Vital Signs with Jacob Effron and Nikhil Krishnan
Jun 24, 2026 · 48 min · 10 segments
Chris Altchek, founder and CEO of Cadence, joins Nikhil and Jacob to discuss how AI is changing the way chronic disease gets managed at scale. Cadence treats 100,000 patients a day across major health…
Chris AltchekGuestNikhil KrishnanHostJacob EffronHostObviously, I feel like anyone who's been in the health tech ecosystem for a while has talked a little bit about the promise of remote patient monitoring or sending stuff to people's homes to make their lives easier, make care pathways better.
And it's gone through a bunch of different arcs, it sounds like, over the years.
But I'm just curious if you could tell listeners a little bit about what the history of some of these remote patient monitoring paradigms have looked like over the time you've done this and maybe where we are today.
So phase one, I'd say like the pre-COVID era, where this premise and this promise that we could monitor patients from home, detect deterioration early, treat them better, was really done in a very experimental, one-off fashion.
All over the country, a lot of people were trying different small experiments with sending devices, collecting data, but not really changing the care bottle.
All of that changed, I would say, in kind of phase two, which was the COVID era, where it went from being optional to something everybody needed to try.
And reimbursement got formalized for the first time in 2020, and the floodgates opened with you know, over a hundred new companies started in this space.
And the good thing was a lot of health systems and a lot of providers experimented at pretty significant scale.
And I would say like now we're entering the third phase, which I think about as like kind of like Like the sorting and scaling phase where, you know, we've generated a lot of data over the last five years, the last six years since COVID now.
And we've started to see how this could actually work at scale in a really foundational way and see sort of like where the where the value really lies.
And now we're in that mode where, you know, people are experimenting less and making decisions around like, how do I kick this from 1000 patients to 100,000 patients? And I think we're in a pretty exciting place today that takes time and healthcare to get here.
One follow up to this is just around your point around like the sort of COVID explosion around these tools.
I feel like, you know, I heard a lot, for example, about hospital at home programs during this time.
And now as we kind of revert back to the mean of healthcare journeys, it doesn't seem like hospital at home, I think, took off in the way that people maybe expected it to.
I'm curious if you have an opinion on maybe why that's the case or if things are changing.
To me, it seems kind of obvious of like, yeah, if you have like a... you know, hospital care level patient and they are able to be treated at home.
It's in the hospital's best interest to free up a bed, patients who want to recover at home.
But there's clearly something I'm missing in translation here of like why that's not happening.
Obviously, I feel like anyone who's been in the health tech ecosystem for a while has talked a little bit about the promise of remote patient monitoring or sending stuff to people's homes to make their lives easier, make care pathways better.
And it's gone through a bunch of different arcs, it sounds like, over the years.
But I'm just curious if you could tell listeners a little bit about what the history of some of these remote patient monitoring paradigms have looked like over the time you've done this and maybe where we are today.
So phase one, I'd say like the pre-COVID era, where this premise and this promise that we could monitor patients from home, detect deterioration early, treat them better, was really done in a very experimental, one-off fashion.
All over the country, a lot of people were trying different small experiments with sending devices, collecting data, but not really changing the care bottle.
All of that changed, I would say, in kind of phase two, which was the COVID era, where it went from being optional to something everybody needed to try.
And reimbursement got formalized for the first time in 2020, and the floodgates opened with you know, over a hundred new companies started in this space.
And the good thing was a lot of health systems and a lot of providers experimented at pretty significant scale.
And I would say like now we're entering the third phase, which I think about as like kind of like Like the sorting and scaling phase where, you know, we've generated a lot of data over the last five years, the last six years since COVID now.
And we've started to see how this could actually work at scale in a really foundational way and see sort of like where the where the value really lies.
And now we're in that mode where, you know, people are experimenting less and making decisions around like, how do I kick this from 1000 patients to 100,000 patients? And I think we're in a pretty exciting place today that takes time and healthcare to get here.
One follow up to this is just around your point around like the sort of COVID explosion around these tools.
I feel like, you know, I heard a lot, for example, about hospital at home programs during this time.
And now as we kind of revert back to the mean of healthcare journeys, it doesn't seem like hospital at home, I think, took off in the way that people maybe expected it to.
I'm curious if you have an opinion on maybe why that's the case or if things are changing.
To me, it seems kind of obvious of like, yeah, if you have like a... you know, hospital care level patient and they are able to be treated at home.
It's in the hospital's best interest to free up a bed, patients who want to recover at home.
But there's clearly something I'm missing in translation here of like why that's not happening.
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