Christian Péan MD, MS · Surgeon · Founder · Duke Faculty

Understand the system. Master the tools.

Health policy and clinical AI, decoded for the people who run healthcare and installed into the way you actually work. Less noise. More signal.

The System
I want to understand it
CMS models decoded — ACCESS, TEAM, CJR-X. AI governance. Operator playbooks executives forward to each other.
Enter the policy wing →
The Tools · for clinicians
I want to master them
Clinical AI training for physicians and builders: ambient documentation, NotebookLM, Cowork, Claude skills, full agentic workflows — a path from your first tool to agents doing the work.
Enter the clinic →
The Stack · The Agentic Clinic curriculum

Learn Claude Cowork, Claude Code & NotebookLM — the tools that run this operation.

Everything published here is produced by the stack below, and everything taught here teaches you to run it: Claude as the engine, an agentic chief of staff on your desktop, and best-in-class tools wired around it. Named outright because that's what you searched for.

The Techy Surgeon stack: Claude, ChatGPT, NotebookLM, Notion, Granola, Netlify and Wispr Flow wired into one agentic workflow
C

Claude Cowork

The agentic desktop: files, agents, skills, and a chief of staff that does the work between meetings.

Core · start here →
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Claude Code

The builder's terminal — how the satellites, engines, and this site itself get made.

Builder track →
N

NotebookLM

Your literature, interrogated: sources in, grounded answers and audio overviews out.

Research loop →
G

ChatGPT

Images, quick reasoning, and the second opinion in the loop — including the visuals on this page.

Creative lane →
Gr

Granola

Meetings captured and structured — the raw material every agent downstream feeds on.

Capture layer →
No

Notion

The team's shared brain; where structured knowledge lands and lives.

Knowledge base →
Nt

Netlify

Where everything ships — this site, the games, the engines, usually the same day they're built.

Ship layer →
W

Wispr Flow

Voice-first input: dictate to every tool above at speaking speed, hands free between cases.

Input layer →
Become a member → Buy skills one-off Join the AI Ops course

Members get every skill on the shelf, every update, and the member essays. Not a subscriber type? Buy skill batches outright — $45–49 a batch, $175 for everything, checkout by Stripe. The Labs teach this stack in order; the AI Ops course builds it with you, live.

“Love your mix of technical understanding with clinical and business expertise. Very helpful in building the next generation of applications.”

Jean-Paul Runge · health-tech builder · paid member

“Love the tech play by an orthopedic surgeon. Brilliant.”

Steve Schutzer, MD · orthopedic surgeon · paid member

“Informative and useful insights for a health data CEO.”

Denny Brennan · health data CEO · paid member

“Your posts are super helpful and practical.”

Scott Walchek · paid member
Two doors, one mission

Pick your track. Or take both.

Everything published under this roof answers one of two promises. The banner above is the editorial test each piece has to pass.

The System track

The System

For Strategists: executives, physician leaders, and policy people who need to know what a rule means before their consultants do.

The ACCESS Model series · 12 Days of ACCESS CMS models, decoded · TEAM · CJR-X · governance The podcast · conversations with operators
The Tools track

The Tools · The Agentic Clinic

Where clinicians learn clinical AI. Start wherever you are: ambient documentation and scribe workflows, note-writing copilots, NotebookLM for the literature, then Cowork, skills, and agents running your admin while you see patients.

Techy Flows · tool-by-tool training series The skills shelf · members download & install Labs · ambient docs → agentic workflows, in order
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90-day impressions
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LinkedIn followers
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Issues published
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Skills on the shelf · growing biweekly
The Policy Radar

The models are arriving faster than the field can read them.

CMS is shipping payment models at a pace most systems can't absorb. This is the live board — what's in force, what's mandated, what's proposed — each with the operator's read, not the press release's.

LiveMandatedProposedWatchlist
Live · Jul 2026

ACCESS

All-payer coverage of evidence-based services · 10-year model

The MSK track went live this month. The question is no longer whether to participate — it's whether your referral network is ready.

The 12-part decode →
Mandatory · Jul 2026

TEAM

Episode accountability · 700+ hospitals, no opt-out

Five surgical episodes, mandatory participation, real downside risk. Most affected hospitals still haven't priced their post-acute leak.

The operator playbook →
Proposed · rule Apr 2026

CJR-X

Joint replacement, extended · anticipated 2027 start

The sequel to CJR with sharper teeth. The comment window is where leverage lives; the prepared will shape it.

The early read →
Watchlist

What's next

LEAD · specialty models · the AI coverage question

The pipeline behind the pipeline. When the next rule drops, the decode publishes here first — usually within days.

Get the next decode →
The Library

The reading room.

One to two essays a week at the intersection of clinic, capital, code, and policy. The full sortable library lands here with the next release; today these doors open into the archive.

01The complete archiveevery issue, chronological → 0212 Days of ACCESSthe policy series → 03Techy Flowsthe workflow series → 04The podcastlisten →
At the desk
The person behind it

Written from inside the system.

I'm an orthopedic trauma surgeon, CEO and co-founder of RevelAi Health, and faculty at Duke's School of Medicine and the Margolis Institute for Health Policy. Techy Surgeon is my working notebook: what I'm learning at the bedside, in the boardroom, and inside the payment models, written so you can use it.

The Studio is the applied wing: this thinking, built into your organization. One conversation starts it.

— Christian

Agentic workflow builds
Studio Wing 01

Agentic Workflow Builds

Your Cowork, set up the way I run mine: agents, skills, and workflows installed on your actual work, your team trained to keep them running.

  • Cowork Setup Sprint — individual or practice
  • Clinical AI Innovation Sprint — one workflow, built end to end
  • Team enablement — your people, fluent
Start a build →
Media and marketing
Studio Wing 02

Media & Marketing

Register-driven creative for healthcare and med-tech: campaign systems, premium stills and film, and media coaching for clinician voices that deserve an audience.

  • Campaign systems — stills, film, and motion in one language
  • MedEd & content strategy — the Zimmer-style engagement
  • Media coaching — voice, platform, cadence
Bring the Studio in →
Policy advisory
Studio Wing 03

The Advisory

Policy decoded into position. For leadership teams navigating the model wave: what to join, what to fight, what to build before the rule finalizes.

  • CMS model strategy — ACCESS · TEAM · CJR-X readiness
  • Executive & board briefings — the operator's read, in the room
  • Keynotes & education series — AAHKS-style programs
Brief the board →

How it runs: Diagnose → Build → Coach · fixed scope · two engagements at a time, never more

Paid members · doors opening for year two

The clubhouse.

Paid subscribers get the working assets behind every essay: the skills shelf to download and install, labs to learn inside, and Play-the-Issue editions of the flagship pieces. Your key arrives in a members-only post on Substack.

evidence-engine.skill
Grounded citations before anything gets written
conference-talk-builder.skill
Topic → deck, handout, visuals
executive-coaching.skill
Transcript → development brief
journey-builder.skill
Members only
notebooklm-learner-pack.skill
Members only
+ ten more on the shelf
Members only
Become a member Preview the clubhouse → Shop the skills → Already a member? Sign in →
The Curriculum · in production for year two

Two courses. Same mission, taught.

Everything the essays teach in pieces, sequenced into something you finish. Subscribers hear first, get first seats, and founding members get in early.

Flagship · first cohort
AI Ops — Your Agentic Chief of Staff
Claude Cowork, end to end, live: the learning loops that stick for knowledge workers, the automations that survive contact with a real week, and by the final session an agentic chief of staff running your operations. Built from the exact system that runs mine.
Operator track
The Agentic Clinic Bootcamp
For clinicians: ambient documentation → NotebookLM → Cowork → your first agents running real work. Finish with a working setup, not a certificate.
Strategist track
The CMS Models Masterclass
For leaders: ACCESS, TEAM, and CJR-X as one strategic map — participation math, governance, and the moves that precede the final rule.

No spam, no card — a seat in line and first word when doors open.

The newsletter

Built for the curious.

One essay a week that respects your time and your intelligence. Free to read; membership opens the clubhouse.

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