Risk Never Sleeps Podcast: Episode #165

How AI is Making Hospital Workflows Smarter and Faster

Guest: Nicholas Lin, Co-founder & CEO, Guava
Host: Ed Gaudet (with special co-host Mark Gaudet)
Date: December 16, 2025

Episode Overview

In this engaging episode, Ed Gaudet sits down with Nicholas (Nick) Lin, the Co-founder and CEO of Guava, to explore how AI is revolutionizing hospital workflows—specifically the burdensome process of medical prior authorization. Lin discusses how Guava leverages AI agents to automate time-consuming administrative tasks without accessing Protected Health Information (PHI) or Electronic Health Records (EHR), thus addressing both efficiency and compliance concerns. The conversation delves into startup challenges, risk aversion in healthcare innovation, and the importance of balancing progress with patient safety.

Key Discussion Points and Insights

1. Guava's Mission and Origin Story

• Founding Background

  • Nick and his co-founder Kelvin met at NYU, bonding over a lack of a weightlifting club and demonstrating early initiative by founding one themselves.

    "We were like, why does the school not have a weightlifting club?...So a few days after we met, we're like, why don't we just make the club ourselves?"
    — Nicholas Lin [01:57]

• Startup Genesis

  • Both founders have families in medicine and wanted to make a tangible impact. After extensive conversations with specialists and administrators, they zeroed in on the inefficiencies of prior authorization.

    "We got a really good sense that obviously we could focus on the manual workflows and that obviously can be automated."
    — Nicholas Lin [08:18]

2. What Guava Does and How It’s Different

• Automation Without PHI or EHR Integration

  • Guava automates the hospital prior authorization process while fully avoiding PHI and EHR access—a unique approach that directly addresses risk-averse hospital policies.

    "Our agents as default, they live outside Phi and EHR, which is a novel concept. A lot of healthcare administrators don't really get how we can automate the entire process without phi."
    — Nicholas Lin [04:25]

• AI-Powered Efficiency Gains

  • AI agents handle coverage checks, policy reviews, and even call payers—performing tedious, repetitive steps up to 95% faster, and only involving a human when absolutely necessary through a 'warm transfer' process.

    "We have voice agents that call the payer for you, win a hold for you, handle all the basic steps. And then once human intervention is required, it performs what we call a warm transfer..."
    — Nicholas Lin [05:19]

  • Medical policy reviews that typically take up to an hour are reduced to mere seconds:

    "We can automate that in about 10 to 15 seconds...our AI agents already trained on all that knowledge and then generates that information for the specialist."
    — Nicholas Lin [07:09]

  • For user input, only non-PHI operational details are needed:

    "All you have to do is type in the drug, type in the payer, the plan and optional diagnosis, and then a minute later you're ready to submit."
    — Nicholas Lin [09:52]

• Production and Traction

  • Currently working through the final steps of AI governance for a pilot at New York Presbyterian, with broader ambitions for national expansion.

    "We're currently working with New York Presbyterian, that's our anchor client...our long-term vision is to be basically the prior authorization automation layer for hospitals across the country."
    — Nicholas Lin [07:30]

3. Navigating Risk and Compliance in Healthcare AI

• Hospitals' Cautious Approach

  • Healthcare institutions' reluctance to adopt new tech is rooted in risk aversion—especially regarding patient data privacy. Guava's design choices arose from firsthand experience with this resistance.

    "Enterprise health systems...they're very risk averse and they have a lot of fears. They don't want you touching their data...any mention and you're out the door."
    — Nicholas Lin [04:56]

• Addressing the Status Quo

  • Nick argues that perpetual risk avoidance and incremental improvements aren’t sustainable for hospitals under pressure from administrative overload and offsite service migration.

    "At a certain point you have to take a risk, right. And you have to ask yourself, is this sustainable to keep going down this direction and following the status quo? And if not, then what is the huge change I need to make in order to make sure this doesn't keep happening?"
    — Nicholas Lin [15:13]

4. Startup Culture and Personal Reflections

• Speed of Execution

  • Guava was launched only three months prior but has moved quickly due to market need and deep user research.

• Naming the Company

  • ‘Guava’ symbolizes integration and cross-cultural unity, reflecting the company’s mission to bridge healthcare and technology.

    "Guava is a symbol of integration in some cultures...it's a universal fruit...a sign of cultural integration. So I want to make it a tech integration."
    — Nicholas Lin [12:13]

• On Risk-Taking

  • Nick describes himself as a calculated risk-taker (“If it’s 0.1% chance that I don’t get to see tomorrow, I’m not gonna [do it]”), showing a measured approach both in personal and business decisions.
    — Nicholas Lin [11:40]

• Life Lessons

  • Nick emphasizes the value of his journey—even mistakes, both minor (like drinking microwaved milk before school) and major—expressing contentment with how things have unfolded.

    "I’ve obviously made mistakes. Right. But I wouldn’t say anything I’ve done that would change the way my life has turned out. I think I’m pretty satisfied with...where I am."
    — Nicholas Lin [12:53]

• Camaraderie and Culture

  • The episode features lighthearted banter between Ed, Mark, and Nick, humanizing the conversation and adding warmth to the tech talk.

Memorable Moments & Notable Quotes

• On AI Empowerment, Not Replacement

  "Hospitals already have teams working on these issues. It's just that they're taking too long with outdated manual workflows...these teams can actually use Guava to get rid of maybe 90%, 90, 95% of the time consuming steps."
  — Nicholas Lin [05:00]

• On Hospital Innovation Reluctance

  "No one wants to be the one that takes the risk...they're like, if it's working as it is, which it's not...They don't want to take the risks to be the one that takes the first step forward."
  — Nicholas Lin [10:50]

• On Integration and Company Philosophy

  "[Guava is] a connection between, I think, healthcare and tech, where that doesn’t exist right now...I want to make it a tech integration."
  — Nicholas Lin [12:13]

Timestamps for Important Segments

• [01:55] — How the founders met and early entrepreneurial spirit
• [04:25] — What Guava does: automating hospital workflows without PHI or EHR
• [05:19] — AI-powered coverage checks and warm transfers
• [07:30] — Current production status and vision for growth
• [08:18] — User research and pivoting for compliance
• [09:52] — Human-in-the-loop and secure, minimal input process
• [10:50] — Reflections on risk aversion in hospital decision-making
• [12:13] — Why the name Guava
• [15:13] — On status quo vs. necessary innovation in healthcare

Tone and Language

The episode is participatory and candid, blending technical insight with personal anecdotes and humor, making complex topics accessible and infusing the discussion with startup energy and authenticity.

Summary Takeaway

This episode presents a compelling case for how thoughtfully engineered AI can address urgent healthcare workflow issues—if innovators commit to both empathy for hospital concerns and operational creativity. Guava’s journey so far illustrates both the pain points of health IT adoption and the possibilities when founders listen closely to users and compliance gatekeepers. Lin’s closing challenge—questioning whether the status quo is truly sustainable—offers a call to action for healthcare leaders everywhere.

"At a certain point you have to take a risk...is this sustainable to keep going down this direction and following the status quo?"
— Nicholas Lin [15:13]