I’ll be honest, when Matthew Holt agreed to appear on The Surgeon’s Record, I was excited and slightly nervous. Matthew is no stranger to those who follow health tech. As founder and publisher of The Health Care Blog, he has spent three decades pointing out the industry’s shortcomings with dry wit and British sensibilities.
Long before “digital health” became a thing, Matthew was hosting conferences and writing about health tech. His recent pieces, such as “How to Fix the Paradox of Primary Care” (pay PCPs more and reduce their patient panels) and “Matthew Explores the Referral Process” (a blow-by-blow of our janky patient hand-off system), capture the earnest skepticism that makes him both a self-avowed curmudgeon and essential healthcare innovation compass.
Until now, our paths had crossed only on social media (curbside orthopedic consults and a few LinkedIn exchanges), so this was our first real conversation. Matthew opened by asking me a pointed question: What makes Commons worth giving up a “slash and burn” career as an Orthopedic Surgeon? The question prompted a wandering exploration of the past, present, and future of healthcare — and why I made the leap.
Though it wasn’t intentional, our conversation perfectly encapsulated exactly why I joined Commons: figuring out how to integrate the care journey, align incentives with clinical value, successfully implement technology, and prove that doing right by patients can also reward investors.
Below are the five take-home points that emerged from our talk. They offer a blueprint for where healthcare must go—and how, through Commons, I think we’ll get there.
Take Home Points:
True Integration Remains Elusive
Matthew pointed out that managed care in the 1990s promised many of the same things we talk about today — coordination, efficiency, better outcomes. Yet fragmentation remains the norm. What’s different now? We have the tools and emerging care models to do it right: clinically integrated systems that align primary, specialty, diagnostics, rehab, and even surgical care under a unified operating model. At Commons, we’re out to prove that this level of integration can finally scale — and stick.
Policy and Coverage are Fickle
The ACA reduced the number of uninsured by tens of millions, but that progress is eroding as pandemic-era Medicaid policies unwind. As Matthew highlighted, we may be heading back toward 30 million uninsured. That reinforces a key lesson in healthcare innovation: regulatory capture and asymmetric policy decisions are inescapable. Delivery models must be resilient to political cycles and legislative whims. Commons is building value-based infrastructure that can serve patients across multiple coverage types, including commercial, direct contracting, health plans, self-insured employers, and even self-pay bundles. Aligning incentives within the confines of the rules brings staying power.Primary Care Needs a Reset, Not More Incremental Tweaks
From RVUs to overly complex value-based pilots, we’ve layered bureaucracy onto a primary care foundation already under stress. Capitation and VBC models tend to incentivize avoidance of specialty care. Matthew argued for a reset: smaller panels, better pay, more time with patients, and less role distortion. We both agreed that PCPs shouldn’t be forced to act as cost-containment gatekeepers. Instead, next generation primary care should educate, prevent, and coordinate. That requires rethinking how patients enter the care system, early detection and intervention, and the balance between primary and specialty care — our exact goal with Commons’ Wholebody program.Specialty Care Can Be Less Expensive and More Efficient — If We Let It
The narrative often frames specialists as cost drivers, but the reality is more nuanced. When deployed thoughtfully, specialty care can prevent unnecessary imaging, surgery, or ER visits. But that means moving away from hospital-centric, high-fee environments and embracing team-based, lower-acuity sites of care. Matthew noted that multi-specialty models, when structured around aligned incentives, can outperform bloated systems while still maintaining quality. However, he also points out that such models haven’t achieved widespread adoption or sustained success. Yet. High-quality, cost-efficient, ambulatory specialty care is core to Commons’ mission, and it’s already been proven in MSK.The Most Important Innovations Will Come from the Outside
Matthew remains skeptical that traditional incumbents —big health systems, payers, even CMS —can lead the next wave of transformation. Too many are constrained by inertia, fee-for-service gravity, and the need to protect existing business models. We agreed that approaches like Commons, which are purpose-built from the ground up, may have the best shot at creating a system that’s clinically and operationally aligned. The goal is to rebuild trust, deliver transparency, and let clinical value drive business value. That’s the bet we’re making.
That Matthew is intrigued about my career transition and the Commons model is enough validation for me! I thoroughly enjoyed our conversation — in a healthcare innovation world that’s prone to hyperbole and substance over style, Matthew’s perspective is both genuine and informed. His level of insight and understanding are meaningful and rare.
Matthew’s 30-year healthcare experience confirms what many feel: we’ve made fits, starts, and small gains in some areas. But the opportunity to put all the pieces together in a way that’s sustainable and makes sense is still out there. And that’s exactly why I left my “slash and burn” Orthopedic career to join Commons!
Ben Schwartz, MD, MBA
Editor-in-Chief, The Surgeon’s Record
SVP Care Services & Strategy
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