Vital Signs with Jacob Effron and Nikhil Krishnan

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/

Ep 63: Narayana Health Vice Chairman on Scaling Quality Care in India and Tech’s Role

This episode features Viren Shetty, Vice Chairman of Narayana Health, discussing how his father founded a cardiac surgery hospital in India 25 years ago that revolutionized healthcare delivery by applying manufacturing efficiency principles to drastically reduce costs while maintaining quality. The conversation explores how Narayana Health scaled from one cardiac center to 19 multi-specialty hospitals across India and one in the Cayman Islands by implementing supply chain optimization, standardization of care, physician specialization, and high-volume operations—enabling them to perform cardiac surgeries at a fraction of Western costs. Shetty discusses the challenges and opportunities of operating in India's largely out-of-pocket healthcare market, the hospital's expansion into insurance and primary care to become a fully integrated provider, their measured approach to AI adoption, and why their high-volume, efficiency-driven model wouldn't directly translate to the US healthcare system despite offering valuable lessons in operational excellence and cost reduction.   (0:00) Intro (1:20) Founding and Growth of Narayana Health (2:48) Cost Reduction Strategies in Indian Healthcare (6:04) Challenges and Cultural Shifts in Standardization (8:16) Scaling and Expansion Bottlenecks (14:10) Impact of COVID-19 on Narayana Health (19:15) Medical Tourism and the Cayman Islands (23:03) High Patient Volume in Indian Hospitals (24:29) Exploring Healthcare Ecosystems (25:25) Automating Healthcare Administration (26:39) Challenges in US Healthcare (28:18) Innovative Healthcare Models (30:28) AI in Medicine (33:22) Driving Efficiency in Hospitals (37:48) Opportunities in Indian Healthcare (40:34) Quickfire   With your co-hosts:  @jacobeffron  - Partner at Redpoint, Former PM Flatiron Health  @patrickachase  - Partner at Redpoint, Former ML Engineer LinkedIn  @ericabrescia  - Former COO Github, Founder Bitnami (acq’d by VMWare)  @jordan_segall  - Partner at Redpoint