Like many healthtech leaders, Walter Jin didn’t start his career in this industry. He began as an investment banker and then joined what was a much smaller Carlyle Group based in Washington DC in the 90’s. The firm had originally focused on aerospace defense but wanted to diversify, and since Walter happened to be doing healthcare deals for them, he was then asked to start their healthcare group. In 2008, he retired from Carlyle and started his own investment firm Three Fields Capital, but after a few years, he decided to take a step back from the finance world when his parents got sick. Walter continued some investing on the side via a family office and was eventually approached by Oscar Salazar (Uber co-founder) about Pager. Originally the “Uber for Doctors and Nurses,” Pager had promise but was plagued by challenges with affordability, supply chain, and access. Walter saw potential though, so he invested in the company, served as Chairman for about 3 years, helped it pivot to a platform focused on access and steerage, and then became CEO, the role he has had for about 3.5 years. Tune into this episode to learn more about Pager’s origins, its new focus and business model, how the company has been able to white-label its platform to embed within many provider/payer stacks, and healthcare’s response to this rapidly growing company, plus Walter’s thoughts on the future of the health system and digital care.

Breaking Health

Episode 147: Chairman & CEO Walter Jin on how Pager is Providing a “Doctor-in-the-Family” Experience so People can Easily Find Care, Get Care, and Follow Up

John Kao is a seasoned entrepreneur and executive. After beginning his career at FHP International, he then started four other companies in succession: Secure Horizons USA, PacifiCare Health Systems, The TriZetto Group, and CareMore Medical Enterprises, before then being compelled to found Alignment Healthcare. Alignment’s origin is a bit more personal to John though, as the business idea arose from his and his mother’s experiences as she had a heart attack. After experiencing a lack of consistency around clinical information, particularly post-discharge home healthcare; poor communication post-discharge about cardiac rehab; and medication mismatches pre- vs. post-hospitalization, John felt he couldn&apos;t be the only one going through this, so he started Alignment Healthcare. He felt there was a huge need for proactive care at the home and/or virtually for the 20% of seniors who are frail or have polychronic conditions, and that the cost savings arising from providing better care for this population could be reinvested in the other 80%. Tune into this episode to learn more about Alignment Healthcare’s origins, its unique business model, its strong values, and the healthcare market’s response to the now-public company, plus a candid conversation about some of the most valuable lessons John has learned transitioning from an entrepreneur to a CEO.John Kao is Founder and CEO of Alignment Healthcare, a consumer-centric platform delivering customized health care in the United States to seniors and those who need it most, the chronically ill and frail, through its Medicare Advantage plans. Mr. Kao has had a long career committed to the healthcare industry and has served in executive roles at CareMore Medical Enterprises, The TriZetto Group, PacifiCare Health Systems, Secure Horizons USA, and FHP International. Mr. Kao believes strongly in the tenets of servant leadership and serves on various boards of non-profit organizations. He received his bachelor’s degree from Santa Clara University and his MBA from UCLA Anderson Graduate School of Management.

Episode 146: Founder and CEO John Kao on how Alignment Healthcare is Taking Care of Seniors like You’d Want Your Parents Treated

Mark Frank has what he calls “professional ADD.” He naturally likes trying different things and building new skills, which is ultimately what led him to become an entrepreneur. Even while serving in the Army after college, Mark still found entrepreneurial aspects as a platoon leader; after all, he was responsible for everything his unit either did or didn’t do. He used to think of himself as an operator or executive, which was his role at his first startup, but now he looks for ideas/opportunities, makes note of them, and eventually either whittles them down into business opportunities or sets them aside. After a challenging and frustrating experience finding a therapist (balancing location, schedules, insurance, and fit is a real nuisance), Mark realized the huge opportunity to help both patients and therapists connect more easily. Hence, SonderMind was born. Tune into this episode to learn more about SonderMind’s origins, its unique business model, how it has tackled some of the big problems in the therapy space, including access to care and providing valuable business support to therapists, plus a conversation about the current challenges and opportunities with many mental health benefits.

Episode 145: Co-Founder and CEO Mark Frank on how SonderMind is Making Mental Health More Accessible and Widely Utilized

After losing his Holocaust-survivor dad as a result of three medical errors at a US academic hospital, Raphael Rakowski was driven to start Medically Home. Trained as an engineer who then successfully launched a few prior companies, Raphael was prepared to try to address the problem of high fixed cost burdens at medical facilities that he felt affected quality of care. He and his co-founders started Medically Home almost 13 years ago with the vision to provide high acuity, complex care, in a home setting. Thankfully, after some behind-the-scenes backing from Mayo Clinic, a momentous decision by CMS to provide a reimbursement code for their care model, and a boost in demand for out-of-hospital care during Covid, the company has recently really taken off. Tune into this episode to learn more about Medically Home’s technology and patient experience, as host Steve Krupa chats with Raphael about the company’s business model, tipping point, traction gained with both patients and providers, and future.Raphael Rakowski has devoted his career to transforming and transcending the ways in which companies provide essential services to the public, particularly in the healthcare industry. Raphael is a life-long entrepreneur, and his knowledge and expertise extends into sectors such as healthcare, consumer products, and renewable energy. In 2000, Raphael was the President of American Healthways, a Share care company, which focuses on using behavior change to track a person’s health. Following this, Raphael founded SAMI (Show All Medical Information) in 2010, a company designed to use modern healthcare technology to provide a simple search platform for families and their doctors. Raphael was also a co-partner at Intersection Partners, a group that helps launch and operate healthcare service companies. Raphael is now currently the co-founder and executive chairman of Medically Home, a company revolutionizing healthcare by providing hospital-level care for high-acuity patients in the comfort of their own homes. Through a combination of 24/7 virtual monitoring and in-person home visits, patients in Medically Home have higher rates of positive outcomes and lower readmission rates than traditional hospital patients.

Episode 144: Co-Founder and Executive Chairman Raphael Rakowski on how Medically Home is Providing High Acuity, Complex Care at Home

As a former Partner at Deloitte, Rajeev Ronanki established and led Deloitte&apos;s Life Sciences and Healthcare Advanced Analytics, Artificial Intelligence, and Innovation practices. He then was offered a chance to join Anthem and lead their transformation to becoming a digital-first enterprise. Rajeev viewed this a great opportunity to help transform healthcare, so he accepted the position. How did he start to tackle this challenge and develop a vision for this insurance giant? First, by simply defining what “digital” meant within Anthem. Once aligned on that, he was able to start implementing automation of core business practices and developing an application to engage consumers in a more personalized manner. Then, the real value came. Leveraging over 10 million users on their digital platform, Anthem was able to improve their app based on user feedback collected on the platform (they tested an average of 180 user experiences per day!). More impactfully though, the group could start deriving real healthcare insights. Tune into this episode to learn more about Anthem’s new digital-first approach, as host Steve Krupa chats with Rajeev on the company’s digital revolution, its partnerships with startups and investors, the opportunity for more upfront diagnosis, and even Rajeev’s thoughts on blockchain’s utility in healthcare.Rajeev Ronanki serves as Chief Digital Officer at Anthem, Inc. He is leading the transformation of Anthem to become a digital/AI-first enterprise through driving the vision, strategy, and execution of Anthem’s Digital, Artificial Intelligence (AI), Exponential Technology, Service Experience, and Innovation portfolios. Through these efforts, Mr. Ronanki is enabling Anthem to harness the power of AI and data to better understand healthcare consumers and provide tailored, personalized care. His experience spans over 20 years of innovation-driven industry and social change across healthcare and technology.  

Episode 143: Anthem’s CDO Rajeev Ronanki on Leveraging Digital Approaches to Transform Healthcare

Having been both an operator and an investor in the healthcare industry, Fay Rotenberg knows the challenges and silos all too well. She was encouraged when she first met the co-founders of Firefly Health though. Initially, she had agreed to meet with them 1 day per week, then that grew to 2 days per week, then 3, and before she knew it, she joined the company as President and CEO about 3 years ago. Firefly is striving to shift healthcare from episodic to continuous care. They are a virtual-first clinical network consisting of primary care, behavioral health, and specialty care, all accessible via a world-class navigation platform. Think of Firefly as a mini and virtual Kaiser, as they are now also expanding into full benefit models for employers. By reducing costs and improving outcomes, they have begun to achieve concierge medicine at scale. Patients interact with their platform an average of 41 times per year and receive a response within 5 minutes, while doctors also love being part of their team-based care approach, as it allows them to focus on tasks that are most value added for them. Tune into this episode to learn more about Firefly Health, as host Steve Krupa chats with Fay on the company’s mission to provide half priced health care that is twice as good, its start with insurers as original customers (now somewhat competitors), its growth to over 50 employees, and its future including developing a health plan replacement for employers.

Episode 142: CEO Fay Rotenberg on how Firefly Health is Striving for Half Priced Healthcare that is Twice as Good

In his final rotation at Harvard Medical School, Andrew was baffled by how many patients were googling their symptoms to make decisions about whether to seek care. Things became personal though when his own father hesitated and waited too long to seek medical attention while experiencing a mini stroke (thankfully he survived). Andrew became convinced that there had to be a way to reduce the effort and hesitancy deterring potential patients from engaging with healthcare professionals. So, he took three years off from medical school and co-founded Buoy Health. The goal was to develop an AI chatbot that could help people answer the simple question: “When do I need to go to the doctor?” Built upon manual review of thousands of medical articles and incorporated user feedback, Buoy quickly became a truly machine-learned algorithm that could not only account for medical best practices but also user demographics. Today, buoy.com services over 30 million people, including being the official COVID-19 screening tool for both Massachusetts and Virginia. The company has also developed a “Back with Care” feature to help employees return to work and is about to release a vaccination module as well. Tune into this episode to learn more about Buoy Health, plus hear host Steve Krupa chat with Andrew on his transition from medical student to entrepreneur, what he wished he knew before starting the business, and Andrew’s vision for the company’s future.

Episode 141: CEO Andrew Le Explains how Buoy Health is Helping People Seek the Right Medical Care at the Right Time

Having started working in the healthcare space directly after graduating, Bryan quickly learned the ins and outs of health insurers, broker distribution, and self-insurers. After a decade in the industry, Bryan decided to pivot to a much smaller company and became both the CEO and just the 3rd employee at RxBenefits in 2005. He then realized the opportunity to help smaller, self-insured companies handle their pharmacy benefits by carving those out. RxBenefits developed a platform connected directly to the major Pharmacy Benefit Manager systems, which enabled them to directly and cost-effectively ingest claims and operate as an apparent larger entity. This approach helped them deliver mid-market employers an average direct pharmacy savings of 27% and an indirect clinical savings of 10% per year. Hear host Steve Krupa chat with Bryan on his transition to a much smaller company, how RxBenefits has leveraged their niche in pharmacy benefits for mid-sized companies, and Bryan’s vision for the company’s future

Episode 140: RxBenefits on Helping Mid-Sized Employers Reduce their Pharmacy Spend

While working as a graduate student intern for a clinical documentation company, Jeff discovered his passion for the healthcare industry. He stayed there for 10 years and benefited from strong mentoring and development opportunities before seeing the company through its exit. Fast-forward 6 years- after another successful exit as a senior manager at a different business- Jeff was introduced to the concept of payment integrity and started ClarisHealth to help solve challenges in this area. Having grown from 3 to over 140 employees, Jeff sees ClarisHealth’s focus as helping plans tackle their entire payment integrity continuum (post-pay to pre-pay) with a longer-term vision of increasing payer-to-provider transparency. ClarisHealth’s Pareo platform is a multi-module SaS solution that helps health plans and payers grow recoveries from 1% to 7% or more. Hear host Steve Krupa chat with Jeff on his decision to start the business and how it has benefited both payers and providers.

Episode 139: ClarisHealth on Helping Plans Tackle their Entire Payment Integrity Continuum

Starting out as a minor league baseball broadcaster, Ben Albert realized he was better at the business side of his role than the on-air aspect. He then landed at a healthcare consulting company and became hooked on healthcare- so many silos and opportunities for automation! After a successful exit at the helm of Care Team Connect, Ben decided to start and lead Upfront Healthcare to help patients navigate the unending waters of their medical journeys. By applying analytics to scheduling, billing, and operational data to develop each patients’ profile, the company can direct patients through an app-less experience to their next right service, which can be booked right then. Not only do patients enjoy this much easier experience, but providers benefit from the improved revenue profile for each patient and reduced administrative overhead. Listen to host Steve Krupa chat with Ben on how he progressed from deciding if he should start the business to now running a company servicing over 1 million patients in less than five years.

Episode 138: Upfront Healthcare’s “Caretraffic Control” Approach to Getting Patients to their next Medical Destination

Host Steve Krupa chats with Aver CEO Bill Nordmark about Bill’s career in the healthcare payer and reimbursement space, including his decision to take over the reins at Aver. Hear Bill share helpful insights on retrospective vs. prospective payment systems and how he is leading Aver on the quest to increase quality of care while reducing costs by helping payers expand and bundle payment programs.

Episode 137: Aver CEO Bill Nordmark on Changing the Reimbursement Models to Drive Value from Care

Steve sits down with Zipari Founder and CEO, Mark Nathan to discuss how his career set him up for entrepreneurship, as well as the motivation and inspiration for starting a health insurance consumer experience platform. Mark shares the challenges associated with taking a homegrown business technology and creating generally available software and gives his best advice for entrepreneurs starting a company. 

Episode 136: Zipari CEO Mark Nathan on Building a Health Insurance Consumer Experience Platform

Greg discusses his early days as a professional musician and shows how creativity and problem-solving helped transition his career into software development, and led him to working in healthcare, helping providers and patients by innovating payment data. He discusses developing new, data-enabled products and using advancements in tech to expand a company footprint.  

Episode 135: The Burgess Group CEO, Greg Burgess: From Music Career to Crisis Leadership, and the Journey in Between

No fan of traditional PBMs, Steve Krupa talks with Jake Frenz, founder and CEO of SmithRx, creator of a new tech-based PBM player.

SmithRx CEO Jake Frenz Explains How the Start-Up Is Using Tech to Take on the PBM Industry

Breaking Health Host Steve Krupa catches up with Peter Foley, founder and CEO of LetsGetChecked, a company that’s empowering patients to monitor their own health through diagnostic tests. Hear how Foley and his team built patient convenience into a powerful business. 

LetsGetChecked CEO Peter Foley Shares the Roots of this Fast Rising Start-Up; Hear More at DHIS

The Breaking Health Podcast features the innovators, investors and entrepreneurs who are building the technology and tools to break down and build up the country’s ailing health care system. With seasoned health care investor Steve Krupa, CEO of the Psilos Group, as host, Breaking Health delivers the earliest insights on the ongoing Digital Health Revolution.

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Breaking Health

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