The Grand Roundup: Debating the future of ESI, concierge medicine's $40K price tag, Elevance/SCAN sue over Stars, ACA rate hikes and death spiral fears, and more

Kevin and Martin open by discussing a question that recently surfaced in the Health Tech Nerds Slack community: is employer-sponsored insurance actually crumbling, or just showing its age? They then move into a conversation about Midi's CEO calling out a $40K/year concierge menopause practice on LinkedIn and a run of quick hits: Elevance and SCAN joining Clover in suing over Stars ratings, a Wall Street Journal piece flirting with "death spiral" language for the ACA, Alignment Health's accounting troubles, and Pearl Health's $110M raise stacked half on credit.

Then Bryan Sivak and Sean Glass join to break down Evidenced, the venture fund they just launched with a $24 million raise. They explain the fund's core thesis — backing early-stage health tech and tech-enabled services companies where a specific regulatory or policy tailwind accelerates buying — and walk through portfolio examples like IMPaCT Care, the community health worker infrastructure company spun out of UPenn.

Sam Melamed, CEO of NCD and self-described "Chief Insurance Nerd," closes things out. He walks through NCD's supplemental benefits business, then dives into forecasting enrollment in CMS's new Bridge program, discussing what full-page Eli Lilly ads in the New York Times signal about the money already flowing into that market, and lays out why he thinks standalone dental and vision plans keep gaining ground alongside Medicare Advantage.

Links referenced

Out of Pocket, Out of Reach: https://www.statnews.com/health-insurance-costs-out-of-pocket-out-of-reach-series/

The Billionaires’ Vagina Club: https://www.newyorker.com/magazine/2026/07/06/the-billionaires-vagina-club

ACA rate increases: https://www.wsj.com/health/healthcare/obamacare-insurers-seek-big-rate-hikes-again-8a4bf9e4

Sean and Bryan (Evidenced): sean@evidenced.com, bryan@evidenced.com

Sam Melamed (NCD): sam@ncd.com

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