR APIs and edge-analytics at the bedside. 4️⃣ Regulated Code Speed (07:14) New FDA “living-algorithm” guidance lets adaptive AI into care if every weight update is version-controlled and explainable—“transparency equals clearance; opacity equals 483-letter hell.” 5️⃣ Shift Care Home-First (08:41) Remote sensors + 24/7 command centers turn the couch into the new ward, with hospital-at-home DRGs capturing full reimbursement. 6️⃣ Retail Keeps Us Honest (10:10) Amazon-style “one-click, same-day, transparent-price” expectations mean health systems must match retail convenience or be replaced. 🔹 11:19 – Three Immediate Plays Plot your risk runway (how many PMPM lives can you manage in 12 months). Open the pipes: map every data silo and unblock within 90 days. Restage site-of-care: move one DRG home this quarter, three next. 🔹 12:24 – Closing Reflection The episode ends urging listeners to ask what “studs are showing” in their own organizations that signal it’s time to smash, sweep, and rebuild toward a system that actually pays for health. Notable Quote: “Transparency equals clearance; opacity equals 483-letter hell.” Get full access to Rewskidotcom by Adam Carewe MD at rewskidotcom.substack.com/subscribe [https://rewskidotcom.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4]

Ep 46 | "Aging While Caregiving" | Dr. Renee Dua | Nephrologist & Serial Co-Founder

Want to support Rewskidotcom Substack and the NerdMDs | Efficiency Unlocked Podcast? ♻️ Share this post with friends in healthcare🫰 Become a paid subscriber📢 Become a sponsor (email me)🌟 Leave a 5-star review for the NerdMDs | Efficiency Unlocked Podcast 🎧 Episode Summary: In this episode of NerdMDs Efficiency Unlocked, nephrologist and serial healthtech founder Dr. Renee Dua [https://www.linkedin.com/in/reneedua/] dives into the personal and systemic challenges of "aging while caregiving." From her pioneering days building a paperless medical practice to co-founding Heal and later Renee (a digital health assistant), she shares how her professional journey intersects with her personal experiences caring for aging parents. The conversation explores the invisible burdens placed on Gen X and Millennials, the financial and emotional toll of caregiving, and the systemic gaps in policy and innovation. Dr. Dua offers candid insights into the cultural, technological, and policy shifts needed to better support caregivers—without sacrificing their own health and future security. 🔹 00:00 – Introduction & BackgroundHost welcomes Dr. Renee Dua, introducing the episode’s theme of “aging while caregiving.” Renee recounts her path from practicing nephrologist to tech founder, including launching Heal, which grew to 13 states before being acquired by Humana. Her entrepreneurial drive emerged from a desire to amplify her reach beyond “hand-to-hand” patient care. “Everybody should receive care this way—kids, moms, dads, parents—everyone in the community.” 🔹 04:33 – Founding Heal & Transition to Caregiver TechRenee shares how building Heal was both exhilarating and all-consuming—launching in multiple states while raising her children. After Heal’s acquisition, she co-founded Renee, a health assistant platform inspired by her experience managing her father’s medical needs. She reflects on the inefficiency of humans doing tasks software could automate, and the deeper realization of how caregiving impacts one’s own health and finances. 🔹 08:28 – The Caregiving Burden for Our GenerationThe discussion turns to the everyday challenges caregivers face—monitoring recurring medical issues, coordinating logistics, and balancing work, family, and self-care. Renee emphasizes how health and finances are intertwined, and how these pressures compound when caregivers lack medical knowledge or support networks. “We are not able to both save for college and make sure our parents don’t keep falling.” 🔹 14:43 – Cultural Expectations & Uncompensated LaborRenee discusses cultural norms, such as the expectation in some Asian families that eldest daughters will care for aging parents. She points out that caregiving has been unpaid labor for so long that society assumes it should remain that way, despite its economic and emotional costs. She notes that startups in the space face a tricky go-to-market challenge, as neither employers nor insurers consistently see caregiving support as their responsibility. 🔹 21:24 – Policy Blind Spots & Certification BarriersRenee critiques the lack of robust caregiver policy across political administrations and questions why informal caregivers must be certified to be recognized or compensated. She suggests caregivers could be essential partners in closing care gaps—if health plans and policymakers valued their role. 🔹 26:02 – Global Models & InspirationFrom India’s multigenerational housing to Cuba’s community doctors, Renee outlines international examples of more integrated caregiving systems. She argues the U.S. could adapt similar models, combining cultural respect for elders with cutting-edge technology, but is hindered by a healthcare system designed to maximize profit over care. 🔹 34:28 – Looking Ahead: Caregiver Assessment & AIWhile still in early development, Renee’s next venture aims to use AI to assess future caregivers early in life, helping them prepare financially, emotionally, and medically before the caregiving stage begins. She stresses the need for proactive planning, rather than crisis-driven response. 🔹 38:29 – Nerd Alert RoundIn a lighter segment, Renee shares her love for morning walks and audiobooks (listening to 50–60 a year), her desire to master the stock market, and recent book recommendations including They Called Us Exceptional and Bono’s memoir. She also reflects on ignoring bad advice to “slow down” during fellowship—a choice that has shaped her rich, unconventional career. Get full access to Rewskidotcom by Adam Carewe MD at rewskidotcom.substack.com/subscribe [https://rewskidotcom.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4]