Claims Denied: A Hospitalogy Podcast

Join one man’s quest to learn everything there is to know about the business of healthcare. Blake Madden and friends cut through the fluff to talk shop with influential healthcare leaders across innovation, strategy, finance, policy, and more. Learn about disruptive health tech startups, hear war stories, stay up to date on emerging health system transformation strategies, and listen in to scalding hot takes on pressing topics and the future of the industry. New episodes drop Mondays. Subscribe to get the latest!

Claims Denied: A Hospitalogy Podcast is a business podcast hosted by Blake Madden, with 28 episodes on record and a Required Pod Score of 80. PitchCentric scores this show on Booking Probability, Listen Score, and live audience signals refreshed every 24 hours.

Blake Madden hosts Claims Denied: A Hospitalogy Podcast, a business show with 28 episodes published.

Our AI reads these to draft pitches. Use them as grounding for a pitch that cites a real guest and a specific topic.

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  Claims Denied: A Hospitalogy Podcast

  The End of Managed Care? How Northwell Built a $2.5B Direct Contracting Machine (with Nick Stefanizzi, CEO Northwell Direct)

  Aug 18, 202657 min

  Blake sits down with Nick Stefanizzi, CEO of Northwell Direct (https://northwelldirect.northwell.edu/) — the man running the most ambitious direct-to-employer play in the country. Since going live in 2022, his team has built a platform serving 70+ employers and unions, 300K members, and $2.5B in medical spend, with 97% retention. Then they landed 32BJ: 20% validated savings, $46M in year one, live as of April. Blake and Nick get into all of it — why Northwell runs Direct as a standalone company (Nick literally negotiates rates against his own parent system), what they rented instead of built, how the 32BJ deal came together in 10 weeks, and what happens to managed care when health systems stop asking permission. If you're a health system exec, benefits leader, or union fund trustee, this one's required listening. --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. ⁠⁠https://navvishealthcare.com/vbc⁠⁠ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠⁠ Like our podcast? Check our previous episodes of Claims Denied here: ⁠⁠⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. --- Follow Nick on LinkedIn: https://www.linkedin.com/in/nickstefanizzi/ Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠⁠

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  Claims Denied: A Hospitalogy Podcast

  Insurance Is the Inflation: Your Health Plan Costs the Same as a Tesla Model Y, and What Collective Health is Doing to Fix it

  Aug 11, 202658 min

  This episode hits the affordability crisis head-on, as Blake sits down with Ali Diab, CEO and co-founder of Collective Health (https://collectivehealth.com/). Ali started the company after his own hospital claim got denied, and has spent the decade since building what he calls the “Stripe” of healthcare benefits — for employers today, and potentially insurers and health systems tomorrow. In this episode, Ali makes the case that health insurance itself is the real inflationary catalyst in American healthcare.  Ali doesn't do the polite version. He calls the MLR a cost-plus contract, compares network "discounts" to markdowns off the Neiman Marcus price, and told me about the time he was charged $340 in coinsurance for a $125 knee brace on his own company's plan.  We dig into why self-insurance and direct contracting are eating the fully-insured market alive, why small employers are legally boxed out of self-funding, and why he thinks healthcare pricing needs an SEC. Also: World Cup takes. Ali's a winger-turned-number-nine and I broke two leg bones playing this sport, so we earned the tangent. Follow Ali Diab on LinkedIn: https://www.linkedin.com/in/alidiab/ Follows Collective Health on LinkedIn: https://www.linkedin.com/company/collectivehealth/home/ --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. ⁠https://navvishealthcare.com/vbc⁠ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠ Like our podcast? Check our previous episodes of Claims Denied here: ⁠⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠

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  Claims Denied: A Hospitalogy Podcast

  25K Patients Deep and Zero Physician Equity: Inside MGB and Regent's Site-of-Service Bet, and their New ASC Ownership Playbook

  Aug 4, 20261h 12m

  For this week's episode, Hospitalogy's Blake Madden puts two people on opposite ends of the same handshake into one virtual room: Travis Messina, CEO of Regent Surgical, and Niyum Gandhi, CFO of Mass General Brigham (MGB), who runs one of the most-watched integrated systems in the country. Nominally, this episode is about ASCs. Really, it's about what a system does when it could build anything itself — and chooses to partner instead. Blake walked in carrying a grudge from his valuation days, when every ASC cap table he cracked open had physician ownership baked in like it was law. Niyum spent 20 minutes calmly arguing the opposite. They also get into MGB's $3B insurance arm (don't call it a provider-sponsored plan to his face), a 25,000-patient endoscopy wait list, robots doing oncology, and the best AI adoption framework Blake's heard a CFO articulate. Travis also reminded Blake that his Geogia Bulldogs bounced Blake's Texas Longhorns during the College World Series — which Blake is choosing to forgive. Follow Travis Messina on LinkedIn: https://www.linkedin.com/in/travis-messina-4460565/ Follow Niyum Gandhi on LinkedIn: https://www.linkedin.com/in/niyum-gandhi/ Follow Mass General Brigham on LinkedIn: https://www.linkedin.com/company/mass-general-brigham/ Follow Regent Surgical on LinkedIn: https://www.linkedin.com/company/regent-surgical/ Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. ⁠https://navvishealthcare.com/vbc⁠ --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠⁠https://hospitalogy.com/⁠⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠⁠

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  Claims Denied: A Hospitalogy Podcast

  Addiction Treatment and Why Your Claims Data Is Lying About Gambling Disorder

  Jul 28, 20261h 1m

  Featuring: Elliott Rapaport (Founder of Birches Health) and Dr. Doug Nemecek (Senior advisor with Birches Health and former Cigna/Evernorth CMO) --- This episode with two experts in the mental health space (Elliott Rapaport, Founder of Birches Health, and Dr. Doug Nemecek, a senior advisor with Birches Health and former Cigna/Evernorth CMO for behavioral health) was one of the more eye-opening conversations Hospitalogy’s Blake Madden has had on payor behavioral spend. Think about this: 39 states + DC have legalized online gambling, FanDuel and DraftKings are sponsoring everything that moves, and yet payors will tell you they don't "see" the gambling disorder volume in their claims data. That's because it's getting coded as depression or anxiety. F63.0 never makes it to the bill. Blake, Doug, and Elliott get into the real prevalence numbers (a recent Pennsylvania study puts roughly a third of the state somewhere on the gambling-risk spectrum), why specialty networks for behavioral process addictions are about to follow the same pattern Equip ran in eating disorders, and what AI actually does in this model (spoiler: it's not replacing the therapist). Blake also pushed Elliott on the "anti-capitalism" of building a clinical model that explicitly wants patients to use you less over time. Elliott’s answer was sharp. Follow Birches Health on LinkedIn: ⁠https://www.linkedin.com/company/bircheshealth/⁠ Follow Doug on LinkedIn: https://www.linkedin.com/in/douglasnemecek/ Follow Elliott on LinkedIn: https://www.linkedin.com/in/er1/ --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. https://navvishealthcare.com/vbc --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠https://hospitalogy.com/⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠

  ListenShow Notes
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  Claims Denied: A Hospitalogy Podcast

  AvoMD’s Series A and the Bet That Epic Doesn't Eat Everything (with Yair Saperstein, MD MPH)

  Jul 21, 202652 min

  Hospitalogy's Blake Madden sits down with Yair Saperstein, MD MPH — co-founder and CEO of AvoMD — fresh off the company's Series A close in Q1. Yair makes the case that the real prize in clinical AI isn't the AI scribe, it's the operating system living inside the EHR itself, and why he thinks most of primary care ultimately gets replaced by AI voice chatbots, at-home labs, and wearables. Blake also pushes Yair on the Open Evidence valuation question (politely sidestepped), how AvoMD sells differently to academic systems versus rural hospitals, and the "avoid the 800-pound gorilla" go-to-market strategy against Epic. Plus: what Dr. Oz told a ViVE crowd about agentic AI being in front of every patient by 2028 — and a closing piece of life advice that somehow involves Frogger. --- Navvis partners with health systems and health plans to deliver real performance improvement across value-based care and fee-for-service models. https://navvishealthcare.com/vbc --- For expert analysis on healthcare M&A, strategy, finance, and markets, join 68K+ readers of Blake Madden’s Hospitalogy newsletter. Subscribe here: ⁠⁠⁠https://hospitalogy.com/⁠⁠⁠ Like our podcast? Listen to previous episodes here: ⁠⁠⁠https://hospitalogy.com/podcast/⁠⁠⁠ Be sure to leave us a review, and share our podcast with colleagues. --- Follow Blake Madden on LinkedIn: ⁠⁠⁠⁠⁠https://www.linkedin.com/in/blakecmadden/⁠⁠⁠⁠⁠

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