After more than two decades practicing emergency medicine and leading large-scale physician organizations, I’ve seen firsthand where the U.S. healthcare system both succeeds and breaks down.
Those experiences have shaped my conviction that value-based care only delivers results when it is built around physicians, partnership, and performance.
From the emergency department to system level change
If you want to understand where the healthcare system fails, spend some time in an emergency department.
That’s where I started my career.
I loved the energy and the idea that no matter what came through the door, you could help someone. Every day was new. But what I eventually realized is that unless you focused on process improvement, yesterday’s work didn’t make today any better.
That realization is what pushed me to think beyond individual encounters.
You see patients who don’t have support at home. You see a lack of coordination in care, addiction, mental health challenges, poverty, and lack of access all converge in one place. In this country, the emergency department has become the default social safety net for problems that started long before a patient arrived at the hospital — and it’s an incredibly expensive one.
It forced me to ask a different question: How do we support people in staying healthy before they ever need to come to the emergency department — and build a system that does so consistently?
Why this moment in value-based care is different
For years, value-based care was often positioned as a future-state transformation. Today, the pressures facing health systems are making it a practical and urgent necessity.
Hospitals lose money on most Medicare medical admissions. Beds are full. Primary care access is strained, and there is a lack of success. Physicians are burned out by volume, and patients are dissatisfied with rushed visits.
For the first time, these pressures are converging in a way that is creating real alignment across payers, physicians, and health systems — around the need for a better model of care.
That shift is also changing how success is defined. This isn’t about perfect care — it’s about being better with measurable improvement.
Take a patient from one of our partner systems who visited the emergency department more than 25 times over the course of a year. Reducing that to 15 represents a dramatic improvement in both outcomes and cost — and a far more realistic path forward than chasing perfection.
But results like this don’t happen automatically. They require the right mix of tools, operations, and incentives — but most importantly, engagement at the front lines.
Execution fails without physician leadership
That’s why execution ultimately depends on physician leadership — not just participation in a model.
One of the biggest mistakes organizations make is trying to implement value-based care without fully bringing physicians along. It’s imperative to start with the why. Physicians need to believe in the data, be part of the vision, and sit at the table every step of the way.
I’ve found physician motivation is remarkably consistent. First, they want to be proud of the care they’re providing. Second, they care about how they’re doing relative to their peers. Financial incentives matter, but they come third.
When that hierarchy is respected, engagement follows — and performance becomes sustainable.
Real success requires clear accountability. When everyone is accountable, no one is accountable. Leaders need to define what “good” looks like at six months, one year, and beyond — and commit to this as a long-term journey, not a quick fix.
Technology doesn’t drive results — people do
I am a big believer in technology. At Honest Health, we use advanced analytics, AI-driven patient engagement, and real time data tools like PULSE to detect signals and drive next best actions.
But technology doesn’t motivate people. It doesn’t win hearts and minds.
What makes these models work is the focus on results— and performance happens at the point of care. It starts with clinicians.
You must put meaningful, actionable data in physicians’ hands and keep it simple. Healthcare has oceans of data and puddles of insight. Our responsibility is to turn that data into something a physician can use today, with the patient in front of them.
“If you can’t win the hearts and minds of clinicians — and engage patients — you can’t do this.”
Equally important is trust. Trust leads to better outcomes, and it starts with the primary care physician.
When a patient hears from their doctor that we’re a partner in their care and then receives a call from a nurse who helps them fix a wheelchair or coordinate medications, trust is built.
Looking ahead: from value-based to outcome-based care
My hope is that someday we stop calling this value-based care altogether. Every clinician believes they provide valuable care — that’s not the point.
What we’re really working toward is outcome-based reimbursement: aligning incentives around supporting people being healthier and delivering measurable results.
I’m optimistic because we know what works. We see the change when it’s implemented well. And the most consistent proof points are frontline physicians who see better outcomes for their patients — and want more of their patients in these models.
At the end of the day, this work isn’t about labels or programs. It’s about building a healthcare system where physicians are empowered, patients are supported, and performance actually translates into better health for our communities. That’s the future worth building.