Perspectives from Honest Health Clinical Leadership
The Honest perspectives shared in this article are drawn from conversations with Honest Health clinical and operational leaders, including Greg Johnson, MD, Chief Medical Officer; Adam Silverman, MD, Chief Medical Officer, New York; Ray Benitez, MD, Chief Medical Officer, Pacific Northwest; Melanie Odelye, MD, Chief Medical Officer, Michigan; and Aaron DeBoer, EVP of Growth. While each leader serves different markets and patient populations, common themes emerged across their experiences caring for Medicare populations and supporting physicians in value-based care environments.
Fee-for-service medicine has a patient cost.
Not a reimbursement or utilization cost — a human cost.
It shows up when physicians don’t have enough time to understand the full picture, when chronic conditions go unaddressed between visits, or when life circumstances derail a treatment plan that looked perfectly reasonable inside the exam room.
Healthcare isn’t struggling because physicians care less. If anything, the opposite is true. Across practices and communities, physicians continue to encounter patients whose health is shaped by factors that don’t fit neatly into a fifteen-minute appointment: chronic disease, medication costs, transportation barriers, caregiver responsibilities, social isolation, and dozens of challenges that influence health long after a visit ends.
The question is not whether physicians recognize those realities but whether the healthcare system is designed to help address them.
That tension sits at the heart of the value-based care conversation. Physicians know patients need more than episodic care, yet much of healthcare remains organized around encounters rather than outcomes. For Adam Silverman, MD, that disconnect became impossible to overlook when comparing the nation’s healthcare spending with the results it produces.
“We were telling ourselves that we had the best health care industry in the world. And so that didn’t make a whole lot of sense.”
The challenge isn’t a lack of commitment from physicians but the reality that a healthcare system built around encounters often struggles to support everything that happens between them.
As healthcare leaders continue searching for ways to improve outcomes, lower costs, and strengthen access, many are arriving at the same conclusion: Patients need a model that extends beyond the visit itself.
When the immediate need is only part of the story
Most healthcare remains organized around encounters: A patient schedules an appointment. A physician addresses the immediate concern. A bill is generated. The patient leaves.
This can work well for acute issues, but patients rarely arrive with just one issue affecting their health. This means that healthcare has increasingly become the management of chronic conditions, complex patient journeys, and long-term relationships.
Aaron DeBoer, EVP of Growth, describes the difference this way:
“Too often, we’re treating the reason a patient came in that day, rather than addressing the full picture of what’s shaping their health over time.”
Value-based care shifts the focus from managing an encounter to understanding and supporting a patient over time.
“The doctor’s trying to maximize how they can produce the best outcome for the patient, not how they can produce the right level of coding for that fee-for-service visit.”
That change in perspective influences what gets discussed, what gets prioritized, and ultimately, what type of care patients receive.
The 23 hours and 45 minutes between visits
Every physician understands an important reality of care delivery: Patients spend very little time with their doctor. Health happens everywhere else.
As Dr. Silverman explains:
“I had 15 minutes with you, but you have 23 hours and 45 minutes away from me.”
The success of a treatment plan depends largely on what happens after a patient leaves the office.
- Do they pick up their medication?
- Can they afford it?
- Do they understand the care plan?
- Can they get to follow-up appointments?
- Do they have support at home?
Historically, physicians had limited visibility into those realities. Today, broader access to data and care coordination capabilities makes it possible to understand a patient’s health journey more completely.
Dr. Silverman recalls an example involving a patient who had reliably filled a prescription for months before suddenly stopping. The issue wasn’t noncompliance or a refusal of care. Follow-up revealed the patient had lost a job and could no longer afford the medication.
That experience reinforces an important lesson:
“Patients want to do what they’re supposed to do, but it’s usually life circumstances that get in the way.”
For care teams, visibility into those circumstances creates opportunities to intervene before missed medications become worsening conditions, hospitalizations, or avoidable complications.
The goal is not surveillance but continuity.
Documentation as patient advocacy
Few aspects of healthcare are discussed as negatively as documentation. For physicians, it is often viewed as an administrative burden layered onto an already full workload. In value-based care, however, many clinicians begin to see documentation differently.
Greg Johnson, MD, describes the shift in perspective:
“When physicians fully capture a patient’s complexity, they’re not just documenting a diagnosis. They’re helping ensure patients have access to the resources and support their care requires.”
Documentation is more than record keeping. It helps healthcare systems understand patient complexity, align resources to patient needs, and give care teams a more complete understanding of the individuals they serve.
Dr. Johnson frames it in even simpler terms:
“I am telling that patient’s story in a way that leads to them having adequate funding for the care they need.”
When a patient’s complexity goes undocumented, the needs that accompany that complexity can become more difficult to identify and support. Accurate documentation gives clinicians a stronger foundation for anticipating risk, coordinating care, and helping patients remain in the most appropriate setting possible.
For Dr. Johnson, this became particularly evident while caring for older adults.
“So many people prematurely ended up in long-term care because they can’t do one activity of daily living.”
The impact extended far beyond cost.
“They lost all of that function. They lost all of that life potential.”
Those are the types of outcomes physicians hope to prevent through earlier intervention, stronger coordination, and more proactive care planning.
Burnout is also a patient care issue
Conversations about clinician burnout often focus on workforce well-being, but the consequences extend to patients, too.
Ray Benitez, MD, sees this connection clearly.
“We still love to spend time with our patients and get to know them. Unfortunately, with how it is now, those opportunities are pretty rare.”
Most physicians enter medicine because they want to build relationships, understand patients deeply, and improve lives over time, yet many find themselves operating in systems where time is increasingly constrained and administrative complexity continues to grow.
Over time, that disconnect takes a toll.
“Burnout is affecting clinicians and healthcare workers across the industry, and over time that translates into real access issues for patients.”
As the Medicare population continues to expand, the loss of clinicians or reduction in patient volume can create even greater access challenges for communities.
Value-based care does not solve workforce shortages, but it can better align physician effort with physician purpose by emphasizing prevention, coordination, and outcomes rather than volume alone.
Creating space to solve real problems
One idea surfaced repeatedly across conversations with clinical leaders: the flexibility and ability to address the barriers actually affecting a patient’s health, not simply what can be billed.
For Melanie Odelye, MD, that flexibility is one of the model’s greatest strengths.
“I love the creativity that comes in a value-based care environment to be able to solve the actual problems that my patients have.”
The challenges facing patients are often remarkably practical:
- Education
- Behavioral health support
- Transportation
- Medication management
- Care coordination
However, many of those interventions have historically fallen outside traditional reimbursement structures.
As Dr. Odelye explains:
“It’s rather frustrating to have somebody who needs diabetic education, behavioral health, or care management, and because of reimbursement rules or out-of-pocket fees, it can be completely inaccessible to my patients.”
When organizations succeed in value-based care arrangements, they gain greater flexibility to invest in services that address those barriers directly.
“Moving to a value-based arrangement allows us to have a surplus of dollars that you can reinvest into patient care to ensure that you continue to see great results in your patient population through the services that you provide.”
At its best, that flexibility allows physicians and care teams to respond to what is actually standing between a patient and better health, even when the solution falls outside the boundaries of a traditional visit.
The question worth organizing around
The financial case for value-based care is important. Health systems need sustainable operating models, communities need access, and physicians need support.
But patients experience healthcare differently. They see whether:
- Someone understood their circumstances.
- Anyone followed up when they went quiet.
- Care was coordinated.
- A problem was addressed before it became a crisis.
Success in value-based care is ultimately measured by something larger than contract performance.
As DeBoer puts it:
“Real long-term success is that you’ve engaged the physicians in a meaningful way. They find value in the different programs that are in place, and you’re producing different and better outcomes for patients.”
Achieving those outcomes requires a simple but often overlooked principle:
“It can’t be done to physicians. It needs to be done with physicians.”
Value-based care is not a perfect solution, but it represents a meaningful shift in focus: from encounters to relationships, activity to outcomes, and treating episodes of illness to supporting long-term health.
For patients, that shift may be the most important outcome of all.