On Episode 2 of Season 4, Vanessa Moldovan interviewed me on her podcast, For the Love Of Revenue Cycle, which I am excited to share. Since starting the Healthcare Reimagined podcast, I founded a healthcare company, Covered Health, and Vanessa interviewed me about what we're doing and why we're doing it.

At Covered, we are automating the most challenging and time consuming elements of appealing denied medical claims for providers. By streamlining access to diverse databases and inputs, Covered uses technology to helps RCM specialists identify denial root causes, and appeal them.

Vanessa and I came together because we share the same vision: preventing patients from getting stuck with bills that should be covered by their insurance, and helping to empower revenue cycle management experts to resolve those denials with greater efficiency.

We discussed my motivation for starting Covered - my brother Russell's experience with unfair insurance denials during his struggle with Ulcerative Colitis. Our family was hit with massive bills, and at a time when we wanted to focus on Russell’s health, instead we were focused on denied claims. Covered intervenes to help providers overturn denials, and prevent bills from becoming patient responsibility.

We discussed my journey through the Special Forces, Parachute Health, and running sales for healthcare companies, and eventually selling into insurance plans prior to starting Covered. We also spoke about Vanessa's career, and her choice to turn down Harvard undergraduate in pursuit of a life and career that aligned with my values of giving back and sharing what I've learned with others, which is why I started this podcast.

Vanessa and I met, funnily enough, because I was looking for a podcast on denials and found this one! We connected over a shared passion to create a denial resolution tool with the goal of harnessing the multitude of databases & sources of truth that a biller has to access in order to identify the root cause of a denial and create an appeal.

We are not only reducing the clicks required to gather the information, but creating a smart tool that will guide RCM professionals through the decisions required to compile the body of the appeal, and eventually generate it for them.

We addressed Covered’s competitive differentiation within the denial management space, and the rapid advancement of AI and LLMs, which have given an advantage to new companies. We touched on the slow moving nature of incumbents, and why they often don’t succeed in building product lines that are as innovative as their original core offering.

If Covered’s mission to fight back against incorrect denials resonates with you, we want to connect! Especially (but not exclusively) if you are an independent specialty provider group, an RCM company fighting denials, or a regional/community hospital/health system. If you are struggling to address denials as a result of staffing shortages/payer policies/behavior, or you are just passionate about denials, please reach out!

Today, Covered acts as a software enabled services company, utilizing technology and Vanessa to overturn denials (we've returned tens of thousands of dollars to physicians). If you're struggling with denials, we can immediately step in and help you, and help identify trends and root causes. In special cases, we also provide consulting services.

You can learn more about Covered on our website, CoveredHealth.ai.

On Episode 1 of Season 4 of the Healthcare Reimagined podcast, I spoke with Manav Sevak. Manav is the founder and CEO of Memora Health, which helps healthcare organizations digitize and automate care journeys, and make complex care delivery simple for patients and clinicians to navigate. Manav's journey to building Memora health began with a personal story - a close friend with a chronic diagnosis, who despite being young and tech savvy, found it difficult to navigate his care.

There are three major challenges that Memora addresses: Digitizing clinical workflows, saving providers time by utilizing automation, and allowing patients to use text messaging to get the information they need about their condition.

By looking at the things that happen for every patient, every time, in the course of a particular care episode, Memora has been able to use technology to automate and even standardize certain follow-up procedures. That has cut down on inbox messages and phone calls, and even eliminated them all together. Research out of Dartmouth suggests that people forget up to 80% of what they’ve heard from their healthcare professional. As a result, getting critical information to patients in a digestible format is crucial, and text messaging has proven itself to be a very reliable format for Memora.

The best course of care will vary based on a given patient’s condition and their response to treatment. However, according to Manav, the way patients get reminded to manage their medications, come to appointments, and the way that symptom management are done, should look very similar across clinical areas. What Memora is aiming to build is a best in class process for conveying information to patients and receiving that information back from them.

Memora is also able to leverage its digital approach to ensure adherence to ever-changing guidelines. When the protocols for screening patients for mental health conditions during the prenatal period changed, Memora was immediately able to update their postpartum care program across different care sites to reflect best practices.

Manav and I went on to discuss the challenges of EHR integration for digital health startups, and the challenge of building technology before Memora had access to data from pilot customers. We closed by exploring what percentage of the back and forth between care teams and patients it might be possible to automate in the future, and the tradeoff for early stage founders between staying at a high level and diving into the weeds.

You can learn more about Memora Health on their website.

On Episode 10 of Season 3 , I spoke with my grandmother, Sydell Aaron. Ultimately, we all become consumers of Healthcare, like it or not. On Healthcare Reimagined, I typically showcase healthcare innovation - the truth is that innovations are only interesting in so far as they are making life better for patients. Last week I spoke with my grandmother about her experience as a consumer of U.S. healthcare over the past 9 decades.

Sydell, or Meema as I call her, was born in 1932. In 1929, 3 years before she was born, the first polio patient was saved. In the 1940’s when Meema was a teenager, scientists succeeded in isolating penicillin and antibiotics became widely available for the first time. Before that, you could die from a simple infection. The first kidney transplant was done in 1952, when Meema was 20. In 1964, for the first time human blood was successfully stored. Meema was 32 years old, with 3 children.

Meema has already lived 50% longer than the average life expectancy for a woman the year she was born (it was 62 back then). We spoke about her family doctor making house calls, the awe and wonder of medicine before technology that made medical information available to all, and about the trade off between safety and independence as one gets older.

We discussed a few quotes from Atul Gawande's book Being Mortal, and the loss of independence as one ages. One of the quotes from Gawande's book really captured the essence of the challenge Meema faces in her interactions with her adult children. They want the best for her, as she knows, but at times, they infringe upon her freedom in an effort to protect her: "We want autonomy for ourselves and safety for those we love.”

We went on to discuss the framework in which death is addressed in U.S. Healthcare, and a system that selects for those who can and want to fix things (Doctors), when sometimes the best option is not to fix but to provide comfort in one's final days.

We closed with a discussion about Meema's own hopes, desires, and observations after over 9 decades on this pale blue dot we all call home.

Please make sure to check out the Society for HealthCare Innovation's (SHCI) website for more content.