The conversation covers Omada’s views on the ACCESS program and the recently announced reimbursement rates, how they’re thinking about using technology to scale their care operations, plus the new cholesterol program they just announced.

Kevin sits down with Jacob Shiff, the Chief AI & Technology Officer at CMMI, to unpack the new ACCESS model and what it means for healthcare innovators looking to reshape care delivery for Medicare populations.

On January 29th, CMS announced that Medicaid Technology Companies had pledged $600 million in savings to support the implementation of community engagement requirements from H.R. 1 and other improvements to the Medicaid tech stack.

To discuss the current state of the Medicaid tech stack, how preparations for the January 1st 2027 implementation of community engagement requirements and twice yearly redeterminations is going, and alternatives to the Deloitte-Equifax “means-testing industrial complex” we’re joined by:

• Nikita Singareddy , CEO of Fortuna Health
• Luke Farrell, former USDS lead for benefits during the PHE unwinding, author of The Means-Testing Industrial Complex and Fellow at the University of Michigan’s Better Government Lab.

Martin and Kevin unpack CMMI’s new Access program, focusing on reimbursement rates that landed well below digital health expectations and what that signals about CMS pushing AI-enabled, lower-labor care models. They discuss Humana’s earnings and its $1B Max acquisition, debates over Medicare Advantage costs versus traditional Medicare, healthcare job growth amid AI narratives, and an earnings roundup covering Hinge, Tenet, and Oscar’s ACA and ICHRA momentum.

In this episode, meet Kelsie Brandt, Chief Clinical Officer at Nest, as she discusses the launch of Nest Origin, a new comprehensive prenatal, postpartum, and infant care program for Medicaid families. Kelsie explains her background in pediatric nursing and the critical role caregivers play in child and infant health. The conversation delves into the challenges Medicaid mothers face, the structure and benefits of the Nest Origin program, and its potential to significantly improve maternal and infant healthcare outcomes. Learn how this initiative, supported by the David and Lucille Packard Foundation and evaluated by UPenn, aims to create a positive shift in healthcare for vulnerable mothers and families.

In this special report episode recorded on February 11th, the Health Tech Nerds team dives into the key takeaways from Humana's recent earnings call. The discussion covers Humana's 25% growth in their individual Medicare Advantage book. Despite their stock trading down, the team finds reasons for optimism, particularly around retention rates and profitable plan sales. They also explore larger industry implications, including the impact of CMS's 2027 rate notice and the future strategies of Humana in relation to other Medicare Advantage plans. Key points include Humana's approach to retention, profitability challenges, and the potential ripple effects on regional and smaller insurance plans. Tune in for an in-depth analysis of Humana's current standing and future trajectory in the healthcare market.

In this insightful episode, we sit down with Anurati Mathur, co-founder and CEO of a Sempre Health, which is focused on improving medication affordability. The main focus of the discussion is on the complex landscape of medication affordability and how his company addresses it by creating a two-sided marketplace between pharmaceutical manufacturers and health plans. The CEO explains the company's innovative approach to distributing existing funds more effectively and aligning the interests of various stakeholders, including manufacturers, payers, PBMs, and patients. He also touches on the underutilization of financial assistance budgets, the model's expansion into different payer types, and the positive outcomes they've achieved in medication adherence and patient satisfaction. Tune in for a comprehensive look at how technology and innovative business models can transform healthcare affordability.

In this episode, we delve into major developments in the healthcare industry, including the recent bankruptcy of Carbon Health and its ambitious goals, the evolving landscape of AI in primary care, and funding trends. We also discuss primary care access challenges, recent earnings reports from major companies like Molina, Centene, and DaVita, and the outlook for PACE models and vertically integrated healthcare systems. Join us for a comprehensive analysis of the shifts and trends impacting the healthcare sector.