Building in regulated industries in the age of AI

In this episode, Drew sits down with Igor Gorlatov, founder of Advisory5, to talk about building in regulated industries in the age of AI. Igor explains why FDA clearance is only the open gate, how the payer and provider fight shapes every product, and why the founders who win find a wedge instead of trying to rebuild the system. Drew shares the moment an executive coach told him his bias toward action had become a weakness, and they dig into why reflection feels good but action is where things change. They close with Drew’s VHS, DVD, and streaming view of AI maturity, an Iron Man metaphor, and why most companies skip the unglamorous foundation work. Takeaways AI makes building faster, but regulated industries still carry the red tape, politics, and compliance that slow people down. FDA clearance is the open gate. Reimbursement is the big boss, so start planning for it two or three years early. Align your product with whoever carries the cost. Garner Health works with employers and, per Igor, saves them at least 12%. AI now lets payers deny claims almost for free while providers use it to file paperwork faster. Founders are walking into that fight. Find a wedge before you chase the big prize. The companies Igor named started with ambient note taking, a HIPAA compliant chat tool for physicians, and stroke prevention. A clinical champion inside the health system beats pitching from the outside, because how decisions get made is not public. If you are an industry outsider, trust and relationships come before the pitch. A team of advisors is a low risk way to build them. Reflection is comfortable. Real action is doing something that could get you a no, like asking a pilot customer to become permanent. Any strength overused can become a weakness. A good advisor learns your tendencies and asks the right question at the right time. Most companies are at VHS and want Netflix. The unsexy work of structured data, guardrails, and governance has to come first. Chapters 00:00 Cold open: reflection versus action 01:21 Intro to the show and Igor 02:01 Igor’s story: go to market to health innovation 03:42 Why building in healthcare is still slow in the age of AI 04:48 The fog: payers, providers, and who profits 06:58 Trust and relationships when you are an industry outsider 10:56 Aligned incentives and the Garner Health example 12:48 Helping early stage founders in Charlotte 14:56 Should you offer equity to strategic advisors? 17:37 How Advisory Five builds trust through a team of advisors 19:49 How executives can use advisors 23:18 Reflection versus action 24:46 Drew’s coach and the bias toward action 29:52 Finding your wedge: three health tech case studies 33:20 The same problems show up in every industry 35:51 Incremental efficiency versus big bets 38:46 VHS, DVD, and streaming: AI maturity 42:03 Software on demand and the plumbing nobody sees 45:18 Iron Man and agent harnesses 47:22 Why the people stuff is the real barrier 49:29 The unsexy foundation work 50:35 Practical advice and what to stop doing 54:02 Closing thoughts 54:53 Where to find Igor Connect with Igor & Advisory Five LinkedIn:  / gorlatov   Website: https://www.advisory5.com/ Connect with Drew & StealthX LinkedIn:   / drewhburdick   Website: https://stealthx.co/