Hard Founder Truths in 2026 | Listener Q&A

We’re back with our monthly rundown of the top headlines in health tech!Today, Halle flies solo to share the biggest stories that shaped Q1, from the rising pressures on PBMs to how consumers are using AI.Stories covered:What's happening to PBMs (it's not pretty)New data from Rock Health on consumer use of AISocial media companies find liable for addictive designHealthcare hiring is slowing as efficiency becomes the focusHave we finally bent the healthcare cost curve in the United States?—The Heart of Healthcare podcast was nominated for a Webby award! We'd so appreciate if you could create a quick account and vote for us here. —📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutubeSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Last year, his independent pharmacy spent $13 million on brand-name drugs for patients processed by the three biggest Pharmacy Benefit Managers (PBMs) which earned a profit margin of 0.01%.In this episode, Halle speaks with Alec Ginsberg, owner and fourth-generation pharmacist at C.O. Bigelow, the oldest surviving apothecary–pharmacy in the United States. Alec is fighting against the forces squeezing independent pharmacies and charting a course for the future of the pharmacist.We cover:How the roll-up of PBMs, health plans, and retail pharmacies changed everythingWhat led him to remove his pharmacy’s Rx-filling robotThe dramatic decline of independent pharmacies along with the closures of big box pharmacy storesThe one health policy he would put in place today to save independent pharmaciesThe history of the pharmacist's role and what’s nextWhat he really thinks about compounding pharmacies and the Hims vs. Novo lawsuit—About our guest: Alec Wade Ginsberg is the fourth-generation pharmacist, owner, and Chief Operating Officer of C.O. Bigelow Apothecary, America’s oldest pharmacy, founded in 1838 and still operating in New York City’s West Village. With a Doctor of Pharmacy degree from the University of North Carolina Eshelman School of Pharmacy, Alec bridges the clinical world of pharmacy with the realities of modern consumer culture.At Bigelow, he oversees the brick-and-mortar beauty retail and pharmacy operations, navigating everything from prescription drug shortages to the pressures of today’s PBM-dominated marketplace. Beyond the counter, Alec is the founder and writer of Drugstore Cowboy, a weekly newsletter that dissects the intersection of drugs, business, and consumer culture — making the hidden mechanics of the U.S. healthcare system both understandable and entertaining for thousands of readers.His work has been featured across national media, and he’s become a trusted voice for translating complex pharmaceutical issues — from GLP-1s to compounding to drug pricing — into plain English. Alec’s mission is simple: to make Americans smarter about the pills in their cabinets and the system that puts them there.—Show notes:Drugstore Cowboy - Alec’s free and super interesting newsletterC.O. Bigelow - The Nation’s Oldest ApothecaryVirtual GLP-1 startups: Pill mills or the future of obesity care?—📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutube See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Chris Klomp, Director of Medicare and Deputy Administrator of CMS, and Senior Advisor to HHS Secretary RFK Jr., has big ambitions to reshape how healthcare works in the United States.This week, ​​Steve sits down with Klomp to discuss how his experience as a digital health entrepreneur is guiding his current role overseeing a roughly $2 trillion department. Klomp shares the government's strategy for restoring trust between providers and payers, driving down costs, and addressing a system where approximately 90% of healthcare dollars are still spent in a fee-for-service arrangement. We cover:Why 90% of US healthcare remains fee-for-service after two decades of reform.The intentional design of the new Access model to be deflationary and fuel entrepreneurship among insurgents.The commitment from the payer industry to make prior authorization invisible to patients and providers by 2027.CMS's aggressive stance on data interoperability and funding enforcement against data blocking.How the Most Favored Nation policy is re-wiring global prescription drug supply to lower prices without compromising innovation.—About our guest: Chris Klomp is the Director of Medicare and Deputy Administrator of CMS, and Senior Advisor to HHS Secretary Robert F. Kennedy Jr. With extensive experience in healthcare payment reform and data sharing, he built and led Collective Medical, the largest U.S. real-time care collaboration data network, acquired by PointClickCare in 2020. There, he partnered with health systems, plans, providers, post-acutes, and state governments to advance value-based care through enhanced data access and insights.Chris has driven healthcare reform at state and federal levels, focusing on value-based care and interoperable health technology. Through Endurance Companies, a San Francisco-based multi-family office he co-founded with Stanford classmates, he has co-founded, invested in, advised, and served on the board of many innovative healthcare organizations, including Nomi Health, Maven Clinic, InnovaCare Health, and Health Joy. He also served as a Utah Senate-confirmed commissioner of the Utah Digital Health Services Commission, where he focused on leveraging technology for cost-effective, healthier outcomes. Previously, he was Vice President in Bain Capital’s North American Private Equity group and worked at Bain & Company. Recognized as Utah Business’ CEO of the Year and EY’s Mountain Region Entrepreneur of the Year, Chris holds a B.A. with honors in Economics and English from Brigham Young University and an MBA from Stanford.—🙏 Thank you to our show sponsor, Quickstudy PR, story brokers for leading healthcare executives. Learn more about quickstudypr.com.—📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutube See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

This week, Halle and Michael sit down for a special in-person listener Q&A to answer a range of founder questions you submitted.Topics include:What investors are prioritizing right now and how first-time founders can stand outHow to think about board seatsWhat to do if your growth has plateauedThings to keep in mind when negotiating a health system contractHow to think about choosing between small funds and mega-VCsWhat “pay to play” really meansHow to handle co-founder equity when someone leaves early—📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutube See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Breakthrough blood tests that can flag dozens of cancers before symptoms appear are gaining momentum, yet questions remain about accuracy, equity, and how these tools will fit into routine care.In this episode, Steve talks with Helmy Eltoukhy, co-founder and co-CEO of Guardant Health, a $14 billion publicly-traded precision oncology company. The conversation explores the science behind cell-free DNA, the rise of blood-based cancer screening, and the broader shift toward data-driven diagnostics.We cover:How liquid biopsy works and why cell-free DNA became such a powerful toolThe path from late-stage applications to large-scale early detectionWhat Medicare coverage of blood-based colorectal cancer screening signals for adoptionThe operational and regulatory hurdles that shape diagnostics businessesLessons from Helmy’s entrepreneurial path across sequencing, diagnostics, and company-building—About our guest: Helmy Eltoukhy is the chairman and co-CEO of Guardant Health, a leading precision oncology company he co-founded in 2012. He is also an active investor and is involved in over 30 startup companies across the technology and healthcare sectors. In December 2024, Eltoukhy expanded his ventures into sports ownership by co-leading the acquisition of Sheffield United Football Club through COH Sports of which he is currently co-chairman.Last year, he was named by TIME100 Health as one of the most influential people in global health. He was also on Time Magazine’s inaugural list of the 50 Most Influential People in Health Care and has been recognized by Fortune (40 under 40), the World Economic Forum (Technology Pioneer), and on the list of the Top 50 Healthcare CEOs in 2021.Beyond his entrepreneurial endeavors, Eltoukhy is deeply committed to various philanthropic efforts and serves on the boards of the Prostate Cancer Foundation, the SETI Institute (Search for Extraterrestrial Intelligence), and the UCSF Cancer Leadership Council. Prior to founding Guardant Health, Eltoukhy co-founded Avantome in 2007 to commercialize semiconductor sequencing, which was later acquired by Illumina. Eltoukhy is a named inventor on over 100 patents and holds PhD, MS, and BS degrees in electrical engineering from Stanford University.—Learn more about the Rock Health CEO Summit at the New York Stock Exchange on March 27th.—📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutube See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Pharma ads, biotech IPOs, $1M longevity programs, oh my!This month's Digital Health Download skews towards biotech, which is having a moment. Tune in to hear Halle and Michael cover the latest headlines.We cover:Why pharma ads are surging and the growing push for restrictions on D2C drug advertisingHims & Hers’ $1.15B acquisition of Eucalyptus, its global expansion strategy, and the FDA crackdown on compounded GLP‑1 drugsThe return of biotech IPOs, with Eikon Therapeutics and Generate Biomedicines signaling investor interest in platform‑based drug discoveryVaccine makers scaling back research amid policy uncertainty, declining uptake, and tighter fundingTrumpRx’s “most favored nation” drug pricing approach, and what one STAT analysis foundBryan Johnson’s $1M per year “Immortals” longevity program—Show notes:Should drug companies be advertising to consumers? (The New York Times) Hims & Hers Enters $1.15 Billion Agreement to Acquire Eucalyptus (PharmExec.com)A sign biotech is back? Four drugmakers go public, raising nearly $1 billion in all (STAT)Vaccine Makers Curtail Research and Cut Jobs (The New York Times) TrumpRx claims to offer the lowest prices. But many drugs have cheaper generics (STAT)Bryan Johnson's Immortals: $1M to try longevity regimen (Axios) —"Halle Tecco wanted to see tech used for better medical services and getting people engaged in their own health. Now, she’s written a book on how she went about it." - The WSJMassively Better Healthcare is out now!—Rock Health's annual CEO Summit is returning to the New York Stock Exchange on March 27th! Learn more and nominate a CEO to join this invite-only event here. —📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutubeSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

When Eric Lefkofsky’s wife was diagnosed with breast cancer, it exposed how little technology and data were shaping cancer care, pushing the serial entrepreneur to build a different model.Lefkofsky is the founder and CEO of Tempus, now a $10B publicy traded health tech company, and previously founded Groupon. At Tempus, he’s building a tech-first company applying multimodal data and AI to make diagnostics smarter and treatment decisions more tailored, starting in oncology and expanding across disease areas.We cover:What Tempus does in plain EnglishWhy Tempus built its own lab, and how it became one of the largest sequencers of cancer patients in the U.S.The hard part: extracting usable clinical data from EHRs and scaling to thousands of hospital connections and hundreds of petabytes of dataHow AI changes the patient-physician relationship, and why patients will increasingly arrive highly informedWhat Eric would change at CMS and HHS to responsibly pay for AI—About our guest: Eric Lefkofsky is the founder and CEO at Tempus, a leader in artificial intelligence and precision medicine. He is the co-founder and General Partner of Lightbank, a private venture capital firm specializing in investments in technology companies. He is also the co-founder of Pathos AI, a clinical stage biotechnology company focused on re-engineering drug development; Groupon (NASDAQ: GRPN), a global e-commerce marketplace; Mediaocean, a leading provider of integrated media procurement technology; Echo Global Logistics (NASDAQ: ECHO), a technology-enabled transportation and logistics outsourcing firm; and InnerWorkings (NASDAQ: INWK), a global provider of managed print and promotional solutions.He co-chairs the Lefkofsky Family Foundation with his wife Liz to advance high-impact initiatives that enhance lives in the communities served. Lefkofsky also serves on the board of directors of The Art Institute of Chicago and Northwestern Medicine. He holds a bachelor’s degree from the University of Michigan and a J.D. from the University of Michigan Law School.—📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutube See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

In this episode (recorded live), Halle Tecco speaks with Dr. Robert Wachter, Chair of Medicine at UCSF, about their concurrently released books on healthcare innovation and AI.They share thoughts on the dual challenge of innovation in healthcare and the role of AI, covering:Why past waves of tech failed to change healthcare and why AI may finally break throughHow AI is making a difference today in healthcareWhere AI-assisted diagnosis and prescribing could go next, and the risks of over-relying on humans “in the loop” How EHR vendors (like Epic) hold the "poll position" for AI implementation due to workflow integrationWhy innovators must become healthcare "anthropologists"; and clinicians must understand technology and AIPlus, a surprise guest from Prenuvo joins us to chime in. Order Halle’s new book, Massively Better Healthcare hereOrder Bob’s new book, A Giant Leap here—About our guest: Robert M. Wachter, MD is Professor and Chair of the Department of Medicine at the University of California, San Francisco (UCSF). Author of 300 articles and 6 books, he coined the term “hospitalist” in 1996 and is often considered the “father” of the hospitalist field, the fastest-growing medical specialty in U.S. history. He is a past president of the Society of Hospital Medicine, past chair of the American Board of Internal Medicine, a Master of the American College of Physicians, and an elected member of the National Academy of Medicine. Modern Healthcare magazine has ranked him among the 50 most influential physician-executives in the U.S. more than a dozen times; he was #1 on the list in 2015. His 2015 book, The Digital Doctor: Hope, Hype and Harm at the Dawn of Medicine’s Computer Age, was a New York Times bestseller. His new book is A Giant Leap: How AI is Transforming Healthcare and What That Means for Our Future.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Physicians now face a world where search bars, chat apps, and large AI models are becoming many people’s first stop for health questions, long before they enter a clinic.Former Google Chief Health Officer and national health IT leader Dr. Karen DeSalvo joins us to unpack what this shift means for clinicians, regulators, and patients, and why 15% of daily Google searches are questions no one has ever asked before.We cover:• Why consumer health search is becoming a powerful entry point into care• How Google built guardrails for safety, quality, and real-time monitoring of emerging risks• What the rise of GenAI “doctor in your pocket” tools could mean• The regulatory tensions ahead as states experiment with AI-driven medical decision support• How global demand, workforce strain, and new data sources (IoT, at-home diagnostics, wearables) are accelerating AI-supported primary care—About our guest: Dr. Karen DeSalvo is a health leader who has committed her career to improving health for everyone, everywhere.  She was most recently Google’s Chief Health Officer, where spearheaded a global team of health professionals dedicated to harnessing Google's technology and platforms to help everyone, everywhere live a longer, healthier life. Before Google, Dr. DeSalvo held significant roles in the U.S. government, including National Coordinator for Health Information Technology and acting Assistant Secretary for Health. She was also the Health Commissioner in New Orleans following Hurricane Katrina, where she led public health recovery efforts. Dr. DeSalvo currently sits on the Boards of Directors for Welltower and CityBlock Health and is a member of the Council of the National Academy of Medicine. —Pre-order Halle's new book, Massively Better Healthcare.—📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutube See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

We’re back with our monthly rundown of the top headlines in health tech!Today, Halle and Steve sort through the biggest stories shaping the year ahead, from AI prescribing to lawsuits galore.We cover:AI prescribing (in Utah!)The FDA updated guidance on clinical decision support for AI in medicineThe lawsuit against Prenuvo after a missed stroke warning, and the broader debate over accountability in AI-assisted diagnosticsTexas’ antitrust case against Epic - are they being anti-competitive?New evidence shows GLP-1 drugs lower employer healthcare costs by 9%Why healthcare hiring is slowing downHalle’s book is now available! (Order now on Amazon)Show notes:Utah begins pilot of prescribing AI medication (Utah Department of Commerce)FDA issues guidance on wellness products, clinical decision support software (AHA)Man got $2,500 whole-body MRI that found no problems—then had massive stroke (Ars Technica)Texas sues Epic, accusing it of running a monopoly (Wisconsin Public Radio)Why cover GLP-1s? They’ll lower employer healthcare costs, study says (Healthcare Dive)Hospitals' make-or-break year (Axios)—🙏 Thank you to our show sponsor, Smarter Technologies, the first automation and insights platform for healthcare efficiency. Learn more at www.smartertech.com—📍 Connect with us:Heart of Healthcare websiteLinkedInInstagramYoutubeSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.