Healthcare costs are taking an ever-larger bite out of American workers’ compensation. This Labor Day, we’re revisiting a conversation with Health Rosetta CEO Dave Chase about why healthcare has become so expensive and what employers can do about it.

Dave argues that healthcare itself isn’t the problem: clinicians receive only a fraction of every dollar spent, while price gouging, administrative bloat, and middlemen consume much of the rest. He explains how community-owned health plans are rebuilding employer healthcare around primary care, transparency, and better incentives—and how the savings can flow back to workers and their communities.

We cover:

• Why rising healthcare costs ultimately come out of workers’ pay
• How community-owned health plans cut out costly middlemen
• Why better primary care can lower costs while improving outcomes
• How employers can rebuild health benefits from the ground up
• Why Dave believes open-source healthcare could challenge entrenched incumbents 

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About our guest:

Dave Chase is the founder of Health Rosetta and creator of the community-owned health plan (COHP) model, a movement that has helped thousands of employers covering more than 5 million Americans build health plans that deliver better care at 20 to 50% lower cost. In 2024 he launched Nautilus Health Institute, seeded with $4 million in Health Rosetta intellectual property, to publish open-source standards and contracting templates that reset market norms for employers, clinicians, and communities. Dave’s work has reached over 1 million people through bestselling books, including “CEO’s Guide to Restoring the American Dream” and his newest, “Relocalizing Health: Taking Back Healthcare. Rebuilding Communities,” along with TED talks and TV and film appearances. He received the World Health Care Congress’ Lifetime Achievement Award for Health Benefits Innovation. Before Health Rosetta, Dave led Microsoft’s $30 billion healthcare ecosystem and co-founded Avado, later acquired by WebMD/Medscape.

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It's our monthly Digital Health Download, and September's stories all circle the same tension: technology keeps promising to fix healthcare's problems, but just as often it moves them somewhere else, or creates new ones entirely. This week, Halle unpacks a news-heavy month, weighing who actually benefits as markets, algorithms, and AI get closer to our health decisions.

We cover:

• Americans can now bet on clinical trials and FDA regulatory reviews - but do we want that?
• Meta's massive settlement over harming children
• The surprising reason AI might be making healthcare more expensive instead of less
• A new study on the biggest lever we're not pulling to bend the healthcare cost curve
• Two lawsuits rattling a popular wearable and a celebrity-backed mental health startup
• What a widely used drug class reveals about bias in hiring, and the uncomfortable questions that raises

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We don't talk enough about how hard it actually is to build a healthcare startup. Behind SmarterDx's story, now one of the biggest health AI exits to date, were 18 months without a single customer, a pivot that seemed to make no product sense, and two co-founders who went back to working as hospitalists just to get by.

In this episode, Steve gets the real story from Dr. Michael Gao and Dr. Joshua Geleris about the challenges they faced and what ultimately unlocked real growth and led to their billion+ acquisition by New Mountain Capital.

We cover:

• Why their first product idea failed and what customer objections actually taught them to build instead
• The counterintuitive workflow that made contingency pricing possible
• How AI translation of clinical notes into billing codes now outperforms the average human, and what that means for coders and nurses
• Why "moat" is the wrong metaphor and what a flywheel looks like instead
• What they'd do differently in the acquisition process

About our guests:

Michael Gao, MD, the CEO and co-founder of SmarterDx. Prior to founding SmarterDx, Dr. Gao was the Medical Director for Transformation at NewYork-Presbyterian, where he led applied AI development, implementation, and strategy for the health system. Dr. Gao holds faculty positions at the Icahn School of Medicine at Mount Sinai and Weill Cornell Medicine. Dr. Gao completed his internship and residency in Internal Medicine at NewYork-Presbyterian.. He received his M.D. from the University of Michigan and a B.S from the University of California Los Angeles.

Josh Geleris, MD, is the Head of Product and co-founder of SmarterDx. Prior to SmarterDx, he was Assistant Professor of Medicine at Columbia University, where he was funded by the National Institutes of Health and the Department of Defense for clinical informatics and data science, and led implementation of Epic for providers. Dr. Geleris completed his MD at the Technion-Israeli Institute of Technology and his Internal Medicine internship and residency at NewYork-Presbyterian. 

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It's back-to-school szn, and while some kids are stressing over earlier wake-ups, this year's incoming medical students have a bigger question to answer: how do you train for a career that could still have you practicing medicine in the 2070s, when the tools of medicine are changing so rapidly?

For our back-to-school episode, we sat down with Stanford University School of Medicine Dean Dr. Lloyd Minor to talk about how AI is already reshaping what future doctors learn and how they're taught, as well as what's still not working in American healthcare.

We cover:

• What medical students are actually being taught about AI, and where Stanford still draws the line
• Why Stanford's tumor boards no longer start with humans
• The surprising way Dr. Minor thinks AI could level the playing field in healthcare access
• Why the same AI tools helping patients feel more informed are also making them more anxious
• The counterintuitive reason new medical technology gets more expensive before it gets cheaper
• What's still standing in the way of a vision for precision medicine that's been decades in the making

About our guest:

Lloyd B. Minor, MD, is a scientist, surgeon, and academic leader. He is the Carl and Elizabeth Naumann Dean of the Stanford University School of Medicine and Vice President for Medical Affairs at Stanford University. Dr. Minor also is a professor of Otolaryngology–Head and Neck Surgery and a professor of Bioengineering and of Neurobiology, by courtesy, at Stanford University.

As dean, Dr. Minor has had an integral role in setting strategy for the clinical enterprise of Stanford Medicine, an academic medical center that includes the Stanford University School of Medicine, Stanford Health Care, and Stanford Medicine Children’s Health. With his leadership, Stanford Medicine leads the biomedical revolution in Precision Health. His book, “Discovering Precision Health,” describes this shift to more preventive, personalized health care and highlights how biomedical advances are dramatically improving our ability to treat and cure complex diseases. In 2021, Dr. Minor articulated and began realizing a bold vision to transform the future of life sciences at Stanford University and beyond – a multi-decade journey enabled by Precision Health.

In August 2023, Dr. Minor was appointed Vice President for Medical Affairs to lead all matters related to health and medicine at Stanford University.

Before Stanford, Dr. Minor was provost and senior vice president for academic affairs of Johns Hopkins University. Prior to this appointment in 2009, Dr. Minor served as the Andelot Professor and director (chair) of the Department of Otolaryngology–Head and Neck Surgery in the Johns Hopkins University School of Medicine and otolaryngologist-in-chief of The Johns Hopkins Hospital.

With more than 160 published articles and chapters, Dr. Minor is an expert in balance and inner ear disorders perhaps best known for discovering superior canal dehiscence syndrome, a debilitating disorder characterized by sound- or pressure-induced dizziness. He subsequently developed a surgical procedure that corrects the problem and alleviates symptoms.

In 2012, Dr. Minor was elected to the National Academy of Medicine.

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We're on summer break and replaying one of our favorite episodes. This episode originally aired on September 22, 2025.

A wearable can collect endless data, but it only matters if people trust it enough to change their behavior.

In this replay, Oura CEO Tom Hale joins Steve and Michael to explain how the company combines clinical-grade accuracy with a consumer-friendly product. They discuss why the ring’s form factor makes overnight tracking so powerful, how Oura turns physiological signals into useful guidance, and why the company is being pulled faster than expected into traditional healthcare.

We cover:

• Why sleep data can reveal changes in the body before symptoms appear
• How Oura designed a health product that supports users without judging or nagging them
• Why accuracy is the foundation for trust, predictions, and behavior change
• How Oura navigates the boundary between wellness products and regulated medical devices
• The company’s expansion into Medicare Advantage, women’s health, metabolic health, and clinical care

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About our guest:

Tom Hale is the Chief Executive Officer at ŌURA and a member of its board. As the CEO he sets the company’s business strategy and vision to make health a daily practice for members all over the world. He has over 30 years of experience across the technology and consumer product industry.

Before joining ŌURA, Hale was president of Momentive where he drove B2B strategy and led product growth. During his time there he was instrumental in taking the company public in 2018, leading the team in key acquisitions, and driving the evolution and rebranding of the company into a multiple SAAS business. Previously, he held leadership roles at HomeAway and Linden Lab as the Chief Operating Officer and Chief Product Officer, respectively, and held executive roles at Macromedia and Adobe.

Hale has a Bachelor of Arts from Harvard University and sits on the boards of Cars.com, RocketReach, and NoiseAware.

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This month is about the gap between what a system offers and what people actually get from it: drugs that work better with support nobody's paying for, AI that's already answering more medical questions than most doctors ever will, and a labor market where staying healthy can mean staying stuck. Halle and Michael break down the stories reshaping digital health in August.

We cover:

• Why GLP-1 funding is shifting from prescribing platforms into "companion" ecosystems
• The FDA panel vote that opens a legal pathway for six unapproved peptides, and what this could mean
• Our thoughts on OpenAI's new ChatGPT Health product, now available to every US adult
• The Florida pastor's lawsuit against OpenAI
• Why nearly one in four US workers are staying in jobs they'd rather leave, just to keep their health insurance
• The healthcare argument buried inside the bill to make daylight saving time permanent

Links:

• Rock Health, H1 2026 digital health funding recap
• Halle's research piece, Virtual GLP-1 startups: Pill mills or the future of obesity care?
• RAPS, FDA advisory committee backs six peptides for compounding list
• TechCrunch, OpenAI makes ChatGPT Health available to all US users
• CBS News, ChatGPT's medical advice nearly killed a Florida man, lawsuit claims
• Gallup, One in four US employees locked in jobs for health insurance
• The Hill, House passes Sunshine Protection Act

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Every day, roughly 100 Americans die in crashes caused by human drivers. Yet when a self-driving car hesitates at an intersection or makes the news for an unusual mistake, public trust can evaporate.

In this special episode, Dr. Jonathan Slotkin reads his latest Noema essay exploring why we demand perfection from machines while accepting human error as inevitable. Drawing on lessons from medicine, psychology, and autonomous vehicles, he argues that the biggest barrier to safer technology is trust.

You'll learn:

• Why humans judge machine mistakes differently than human mistakes
• What healthcare learned about the difference between being safe and feeling safe
• Why autonomous vehicles may already be far safer than human drivers
• How public perception can slow the adoption of life-saving technology
• What every AI company should learn about transparency and trust 

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About our guest:

Dr. Jonathan Slotkin is Chief Medical Officer for Strategy & Growth at Geisinger, where he drives growth at the intersection of care delivery, insurance, and digital transformation. A practicing neurosurgeon, he previously served as Geisinger's associate chief medical informatics officer.

Jon's current research and writing examine safety, trust, and adoption of autonomous systems in public life. His New York Times guest essay on self-driving car safety was entered into the Congressional Record. His writing regularly appears in Harvard Business Review, STAT, and Noema Magazine. He has authored more than 70 peer-reviewed scientific publications.

Previously, as co-founder and chief medical officer of Contigo Health, he partnered with the nation's largest employers to reimagine care for their associates. He co-founded Scrub Capital, a clinician-powered venture capital firm, where he serves as a Partner. He completed neurosurgery residency at The Brigham and Women's Hospital, Harvard Medical School, where he served as chief resident.

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This piece was commissioned, edited, and published by Noema Magazine. Noema publishes longform journalism exploring fresh ideas. To read this piece and others, head to noemamag.com.

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Healthcare companies are built to improve patients' lives. So why do so many prioritize shareholders over the people they're meant to serve?

This week, Halle sits down with Eric Ries, author of Incorruptible, to unpack the rise of shareholder primacy, what it is, and why he believes it's at the root of many of society’s biggest challenges. They discuss the surprising history of corporate governance, the lessons behind Novo Nordisk's century-long success, and what founders can do today to keep their companies aligned with their mission as they grow.

We cover:

• Why shareholder primacy reshaped corporate America (and where we go from here)
• How Novo Nordisk's unusual ownership structure may have saved GLP-1 research
• The simple governance change that could preserve your company's mission for decades
• How boards, investors, and acquisitions can slowly pull companies away from their original purpose
• The founder mistakes that make mission drift almost inevitable

About our guest:

Over the last two decades, Eric Ries’s ideas about continuous innovation, long-term thinking, governance, and market reform have reshaped company building and management practices. He is the creator of the Lean Startup method, and the author of two New York Times bestsellers The Lean Startup and Incorruptible; The Leader’s Guide; and The Startup Way. 

As a founder, he has put his own ideas into practice with The Long-Term Stock Exchange (LTSE); Answer.AI, an AI R&D lab; Virgil, a legal services startup; and IMVU. On The Eric Ries Show, he talks with world-class technologists, thought leaders, and executives building for the long-term. 

Check out his book, Incorruptible: Why Good Companies Go Bad…and How Great Companies Stay Great

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Over the last decade, the number of drug candidates entering development has doubled, yet the number of successful drug approvals remains flat at ~50 per year.

This week, we sit down with Formation Bio founder and CEO Ben Liu. His company has raised more than $600 million to build what he hopes will become the first new enduring pharmaceutical company in decades, powered by AI. Ben explains why he believes clinical development, not drug discovery, is becoming the industry's biggest bottleneck, and how AI could fundamentally change the economics of bringing new medicines to patients.

We cover:

• Why there hasn't there been a big pharma company created since the 1980s
• Which drug categories Ben believes could become the next GLP-1s and reshape healthcare
• Why Formation Bio chose to become a pharmaceutical company instead of selling software
• The real bottleneck in bringing medicines to patients
• Ben's roadmap for how AI will transform drug development over the next 10 to 20 years

About our guest:

Ben Liu is the co-founder and CEO of Formation Bio. He received his DPhil at Oxford as a Rhodes Scholar, leveraging machine-learning, AI, and big-data to develop diagnostics and therapeutics for Parkinson’s and Alzheimer’s disease. During his graduate work, he observed the way clinical trials bottlenecked the development of new treatments for patients, compelling him to start Formation Bio.

Before Formation Bio, Ben graduated from Yale where he was awarded the college’s highest honor at graduation and received his MPhil with distinction in Computational Biology from the Department of Applied Mathematics and Theoretical Physics at Cambridge as a Paul Mellon Fellow. Ben also serves as an Advisor to Harvard Business School’s MS/MBA Program in Biotechnology.

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They built a $1.2 billion healthcare AI company in under three years, but they say the hardest part of healthcare AI isn't the AI.

This week, Halle sits down with Assort Health co-founders and co-CEOs Jeffery Liu and Jon Wang, whose company reached a $1.2 billion valuation in under three years. They discuss why building great healthcare AI takes far more than good models, how they scaled from 15 employees to nearly 250 in a year, and what they've learned from more than 190 million patient interactions. They also share why voice AI is harder than it looks, how they're thinking about building durable moats in the age of foundation models, and why helping patients navigate the healthcare system may be one of AI's biggest opportunities.

We cover:

• The AI role suddenly showing up at every healthcare startup
• The surprising demographic that gives AI voice agents the highest satisfaction scores
• How healthcare AI is shifting from single-purpose tools to platforms that remember patients across every interaction
• Why the biggest moat in healthcare AI may not be the model itself
• The biggest misconception investors have about moats in healthcare AI
• How to triple your team without losing the culture that made the company successful

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July marks five years of The Heart of Healthcare, and we're grateful for every listener who's tuned in. If you've enjoyed the show, please show your love by leaving us a review!

This month, Steve and Halle take stock of an industry where capital is concentrating, incumbents are making big bets, AI is moving from promise to early proof points, and a public health crisis is quietly building in the background.

We cover:

• The digital health funding numbers that just dropped, and what they reveal about where the money is really going
• A $12 billion deal that has the RCM world buzzing
• The Nature study that has clinical AI companies on edge
• A new entrant into medical imaging that nobody saw coming
• The public health crisis that sports betting built, and why healthcare isn't talking about it enough
• Early data out of Utah that could change how we think about AI in clinical settings

Links:

• IPO Watch List: https://halletecco.substack.com/p/the-digital-health-ipo-watchlist
• Ensemble Health / Thoreau deal: https://hitconsultant.net/2026/06/18/thoreau-makes-strategic-investment-in-ensemble-health/
• Nature Medicine AI study: https://www.nature.com/articles/s41591-026-04431-5
• Midjourney Medical: https://www.theverge.com/ai-artificial-intelligence/952011/midjourney-medical-ai-ultrasound-scan
• Doctronic pilot outcomes: https://commerce.utah.gov/wp-content/uploads/2026/05/Doctronic-Outcomes-May-2026.pdf

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