DC EKG

Guest: John Bertrand, former Digital Diagnostics

Episode Description
Joe Grogan sits down with John Bertrand, a veteran healthcare technology executive who scaled Digital Diagnostics to 75 health systems and achieved the first FDA approval and CMS reimbursement for an autonomous AI diagnostic device without a physician in the diagnostic loop. Bertrand reveals the harsh realities of bringing AI innovation to market: FDA and CMS regulatory frameworks are built for traditional medical devices and physician-driven care, not autonomous AI diagnostics. The conversation covers the shocking CMS reimbursement draft that came in 40-60% below cost of goods sold, the massive first-mover disadvantage in regulated medical device AI, and why reimbursement is the true gating factor for adoption—not clinical superiority. Bertrand explains how workflow integration and financial incentives matter far more than being clinically better. The episode explores the massive gap between what entrepreneurs think should happen with new innovations and the regulatory reality. He concludes with a sobering assessment: if building diagnostic AI again, he would choose supply chain automation instead because the regulatory and reimbursement headwinds are so significant they punish innovators. Where AI is actually making an impact today is patient-facing triage agents, administrative automation, and revenue cycle management—areas with far less friction.

KEY TIMESTAMPS
0:40 Joe introduces John Bertrand and his healthcare tech background
1:28 John clarifies he recently left Digital Diagnostics for supply chain work
2:40 John's career: 13 years at Epic Systems across multiple roles
6:10 What does Digital Diagnostics' AI device do? Automating retinal imaging
7:56 First FDA approval and first CMS reimbursement for autonomous AI diagnostic
9:02 Joe's threshold question: shouldn't better innovation be easily adopted?
9:50 Reality: workflow integration and reimbursement matter more than clinical quality
11:50 The adoption curve: all successful FDA-approved AI devices have CMS reimbursement
14:10 FDA experience: desire to help but frameworks built for old technology
15:40 FDA scrutiny on AI exceeds scrutiny on human clinicians
18:05 FDA guidance changes every 6-12 months, creating constant pivoting and delays
20:08 Shifting to CMS: the shocking draft reimbursement story
20:45 Draft came in at $10 per test, needed $30+ to be viable
22:42 Four months of negotiations with CMS to shift value argument
24:40 Process not codified: each company follows unique regulatory path
28:04 Six years at Digital Diagnostics: was it worth it?
28:44 John would not recommend diagnostic AI to new founders
33:02 Turning down multiple diagnostic AI opportunities post-Digital Diagnostics
34:19 AI hype vs reality: where are patients actually seeing life improvements?
34:19 Patient-facing triage agents are the second inning of real AI opportunity
36:25 Reimbursement for chat-based triage: who gets paid?
38:23 Autonomous vs assistive AI: the regulatory gap that exists
40:31 Could Digital Diagnostics have done physician-in-loop from the start?
41:33 Real opportunity: clinical practices deploying their own AI
42:20 State licensing nightmare: deploying AI across 50 states
44:55 The real concern: RCM automation becoming a zero-sum AI bot battle
45:20 Dead Internet Theory applied to healthcare revenue cycle
47:38 Closing: a tour de force on AI healthcare reality

Key Topics
AI in healthcare, FDA approval process, CMS reimbursement, autonomous AI diagnostics, Digital Diagnostics, diabetic retinopathy, regulatory frameworks, first-mover disadvantage, workflow integration, reimbursement strategy, patient-facing AI, healthcare innovation, regulatory friction, adoption barriers, state licensing, RCM automation, healthcare AI reality

About the Guest
John Bertrand is a veteran healthcare technology executive with over 20 years of experience. He spent 13 years at Epic Systems in analyst, product manage

This is a legacy episode recorded in January 2026. At the time of recording, Naomi Lopez was founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform.

Joe Grogan sits down with Naomi Lopez from Nexus Policy Consulting to recap the first Healthcare AI Policy Summit held in December 2025 in Washington, DC. They discuss big themes shaping healthcare AI, HHS approaches to AI adoption, and what regulatory clarity could look like. The conversation covers new federal initiatives like ACCESS and TEMPO that may reshape chronic disease management for Medicare patients. They unpack HHS Deputy Secretary Jim O'Neill's vision for AI in government, including using large models to improve physician productivity, payment integrity, and care coordination. They dig into ACCESS Medicare payment model and FDA TEMPO initiative, explaining how these pilots test AI tools in real-world chronic disease management for hypertension, diabetes, musculoskeletal pain, and depression. The discussion widens to physician burnout, interoperability, rural care, states and federal preemption, and what tech companies becoming Medicare Part B providers could mean for healthcare innovation.

Key Timestamps

0:00 Intro and why the Healthcare AI Policy Summit matters
2:00 Summit recap: big themes and regulatory pressure points
6:00 Jim O'Neill at HHS: regulatory clarity and adoption inside government
12:00 ACCESS explained: Medicare chronic disease management payment model
18:00 TEMPO explained: FDA's risk-based approach for chronic care tools
24:00 Wearables, remote patient monitoring, and virtual ICU models
30:00 Privacy, de-identification, and re-identification risk
35:00 AI inside HHS and FDA: productivity, payment integrity, care coordination
41:00 Reducing admin burden and physician burnout
47:00 Rural healthcare: scaling diagnostics and access with AI
52:00 Interoperability and data sharing: APIs, friction, and incentives
58:00 State AI laws versus federal preemption
1:04:00 2026 outlook: tech companies as Medicare Part B providers
1:09:00 Wrap-up and what to watch next

Key Topics
Healthcare AI, ACCESS payment model, TEMPO initiative, FDA regulation, Medicare reimbursement, chronic disease management, AI in government, physician productivity, care coordination, wearables, remote patient monitoring, privacy and de-identification, rural healthcare, interoperability, state AI regulation, federal preemption, healthcare innovation, payment integrity

About the Guest (at time of recording, January 2026)
Naomi Lopez is the founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform. She co-founded a healthcare AI working group and co-hosted the inaugural Healthcare AI Policy Summit in December 2025 in Washington, DC. Her work focuses on how regulation, Medicare and Medicaid policy, and state law shape healthcare innovation, access, and affordability.

Podcast: DC EKG with Joe Grogan
Host: Joe Grogan
Guest: Naomi Lopez

Sponsor: Survivors for Solutions
Executive Producer: John CZ Czwartacki, DC EKG Podcast

In this "REFILL" episode, Joe Grogan sits down with Jackson Hammond from Paragon Health Institute to unpack what the latest CMS National Health Expenditure data says about where U.S. healthcare is headed. They break down spending trends from $5.2 trillion to projections of $8.6 trillion, explaining what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. The conversation connects spending outlook to Jackson's work on CMS Innovation Center reform and debates whether CMMI is bending the cost curve or adding bureaucracy without accountability. Jackson argues we should aim for healthcare so affordable you barely need insurance, exploring how choice and competition could reshape the system.

Key Timestamps

0:55 Jackson's background and how he got into health policy
3:39 Focus areas: Medicare, hospitals, drug pricing, PBMs, and 340B
5:14 What the NHE report is showing
6:14 Healthcare spending trajectory: $5.2T to $8.6T and why it matters
8:00 Why health spending is not really optional
10:11 Where the money goes: payer mix and per-enrollee costs
12:23 Medicaid costs, provider taxes, and state financing tactics
15:58 Medicare spending pressure and fiscal risk
21:06 Misconception: coverage equals care
26:18 Why provider payments keep rising after COVID demand and consolidation
33:01 Rural care, consolidation, and rural emergency hospital models
40:08 Drug pricing: retrospective versus prospective MFN approaches
49:20 2026 outlook and closing thoughts

Key Topics
National Health Expenditure, healthcare spending, CMS reform, CMS Innovation Center, Medicare spending, Medicaid costs, hospital consolidation, rural healthcare, drug pricing, PBMs, 340B program, provider payments, patient-centered care, healthcare affordability, choice and competition, fiscal policy

About the Guest (at time of recording, January 2026)
Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's Paragon Prognosis analyses and has written extensively on CMS Innovation Center reform and strategies for making healthcare more affordable through competitive market approaches.

Podcast: DC EKG with Joe Grogan
Host: Joe Grogan
Guest: Jackson Hammond

Sponsor: Survivors for Solutions
Executive Producer: John CZ Czwartacki, DC EKG Podcast

This is a legacy episode recorded in January 2026. At the time of recording, Michael Cannon was Director of Health Policy Studies at the Cato Institute, a leading voice on healthcare reform, the Affordable Care Act, and market-based health policy solutions.
Episode Description
Joe Grogan sits down with Michael Cannon from the Cato Institute to discuss short-term, limited-duration insurance (STLDI), also known as "Obamacare-exempt" plans, and why they can be significantly cheaper than ACA exchange coverage. Cannon explains how renewal guarantees work and why allowing more consumer choice can reduce pressure on exchange risk pools. The conversation covers the politics of pre-existing conditions, how ACA rules change insurers' incentives, and why coverage debates often miss the real drivers of cost, access, and quality. They also discuss public trust in healthcare following the Brian Thompson murder and explore how policy choices shape what insurers can and cannot do.
Key Timestamps
0:23 Michael Cannon joins and what STLDI is
2:27 STLDI explained: Obamacare-exempt plans, renewal guarantees, and lower premiums
6:00 ACA history: why STLDI was restricted
7:46 International comparisons and pre-existing conditions incentives
12:10 Why healthcare stays broken: regulation, lobbying, and government-designed systems
16:59 Subsidies and the politics of pre-existing conditions
22:22 Renewal guarantees, employer tax exclusion, and Medicare history
30:37 Public trust after Brian Thompson's murder and Cannon's letter
41:56 Wrap-up and key takeaways

Key Topics
STLDI insurance, short-term limited-duration plans, ACA coverage, renewal guarantees, risk pools, pre-existing conditions, insurance regulation, healthcare costs, consumer choice, affordability, public trust, healthcare policy, market-based reform, junk insurance debate, employer-based coverage, Medicare policy
About the Guest (at time of recording, January 2026)
Michael Cannon is the Director of Health Policy Studies at the Cato Institute and a leading voice on healthcare reform, the Affordable Care Act, health insurance regulation, and market-based health policy solutions. He is a policy expert focused on expanding consumer choice and reducing the regulatory barriers that limit access to affordable coverage options.
Podcast: DC EKG with Joe Grogan
Host: Joe Grogan
Guest: Michael Cannon

Sponsor: Survivors for Solutions
Executive Producer: John CZ Czwartacki, DC EKG Podcast