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NerdMDs StackBytes
A rapid‑fire audio companion to NerdMDs Substack writing—each episode packs a recent essay, insight, or framework into a 10‑minute listen. Perfect for your coffee break or between meetings, StackBytes delivers:
Top takeaways from the latest Substack @ Rewskidotcom.substack.com
Actionable tips you can apply today in clinical practice, health tech, or productivity
Concise reflections that complement the written piece
When it drops: Between every main podcast interview, so you never miss a fresh StackByte. Tune in, think different—and stay efficient. Subscribing ensures you catch every byte, straight from the page to your ears.
🎧 StackByte Episode Summary (Ep #5 – “Health Delivery 2.0”)
Drs. Adam Carewe and Dale Gold distill Carewe’s recent Substack essay on rebuilding U.S. health-care economics from “sick-care” to true health delivery. Citing Medicare fee-schedule cuts, exploding costs, and tech tailwinds, they argue that incremental margin hacks are dead; only a wholesale redesign of the payment-and-care stack can keep providers solvent and patients healthy. Carewe lays out six structural “moves” — from killing fee-for-service to making data liquid and shifting hospital-level care into the living-room — and closes with three 90-day action items any operator can start today. (Read the full essay on the NerdMDs Substack).
🔹 00:00 – Welcome & Why This Matters
The hosts frame the chat as a “10-minute power session” translating Carewe’s Substack into audio, warning that the current system is on a financial “burning platform.”
🔹 01:22 – From Sick-Care to Health Delivery
Carewe stresses that keeping people well is now an urgent necessity for survival, not a nice-to-have. A fresh 2.9 % CMS fee-schedule cut against CPI + 5 % cost inflation shows why tweaks won’t cut it.
🔹 02:48 – The Six Moves Overview
He introduces six radical moves and warns: “Your margin … won’t save you. Your model will.”
1️⃣ Kill Fee-for-Service (02:48)
Volume is “officially on hospice.” Providers must swap RVUs for population-health upside payments.
2️⃣ Pay for Risk, Not Visits (04:03)
Capitation already touches 14 % of U.S. spend — double four years ago — and mastering RAF coding plus prevention is now table stakes.
3️⃣ Make Data Liquid (05:33)
The January 2025 TEFCA rule imposes $1 M fines per blocked record, forcing open FHIR APIs and edge-analytics at the bedside.
4️⃣ Regulated Code Speed (07:14)
New FDA “living-algorithm” guidance lets adaptive AI into care if every weight update is version-controlled and explainable—“transparency equals clearance; opacity equals 483-letter hell.”
5️⃣ Shift Care Home-First (08:41)
Remote sensors + 24/7 command centers turn the couch into the new ward, with hospital-at-home DRGs capturing full reimbursement.
6️⃣ Retail Keeps Us Honest (10:10)
Amazon-style “one-click, same-day, transparent-price” expectations mean health systems must match retail convenience or be replaced.
🔹 11:19 – Three Immediate Plays
Plot your risk runway (how many PMPM lives can you manage in 12 months).
Open the pipes: map every data silo and unblock within 90 days.
Restage site-of-care: move one DRG home this quarter, three next.
🔹 12:24 – Closing Reflection
The episode ends urging listeners to ask what “studs are showing” in their own organizations that signal it’s time to smash, sweep, and rebuild toward a system that actually pays for health.
Notable Quote: “Transparency equals clearance; opacity equals 483-letter hell.”
