It’s rare that an article title alone makes me want to stop what I’m doing and read it, but that’s what happened when I saw the title of Jess Craig’s recent article, “Why More Doctors are Billing Their Patients Like it’s the 1920’s.”

In this article, and subsequently, our conversation here on the podcast, Jess explains what she means, citing the growing number of physician practices organized around the concept of direct pay. That is, the practice or physician determines a set cash price for their services and the patient pays that price out of pocket. This model may seem like we’re going backwards, to a time when health insurance didn’t exist, but in fact, it’s starting to be seen as one of the most progressive ways of managing rapidly inflating costs and concern about quality. While there are still questions around accessibility, as Jess points out, it may be one of the first advances we’ve seen in over a decade that could actually move the needle.

Jess Craig is a health reporter for Straight Arrow News (SAN). Prior to joining SAN, Jess worked as an infectious disease epidemiologist and health security technical advisor for international research institutes and US government agencies, including the CDC, USDA, and USAID. Jess worked as a freelance journalist for eight years, covering science, health, and world news for various outlets. She also served as a reporting fellow for NPR in 2020 and for Vox in 2024.

With the recent explosion of GLP-1 drugs, the war on obesity seems to have taken a new and potent turn, but many are concerned about the recidivism, the side effects, and our reenergized obsession with being thin.

Our guest today, Dr. Laure DeMattia, is a board certified family medicine physician and obesity specialist. For her, obesity is personal, as she has struggled her entire life with this chronic condition. In this episode, Dr. DeMattia breaks down for us how GLP-1 drugs work to hyperdrive weight loss, why that loss is rarely sustainable without long term use of the drugs, and her own philosophy outside of medication that helps her patients feel seen, heard, and safe. It’s both an educational conversation and a behind-the-curtains look at the obesity epidemic from someone on the front lines.

Dr. Laure DeMattia helps women stop blaming themselves for their physiology and find lasting health for over 20 years. Her dual perspective as both a doctor and a patient makes her uniquely compassionate, challenging the myth that willpower is the solution. Author of the book, The 4 Food Cues, Dr. DeMattia hosts her own YouTube channel, Navigating Obesity with Dr. D, where she offers a compassionate, realistic viewpoint about weight and weight loss.

“It doesn’t matter what is going on in your life, nutrition is relevant.” And, at least for most Americans, getting help with their nutrition is covered by their insurance. So, why isn’t working with a dietician a normal part of every American’s care plan?

Our guest today is trying to address that question. Noah Kotlove, the CEO and Co-Founder of Berry Street, went through his own nutrition journey after spending his first thirty years clinically obese. He tried every fad diet imaginable, with great success, but like many, gained all of the weight back because of the unsustainability of so much restriction. He finally found lasting change when he met with a dietician, a step recommended by his primary care provider, and, surprisingly to him, totally covered by his insurance plan.

That personal experience led Noah to create Berry Street, an online, DTC nutrition therapy platform that helps clients access registered dieticians while taking the guesswork out of the payment part. In this episode, Noah shares how Berry Street works, why the relationship between dietician and client is such a critical part of success, and how they leverage information, expertise, and technology to improve the customer experience and increase the likelihood of sustainable outcomes.

Noah founded Berry Street after losing 60 pounds through nutrition therapy, aiming to scale insurance-covered care through technology and change the way Americans eat. A serial entrepreneur, Noah is also the Founder of Sobrietysoft, an addiction recovery app with over 6 million users. He sees technology as a tool that allows us to get creative about outcomes over products.

“As an internist, we are always focusing on risk factors. Instead, in lifestyle medicine, we are focusing on root causes.”

We’ve heard this before – nutrition, exercise, sleep, stress, toxins, community – so it should be no surprise that these are also the six pillars upon which lifestyle medicine is based. The difference is that in this discipline, these six pillars are the prescription for how we deal with chronic health conditions. Our guest today, Dr. Padmaja Patel, talks about how she implements these factors into clinical medicine so that patients leave with a precise, personalized lifestyle plan. The goal? Put chronic conditions in remission.

Padmaja Patel, MD, FACLM, DipABLM, CPE is a board-certified internist and nationally recognized physician leader specializing in Lifestyle Medicine, Whole-Person Health, and value-based care transformation. She currently serves as President of the American College of Lifestyle Medicine (ACLM) and Chief Medical Officer of Nudj Health, an ACLM-certified Lifestyle Treatment Program focused on scalable, evidence-based lifestyle interventions.

What if employers just stopped offering healthcare benefits to their employees? Could that happen? If the astronomical cost of healthcare keeps expanding, some employers will have no choice.

That’s where our guest this week comes in. Shawn Gremminger is the President and CEO of the National Alliance of Healthcare Purchaser Coalitions. His organization works with regional coalitions of employers to help them advance health policy, leverage their collective power, and drive market change. In this episode, we talk about some examples of what that looks like in real time and how things like direct contracting may help employers continue to offer benefits while staying in business.

Known for his wide-ranging policy expertise, and government relations experience, Shawn brings to the National Alliance a successful record of working with coalitions, employers and other healthcare purchasers, policymakers, and industry stakeholders toward the mission of achieving high-quality, affordable, equitable healthcare. He began his career as a lobbyist for the Children’s Hospital Association and has since held senior leadership roles at Families USA and America’s Essential Hospitals.

Decreasing cost. It’s the Holy Grail. The thing we all know must happen in order for healthcare to become sustainable and usable for the majority of Americans.

We know data analytics help. They help to identify those who are at the highest risk and who are the highest cost. But, what if we were able to look at those who are currently low cost and predict who might become high cost? Taking it one step further, could we then reach out to those folks and offer a clinical intervention built on relationship that might help prevent that high cost event from ever happening? That’s exactly the kind of model our guest today has built at Converging Health.

Dr. Conard operates at the intersection of clinical medicine, advanced analytics, medical group leadership, and business strategy for early and emerging companies. He began his journey as a solo practitioner, eventually growing his medical practice to over 510 clinicians over 20 years. After the practice was acquired by a hospital system, Dr. Conard became the Chief Medical Officer for a brokerage/consulting firm and led an innovation lab focused on effective health risk reduction interventions. Currently, he is the Co-Founder of Converging Health, LLC, a technology-empowered consulting and services company. Converging Health collaborates with at-risk entities such as self-insured corporations, medical groups, accountable care organizations (ACOs) taking financial risk, and insurance captives to enhance well-being, reduce costs, and improve member experiences.

When employers look at all of the point solutions that are out there to add to their list of employee benefits, the top three should be…

1. Primary care
2. Primary care
3. Primary care

As a family medicine physician with an extensive background in advanced primary care, our guest today knows how true this is not just in theory, but in practice. Her work these days is getting employers to see the import of this investment as well. In her role as Chief Medical Officer, Dr. Marla McLaughlin partners directly with employers to identify workforce health priorities, design targeted strategies and apply real-time clinical insights to improve outcomes.

Dr. McLaughlin has dedicated her career to expanding access to high-quality primary care, guiding patients to the right care at the right time and fostering trusted patient-provider relationships. She believes the most effective healthcare combines technology with human-centric care to improve outcomes and experiences. McLaughlin brings that perspective and passion to Castlight Health and Vera Whole Health, where she plays a pivotal role in strengthening clinical operations, improving care quality and enhancing both patient and care team experiences.

“Let’s inspect what we expect.”

What a powerful statement. If we expect cost transparency, let’s inspect what those costs have been to date. If we expect freedom of choice, let’s evaluate how that has worked for employees up to this point. And let’s expect an “and” approach instead of an “or” approach. As I say often these days, the devil is in the details, so it only makes sense that we put some energy and effort into inspecting what those details are and have been so we can expect what they will be in the future. That’s exactly the goal and role of today’s guest.

Jeff Bak is the President of Imagine360, whose mission is to reduce health plan costs for employers, employees and their families. He has three decades of experience in managing and growing healthcare services companies. Prior to Imagine360, Jeff served as the global practice leader of the Health, Life Sciences & Business Process Outsourcing (BPO) division for Wipro Limited, and was the president and CEO of HealthPlan Holdings (HPH)—a leading healthcare solutions business.