Healthcare Trailblazers

Ian Koons, co-founder and CEO of Karoo Health, joins Mendel Erlenwein on Healthcare Trailblazers fresh off a new funding round. Karoo started with value-based care for cardiac patients. Ian explains why that was only the entry point, and how the company plans to own the full cardiology stack across services, clinical care, and technology.They talk about why Karoo places a patient enrollment specialist at the point of care to catch patients when trust is highest, and whether AI agents can ever keep that trust. Ian also covers why he chose 7wire Ventures' Lee Shapiro and Jeff Stolte as partners, and how Karoo is beating its total-cost-of-care guarantees by 2–3x. He describes the "GDMT easy button" that takes guideline-directed therapy off cardiologists' plates.On the culture side, Ian lays out his "don't ask for permission" manifesto, monthly town halls where the team calls out leadership, and his reasons for keeping Karoo small. He also announces Karoo's new headquarters in Denver, Colorado, live on the show.Timestamps:00:00 Intro00:25 Karoo's strategy beyond value-based care01:37 Why Karoo raised this round and who it brought on03:44 What Karoo looks like in five years04:56 The race to the patient and reaching unengaged patients06:06 Embedding enrollment specialists at the point of care08:20 Would the model work without humans?09:29 AI agents, public trust, and the chicken-and-egg problem11:32 Go slow to go fast: testing AI in small groups12:09 Scaling culture: "Don't ask for permission"13:14 Monthly town halls where the team calls out leadership14:31 Skip-level truth-seeking15:21 Why Karoo is staying small (~70 people)16:22 Announcing Karoo's Denver headquarters18:25 Why in-person matters: speed compounds20:29 Remote talent vs. in-person speed21:13 Balancing authority and responsibility in a flat culture23:10 Karoo's 2027 priorities: beating guarantees, hiring, and the GDMT easy button27:01 Who actually pays Karoo?27:51 "How did I get here?" Pressure as a privilege30:59 Wrap-up

What happens when healthcare providers get paid for outcomes instead of activities?In this episode of the Healthcare Trailblazers Podcast, we sit down with Jacob Shiff, Chief AI and Technology Officer at the CMS Innovation Center (CMMI), for an inside look at the CMS ACCESS Model and the thinking behind one of the most ambitious experiments in technology-enabled value-based care.Jacob explains why the current healthcare payment system often pushes technology toward generating more billable activity — and how ACCESS is designed to change those incentives by paying organizations for measurable improvements in patients’ health.We get into how outcome-aligned payments work, why the model is intentionally technology-forward, what it could mean for chronic care, and how organizations may use new tools and patient incentives to improve outcomes.We also step beyond ACCESS to discuss a bigger question: What would healthcare look like if patients could actually compare providers based on outcomes and cost?Later in the conversation, Jacob shares his journey from healthcare technology founder to government, what it means to be a “policy entrepreneur,” the surprising reality of getting things done inside the federal government, and why he believes this work can meaningfully affect how long millions of people live.In this episode:• Why CMS created the ACCESS Model• Paying for outcomes instead of healthcare activities• Why healthcare technology follows financial incentives• How CMS determines payment rates• Why ACCESS may require technology to work economically• Patient engagement and incentives• Giving patients better information about provider quality and cost• Value-based competition vs. value-based care• Building healthcare policy like an entrepreneur• What Jacob learned moving from startups into government• Burnout, long hours, and mission-driven workTimestamps00:00 — Introduction to Jacob Schiff and the CMS ACCESS Model01:33 — Jacob’s role at CMS and how ACCESS came to be03:41 — The three insights that led to ACCESS04:46 — Why technology follows healthcare’s financial incentives05:34 — Why fee-for-service limits technology-enabled care06:19 — The limitations of shared-savings models06:49 — ACCESS: paying for outcomes instead of activities07:08 — How do you determine what an outcome is worth?08:30 — Clinical outcomes vs. avoided healthcare utilization09:31 — How CMS sets outcome-aligned payment rates11:46 — Does ACCESS require technology to work?12:11 — The one-minute explanation of the ACCESS Model12:44 — Why lower payment rates can improve affordability13:26 — The upcoming ACCESS launch event15:03 — Jacob’s background, curiosity, and approach to the job15:58 — Why Jacob believes this work can affect millions of lives16:24 — Going from healthcare startup founder to CMS17:48 — What does it feel like to see your ideas become national policy?18:02 — Becoming a “policy entrepreneur”19:19 — The missing piece: getting patients engaged20:45 — Patient incentives and ACCESS safe harbors22:16 — Why not pay patients directly for better outcomes?23:17 — Using outcome payments to incentivize patients24:16 — The most important healthcare decision a patient makes24:49 — Why choosing the right provider changes cost and quality26:01 — What healthcare could look like with real provider transparency26:39 — The original meaning of “VBC”: Value-Based Competition28:42 — Measuring risk-adjusted outcomes per dollar29:36 — Rapid-fire questions29:55 — What ACCESS participants struggled to operationalize30:25 — Learning when not to answer a question in government30:52 — The power of silence and asking simple questions31:52 — Moving from startups into the federal government32:43 — What surprised Jacob most about working in government34:22 — Long hours, family life, and avoiding burnout35:44 — Closing thoughts

CMS has proposed sweeping changes to remote patient monitoring in the 2027 fee schedule — and the whole industry is doing the math in public. Dr. Eve Cunningham, CMO of Cadence, comes back on Healthcare Trailblazers to answer the question underneath all of it: is there actually an ROI on remote patient monitoring?0:00 Cold open2:17 The 2027 proposal that guts RPM3:17 The elephant: is there an ROI?7:10 Cadence's receipts9:30 Paid for activity, not outcomes10:05 Paying landscapers to push lawnmowers17:07 Where agentic AI actually breaks23:20 Why half the med titrations never happen26:34 The gray wave31:43 "Robots should wipe butts before they do surgery"35:29 The employment clause38:17 What OB hospitalists already proved41:34 Integration or fragmentation

American healthcare is built around the physician. Jenna MG thinks that's the mistake. As CEO and co-founder of PocketRN — and a caregiver to her own mother — Jenna makes the case that in dementia and chronic care, the person you actually have to treat is the exhausted family caregiver. And that the missing piece isn't another doctor. It's a nurse who stays.

Dr. Tom Keane — the National Coordinator for Health Information Technology — brings a rare dual perspective: he writes the policy by day and lives with its consequences at the bedside. Our conversation covers the history of the ONC, the HITECH Act and the Cures Act, the three levers driving interoperability (TEFCA, standards, and information-blocking enforcement), the difference between data blocking and "functionality blocking," real-time drug pricing and cash-pay tools like Trump Rx and Cost Plus Drugs, behavioral health data sharing, and a market-first vision for governing AI in medicine — from AI scribes and stroke detection to agentic AI that finally puts patients in control of their own records. Healthcare Trailblazers is sponsored by CareCo: Turn admin time into patient time with clinical AI for care teams. Timestamps:0:00 — Cost-conscious medicine and the price of non-compliance1:35 — Welcome and introducing Dr. Tom Keane2:20 — From radiology to government5:05 — How policy and bedside practice inform each other8:02 — Care Conference: the care you'd give your own family9:27 — Treating the full context of a patient's care11:03 — The CareCo vision: a shared "brain" that directs care14:26 — Care coordination then vs. now (Johns Hopkins to Maryland)17:33 — Interoperability and who really owns patient data19:05 — A short history of the ONC: HITECH and the Cures Act21:32 — Three tools to free the data: TEFCA, standards, info blocking23:45 — Enforcing the information-blocking rule24:30 — Data blocking vs. functionality blocking and the G10 API27:56 — When incentives align: the HTI-4 rule and real-time drug prices31:04 — Cash-pay pricing: Trump Rx, Cost Plus Drugs, GoodRx32:43 — The secondary-insurance blind spot34:40 — Where government doesn't belong36:21 — Governing AI without strangling it37:25 — Why AI rules should be national, not a 50-state patchwork40:41 — Behavioral health IT grants and 42 CFR Part 243:09 — Project Hope in Huntington, West Virginia44:11 — Lessons from HITECH for the AI era (and the PACS contrast)47:04 — AI in practice: scribes and stroke detection49:40 — The next ten years of healthcare52:11 — Two big AI use cases: administrative and clinical54:01 — Patient empowerment and agentic AI56:44 — Closing thoughts

Dr. Mehmet Oz, Administrator of CMS, and Amy Gleason, Director of the U.S. DOGE Service, sit down with Mendel Erlenwein at CMS headquarters in Washington D.C. to reveal how they're tackling $140 billion in Medicare fraud — including shutting down 221 fake hospices in Los Angeles linked to Russia, China, and Cuba.In this episode of Healthcare Trailblazers, Dr. Oz and Amy Gleason discuss the "Kill the Clipboard" patient data initiative, why Medicare still runs on 1970s COBOL code, and what happens when foreign governments infiltrate America's healthcare system. As Dr. Oz puts it: "When there's friction in the system, somebody's making money."TIMESTAMPS:0:00 Inside CMS headquarters with Dr. Oz and Amy Gleason2:41 "Kill the Clipboard" — fixing patient data access8:52 Patient engagement crisis and the path forward15:54 $140 billion in Medicare fraud — where the money goes17:39 Shutting down 221 fake hospices in Los Angeles18:45 Foreign government involvement: Russia, China, and Cuba21:10 Medicare runs on 1970s COBOL code23:26 "When there's friction, somebody's making money"ABOUT THE GUESTS:Dr. Mehmet Oz serves as Administrator of the Centers for Medicare & Medicaid Services (CMS), overseeing $2 trillion in annual Medicare and Medicaid spending.Amy Gleason is the Director of the U.S. DOGE Service and Strategic Advisor to CMS. A former ER nurse turned healthcare technology leader, she previously served at the U.S. Digital Service under both the Trump and Biden administrations.SUBSCRIBE to Healthcare Trailblazers for conversations with the leaders transforming American healthcare.#MedicareFraud #CMS #HealthcareReform #DrOz #DOGE

In this episode of the Healthcare Trailblazers Podcast, we sit down with Ryan Eder, CEO of LainaHealth, to unpack a rare 20-year healthcare journey that spans hardware, software, computer vision, AI, military research, COVID pivots, and ultimately the creation of a nationwide virtual physical therapy practice.Ryan walks through how a senior design thesis turned into a decade-long R&D effort, why the company shut down millions of dollars of hardware overnight, and how AI-driven computer vision became the backbone of scalable, tech-enabled MSK care.This is a candid, execution-level conversation about building real healthcare companies, surviving pivots, and designing care models that actually work — for patients, providers, and payers alike.👇 Chapters below — jump to what matters most.00:00 – AI in Healthcare Is Not Optional02:48 – It Started as a College Design Project05:57 – 13 Years of Hardware… Then We Shut It Down10:58 – Why Virtual Physical Therapy Finally Works14:32 – The Numbers No One Likes to Share19:18 – AI as a Clinician’s Force Multiplier22:35 – The CMMI ACCESS Model: Reality vs Hype25:05 – Where Virtual Care Goes Next

Lt. Col. Jayme Hanson, former CFO overseeing half of the National Capital Region's military healthcare system, shares eye-opening insights about the Defense Health Agency (DHA), veteran suicide epidemic, and why moving military healthcare to private sector care could be a costly mistake. From combat medic to healthcare executive, Hanson exposes the hidden dynamics between politics, healthcare, and the military that most people never see.Lt. Col. Hanson brings decades of experience from serving as a combat medic to leading healthcare operations for major military facilities including Pentagon, Fort Belvoir, and more. His candid perspective on leadership, government inefficiency, and solutions for the veteran crisis is both sobering and hopeful.Timeline:0:00 - Introduction: Healthcare meets military leadership8:28 - Inside military healthcare: The 10M person system nobody knows20:20 - The veteran suicide crisis and PTSD solutions29:44 - Why young Americans are physically and mentally unfit37:30 - How military healthcare actually gets funded42:16 - Leadership advice for fixing the system#MilitaryHealthcare #VeteranCare #DefenseHealthAgency #VeteranSuicide #HealthcareReform #MilitaryLeadership

Learn how you can scale your care team with AIhttps://link.CareCo.ai/rmvhvq Dr. Sandeep Palakodeti, founder and CEO of Velocity Health, joins host Mendel to discuss how his concierge precision medicine clinic is reimagining primary care. With experience from Kaiser, Harvard, Mayo Clinic, and as Chief Population Health Officer at a major health system, Sandeep explains why traditional insurance-based healthcare fails at prevention and how Velocity Health's cash-pay model solves this problem.The conversation covers the broken incentive structures in American healthcare, why patients switching insurance plans prevents long-term health investment, and how life insurance companies could be natural partners. Sandeep shares the complete patient experience—from comprehensive diagnostics to ongoing support from interdisciplinary teams—and introduces the concept of "longevity escape velocity": the idea that living long enough today means we might live indefinitely as medical technology advances.This is a practical blueprint for what primary care could be when aligned incentives meet innovative delivery models.Timestamps:00:00:40 - What is Velocity Health and the concierge precision medicine model00:12:17 - The fundamental problem: Why patients choosing insurers prevents healthcare investment00:16:38 - Aligned incentives: Why life insurance companies are the perfect partners00:19:43 - Inside the patient experience: From onboarding to ongoing 24/7 care00:32:47 - Sandeep's journey and why entrepreneurship drives healthcare change00:40:44 - Longevity escape velocity: The future of living indefinitely through medical advances

The "NICU Graduate" celebration is one of the happiest moments for a family, but is it a false sense of security?In this episode, Mendel talks with Dr. Ross Sommers about the "NICU Cliff." We pour billions into saving babies born as small as 400 grams, only to send them home on oxygen and feeding tubes with almost zero support.Dr. Sommers reveals the heartbreaking reality of why "goodbye and good luck" isn't a medical plan, the PTSD parents face, and how First Day Healthcare is finally building a safety net for the world’s most vulnerable patients.Key Chapters:00:00 – The NICU Cliff: Why leaving the hospital is the scariest day.03:43 – The reality of Parent PTSD after the NICU.05:43 – How Remote Monitoring is changing the "Feeder-Grower" game.07:23 – The $40 Billion Business of Neonatology.14:04 – Why pediatric innovation lags 7 years behind adult care.17:40 – The Personal Mission: Why "graduation" isn't the end of the story.