Episode Description
In this episode of Neural Compass, host Mark Jacobstein sits down with Mike Kopko — co-founder and CEO of Pearl Health — for a conversation about why American healthcare behaves the way it does, and what it would actually take to fix it.
The answer Mike keeps coming back to isn't a new drug, a better algorithm, or a breakthrough device. It's a payment model. When the person consuming care isn't the person paying for it, markets behave strangely — and things that would obviously be built don't get built. Not because they're hard. Because nobody gets paid to build them.
New episodes every two weeks. This one reframes a lot of what feels broken about healthcare into something that almost makes sense.
This episode covers:
- The open credit card problem: why fee-for-service misaligns every incentive in the system
- Why Medicare's longer investment horizon changes what's possible in value-based care
- The windshield problem: why medicine is built to answer "what did we do?" instead of "what's about to happen?"
- Why dumping more data into an EHR makes physicians worse, not better — and what actually helps
- Why behavioral health hasn't broken through in value-based care yet — and what would change that
About the Speakers
Mike Kopko is co-founder and CEO of Pearl Health, which helps primary care physicians make the shift from fee-for-service to value-based payment models — starting with Medicare, where the investment horizon is long enough to actually change outcomes.
Before Pearl, he worked at Bridgewater Associates, where he learned to make rigorous data-driven decisions at scale before trying to invent his own system. He brought that directly into how Pearl operates.
He is currently reading Howard Zinn and Abundance, and follows Health Tech Nerds.
Mark Jacobstein is the co-founder and president of Jimini Health. A longtime entrepreneur at the intersection of AI and health tech, he now leads Jimini’s mission to transform mental and behavioral health through clinically grounded, AI-powered care.
For healthcare executives, researchers, investors, and anyone who thinks the mental health crisis deserves serious answers — this is the show.