Advertise on podcast: Vital Signs with Jacob Effron and Nikhil Krishnan

Aidan Dewar, co-founder/CEO of Nourish, walks through how the dietitian-led metabolic care company has evolved from a pure lifestyle-change complement to GLP-1s into a full prescribing platform, and why timing that shift right took four years of deliberate positioning. The conversation covers Nourish's differentiation thesis (scale, product, distribution, and above all execution), how the company built its AI stack from administrative automation to a full patient-facing AI health assistant and provider copilot, and Aidan's view on where AI does and doesn't replace clinicians. It closes with reflections on policy (incentive design, food-as-medicine momentum, MAHA), hiring in the AI era, and candid founder lessons.   (0:00) Intro (0:42) Nourish Today Explained (2:12) Big Vision and Root Problems (3:31) GLP-1 Prescribing Strategy (5:47) How Nourish Wins (9:11) Reimagining Virtual Primary Care (10:56) Building In-House vs Partnering (12:18) AI for Providers and Patients (15:36) Meal Logging and Model Limits (16:30) Future of AI-Led Care (20:05) Food Partnerships and Coverage (22:44) Policy Momentum and MAHA (24:06) Dietitian Supply and Training (25:54) Running a Company with AI (28:07) Hiring for AI Proficiency (29:49) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/

Chris Altchek, founder and CEO of Cadence, joins Nikhil and Jacob to discuss how AI is changing the way chronic disease gets managed at scale. Cadence treats 100,000 patients a day across major health systems and has published some of the largest cost and outcomes studies in the space, including a nearly 17,000-patient analysis in Mayo Clinic Proceedings and a 24,000-patient study in the Journal of the American College of Cardiology. The conversation covers the three phases remote patient monitoring has gone through since before COVID, why hospital-at-home has struggled to scale despite strong clinical outcomes, and how AI voice agents cut Cadence's average alert response time from 1.8 hours to 3.5 minutes. Chris also explains Cadence's "proactive titration agent" for adjusting medications in real time, an unexpected discovery that their monitoring system catches early signs of sepsis, and why he believes digital health companies have a responsibility to engage with new CMS payment models like ACCESS, even when the economics aren't ideal on day one. They close on how Cadence is rethinking hiring and internal workflows as AI changes what the job requires. (0:00) Intro (1:22) Remote Monitoring Three Phases (3:44) Why Hospital at Home Stalled (6:06) Cadence Vision and Scale (8:50) GenAI Boosts the Product (13:45) Where AI Still Breaks (18:30) Building Proactive Workflows (22:50) Outcomes and Surprising Savings (25:07) Access Program and Payment Model (30:10) Engaging Seniors at Scale (34:42) Wearables FDA and Device Costs (37:59) Running a Company with AI (41:15) Quickfire Out-Of-Pocket: https://www.outofpocket.health/

Nick Reber, CEO and founder of Garner Health, joins Jacob and Nikhil to walk through what is arguably one of the most structurally underrated problems in American healthcare: that the single biggest driver of cost and quality variation isn't which hospital system you use or whether your plan is value-based — it's which individual doctor you see. Nick traces the intellectual journey from his time at Oscar Health, where he first encountered 4x variation in complication rates across physicians at the same brand-name institutions, to building Garner's core infrastructure: a dataset of 320 million patients used to score every doctor in the country on quality-adjusted outcomes, layered on top of existing employer health plans with financial incentives to steer patients toward top performers. The episode drops alongside the announcement of Garner's Series E with Index Ventures, valuing the company at approximately $2.7 billion. The conversation covers the technical depth required to actually measure physician quality fairly (and why existing methodologies are fundamentally flawed), why value-based care has largely failed and what actually moves patient behavior, how AI will reshape the front door of healthcare, what it will take for AI health companies to build durable businesses beyond 2030, and why the solution to the US healthcare cost crisis may be as simple — and as politically hard — as treating it like a corporate expense policy.   (0:00) Intro (0:30) Garner's Origin Story (2:05) Doctor Choice Is the Biggest Lever (3:45) How Garner Works (5:43) Why Old Scoring Methods Failed (7:39) The Knee Pain Problem (11:58) Consumer UX, Incentives, and AI (33:44) How Much Spend Can AI Actually Touch? (36:00) Why Doctor Choice Needs Plan Integration (39:18) Build vs. Buy: Garner's AI Philosophy (41:38) The Unified Data Flywheel (43:01) What Actually Predicts Doctor Quality? (46:28) Enabling Independent Providers (51:37) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/

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/

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/

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/

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/

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

This episode captures Walid Mehanna's perspective on how Merck KGaA has approached enterprise AI adoption through a federated strategy that prioritizes people over technology. The core message is that successful AI implementation requires building organizational capability across three dimensions - people, processes, and technology - rather than seeking a single transformative solution. Walid argues that companies must establish a broad foundation of AI literacy (exemplified by their internal MyGPT tool reaching 25,000 users) before pursuing specialized applications, while maintaining human accountability to prevent complacency. He emphasizes that AI works best when it's treated as an experimental, iterative capability distributed across the organization rather than controlled centrally, with success depending on persistence through the inevitable J-curve of initial productivity drops. The conversation reveals how a large multinational navigates the practical realities of AI deployment - from managing regulatory complexity across different geographies to making pragmatic build-versus-buy decisions - while maintaining focus on the fundamental principle that AI should augment human expertise rather than replace human judgment and responsibility.   (0:00) Intro (0:29) How AI is Used at Merck (2:18) AI Applications Across the Value Chain (4:31) Challenges and Risks of AI Implementation (5:35) Federated Approach to AI Prioritization (6:44) Future AI Use Cases and Data Challenges (10:38) Building and Partnering for AI Solutions (15:11) AI in Drug Discovery and R&D (26:47) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/

In this episode, Jacob sits down with Joshua Meier, co-founder of Chai Discovery and former Chief AI Officer at Absci, to explore the breakthrough moment happening in AI drug discovery. They discuss how the field has evolved through three distinct waves, with the current generation of companies finally achieving success rates that seemed impossible just years ago.    The conversation covers everything from moving drug discovery out of the lab and into computers, to why AI models think differently than human chemists, to the strategic decisions around open sourcing foundational models while keeping design capabilities proprietary. It's an in-depth look at how AI is fundamentally changing pharmaceutical innovation and what it means for the future of medicine.   Check out the full Chai-2 Zero-Shot Antibody report linked here: https://www.biorxiv.org/content/10.1101/2025.07.05.663018v1.full.pdf   (0:00) Intro (1:25) The Evolution of AI in Drug Discovery (5:14) Current State and Future of AI in Biotech (10:08) Challenges and Modalities in Therapeutics (14:44) Data Generation and Model Training (22:52) Open Source and Model Development at Chai (29:52) Open Source Models and Their Impact (34:36) How Should Chai-2 Be Used? (38:53) The Future of AI in Pharma and Biotech (42:46) Key Milestones and Metrics in AI-Driven Drug Discovery (47:20) Critiques and Hesitation (54:01) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/

Elliot Cohen—PillPack co-founder and now co-founder of General Medicine—joins Jacob Effron and Nikhil (Out-of-Pocket) to unpack what “best care” really means in 2025. He explains why General Medicine is building a broad front door to care. Elliot also revisits the PillPack vs. PBMs saga, what Amazon Pharmacy got right (and what was unexpectedly hard), and how AI is already raising the bar in intake, clinical prep, and follow-up.   (0:00) Intro (0:58) Simplifying Healthcare with General Medicine (1:53) The Importance of Triage in Healthcare (3:22) Consumer Empowerment in Healthcare (5:10) Patient Experience and Structured Forms (6:27) Challenges in Healthcare Pricing Transparency (8:28) Diverse Patient Needs and Quality of Care (10:00) The Philosophy Behind General Medicine (16:43) Consumer Directed Care: Pros and Cons (18:57) PillPack (35:53) Debating Insulin Search Results (38:16) AI in Healthcare: A New Era (39:15) Integrating AI with Clinical Teams (41:39) Challenges and Opportunities in Digital Therapeutics (58:21) Building a Healthcare Company: Lessons from Amazon (1:01:25) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/

Flashback episode in honor of Hinge Health's IPO this week. In the episode, Jacob and Nikhil sit down with Daniel Perez, the Co-Founder and CEO of Hinge Health, a digital clinic for patients with joint and muscle pain. They discuss Hinge Health’s strategy for selling to employers, how digital health solutions can reach and retain users, the role of software x hardware in disrupting healthcare, and more.   (0:00) Intro (2:34) The Evolution of Employer Health Solutions (4:03) Challenges and Strategies in Digital Health (7:07) Focus on Musculoskeletal Care (9:51) Engaging and Retaining Patients (16:17) Marketing and Awareness Strategies (19:31) The Role of Independent Validators (22:27) Clinical Validation and R&D Excellence (23:04) Healthy Competition and Market Differentiation (23:59) Product Superiority and Customer Validation (26:05) Team Dynamics and Tough Decisions (29:49) Future of Hinge Health and Healthcare Automation (31:44) AI and Technology Integration (36:18) Hardware Innovations and Market Impact (39:19) Value-Based Care and Outcome Guarantees (41:14) Regulatory Challenges and Innovation Constraints (43:38) Closing Thoughts and Entrepreneurial Advice   Out-Of-Pocket: https://www.outofpocket.health/

Jacob and Nikhil sit down with Otto Sipe. Otto is the CEO and Co-Founder of Photon Health, which enables patients to select their own pharmacies with price and inventory transparency. The company has raised over $16 million from investors including Flare Capital Partners and Notation Capital. They discuss where pharmacies and PBMs are headed, the evolution of E-Prescribing, the impact of GLP-1s & AI, and more.   (0:00) Intro (0:51) History and Evolution of E-Prescribing (3:02) Challenges in Current E-Prescribing Systems (6:28) Photon Health's Innovative Approach (8:17) Patient and Provider Behavior Changes (11:21) Pharmacy Industry Landscape and Future (13:43) Interactions with PBMs and Market Dynamics (16:48) Future of PBMs and Drug Pricing (20:38) Quality and Marketplace Experience in Pharmacies (23:30) Advising Independent Pharmacies for Future Success (24:24) Challenges and Strategies in Retail Pharmacy (25:45) Pharmacy Economics and Supply Chain Issues (30:21) The Role and Potential of Pharmacists (36:01) AI in Pharmacy: Photon’s Approach (38:28) Quickfire   Out-Of-Pocket: https://www.outofpocket.health/

Jacob and Nikhil sit down with Dr. Rushika Fernandopulle. Rushika is the former CEO and Co-Founder of Iora Health, a primary care provider centered around value-based care and Medicare that One Medical acquired for $2.1 billion. They discuss why we’re still in the second inning of value-based care, intersections of tech and healthcare, what it takes for VBC to succeed, and more.   [0:00] Intro [0:29] Early Days of Value-Based Care [2:34] Challenges in Commercial Value-Based Care [5:20] Adapting Care Models for Different Populations [13:08] Medicaid and Long-Term Care Issues [16:30] Big Tech's Foray into Healthcare [20:37] Amazon's Healthcare Strategy [21:09] Challenges in Serving Low-Income Seniors [21:43] Innovative Solutions for Patient Transportation [22:16] The Economics of Healthcare Visits [23:22] Building a Custom EHR System [27:34] The Role of AI in Modern Healthcare [33:17] Future of Primary Care and Policy Implications   Out-Of-Pocket: https://www.outofpocket.health/

Jacob and Nikhil sit down with Frank Wu, the Co-Founder and CEO of Taro Health. Taro Health is a health insurance plan currently live in Maine and Oklahoma that offers unlimited primary care and mental health visits. The company has raised over $18m from investors like Hummingbird Ventures, Quiet Capital, and FPV Ventures. They discuss creating value in InsurTech, building a health plan for Direct Primary Care providers, what’s next for health insurance, and more.   [0:00] Intro [0:18] Frank’s Background and Journey [1:17] Introduction to Taro Health [2:50] Challenges and Strategies in Health Insurance [7:24] Direct Primary Care Model [13:01] Patient and Doctor Archetypes in DPC [17:01] Enrollment and Market Strategies [28:56] Generative AI in Health Insurance [35:31] Quickfire   Out-Of-Pocket: https://www.outofpocket.health/