Reframing Value in Healthcare: A Conversation on Innovation and Leadership
With Dr. Phil Louie of Measured Scalpel
What happens when two orthopaedic surgeons passionate about healthcare innovation compare notes on the future of medicine? Sparks of insight, debate, and hope.
Building a professional network is always rewarding, but it’s especially gratifying to meet a kindred spirit — someone whose interests, ambitions, and vision align closely with your own. For me, that person is Philip Louie, an accomplished spine surgeon, startup founder (StreaMD), and blogger (Measured Scalpel) with a growing social media presence. Though I’m a little older (and grayer), I’ve had the pleasure of getting to know Phil over the past year.
We first crossed paths as co-members of the clinical advisory board of a value-based care (VBC) focused musculoskeletal health-tech startup. Like me, Phil has a deep interest in health care innovation, which he encapsulates in a thoughtful framework he calls the “E’s.” They are:
Economics of healthcare (VBC)
Enabling technologies (creating a common language through tech)
Ergonomics (physician health and wellbeing)
Education (inspiring the next generation of clinician-scientists)
It’s a brilliant approach that resonates deeply with my own journey and aspirations. I’ve always enjoyed comparing notes with other orthopaedic surgeons who not only understand the challenges we face but are also willing to lead the charge toward solutions.
In this week’s edition of The Surgeon’s Record, I’m excited to share a recent email exchange between Phil and me. We dive into the growing backlash against value-based care, explore what innovation really means in today’s health care landscape, and discuss actionable steps for other doctors who want to get involved.
Our conversation offers a candid perspective on how surgeons can actively shape the future of health care. I hope you find it as thought-provoking and inspiring as we did.
Ben: Orthopedic Surgeons are known for being innovative, but it’s usually in the realm of developing new surgical techniques and instruments or consulting for industry. It’s less common to see our peers deeply involved with VBC startups or serving on advisory boards for VC-backed companies. What sparked your interest in the kind of work?
Phil: Great question — and probably a different answer depending on who you ask. For me, it boils down to a surgeon’s innate drive to turn ideas into impact. We all have ideas that fuel our passions, and we hope those ideas will make a meaningful difference. But transforming an idea into something impactful is incredibly challenging, especially when you're confined to the silo of your practice, community, or hospital system.
In many ways, we’re inherently innovative in our work because we have to be. We’re always striving to improve in a world of limited resources. Surgical techniques, instrument design, and consulting are natural entry points for innovation because they come with established blueprints and industry-supported pathways. However, this kind of innovation often feels “inside the box.”
What happens when our ideas and innovations fall outside the scope of these established mechanisms?
You and I share similar passions — not just with health tech but in the larger scope of health care economics and advanced care pathways. (Although your mind is far more advanced than mine! [Editor’s Note: Phil’s being too modest here!]). On the front lines, we confront the challenges of a health care system that struggles to deliver the right care at the right time in an economically responsible way. We also recognize that compensation should reflect the quality of care provided. But no matter how passionate or innovative we are, moving the needle is nearly impossible when we’re confined to the silos of our practices.
For me, taking a passion from idea to impact requires collaboration on a much larger scale — working with people who share those passions and are willing to “put their money where their mouths are” to invest in transformative initiatives. That’s where our paths crossed. Collaborating with VC-backed companies and serving on advisory boards has allowed me to connect with like-minded individuals and gain access to the infrastructure and investment needed to make a real difference.
This kind of work is inherently riskier, and there aren’t as many roadmaps to follow. But these opportunities are critical for reshaping how we deliver musculoskeletal care.
How about you Ben? You clearly are an expert in your domain and have made incredible contributions to the field with your writing, leadership positions, and collaborations. What draws you towards VBC startups, advisory boards, and VC-backed companies? And perhaps more importantly, how do you advise our colleagues to pursue similar opportunities?
Ben: The first 10 years of my career followed a pretty traditional path for a private practice surgeon: see patients, operate, take call, go home. Like most of us, I didn’t give much thought to health care economics or policy when I came out of training. It’s not something we’re taught in medical school, residency, or fellowship. Yes, private practice is essentially like running a small business, but we’re conditioned to think like widget-makers — and the more widgets we make, the better.
Eventually, I reached a point where the “game slowed down” for me. My clinical career became more routine, and I had the mental bandwidth to explore other interests. I’ve always been fascinated by technology, so the rise of digital health platforms caught my attention.
At the same time, I found myself increasingly frustrated by the inefficiencies, inertia, and “that’s how we’ve always done it” mindset that dominates traditional health care.
What frustrated me most was how many people acknowledge these issues but seem uninterested — or unwilling — to do anything about them. I’m a tinkerer by nature, always looking for ways to improve and optimize. Traditional health care innovation often focuses on surgical techniques, medications, and implants. But so many of these “advancements” add cost without delivering a proportional return on clinical outcomes. It became clear to me that the real outside-the-box thinking was happening outside the traditional system, particularly in startups.
As for how to pursue these opportunities, there’s no single right way. For me, it started with stepping out of my comfort zone and putting myself out there. I began posting more on social media, sharing my thoughts, and making connections. I participated in hackathons, podcasts, virtual meetings, and other events that allowed me to grow my network. That unlocked a lot of doors.
If I had to give advice, I’d say the first step is to take the leap and engage. You don’t have to be controversial or edgy to stand out. Just share something interesting or thoughtful and focus on quality over quantity. Authenticity and consistency go a long way.
Still, one of the most frequent questions I get from other docs is how to surface these opportunities. I don’t think there’s any single correct approach. How about you, Phil? Do you have a playbook for finding these opportunities? How do you balance your clinical practice with side gigs and avoid stretching yourself too thin?
Phil: That’s the challenge with these “non-traditional” — yet increasingly relevant — opportunities in health care. There really is no playbook! Each person’s journey is so unique, shaped by their circumstances, personality, and skillset, that it’s hard to replicate. You’re right — we’re not trained to think outside the box. Much of our education, from the sciences through the rigor of surgical training, is built around evidence-based dogma. We’re taught to accept established facts and apply them with precision, whether clinically or surgically.
We can forget that there’s so many other factors that influence how we provide care to our patients beyond the daily grind of our clinical practices.
We are good at complaining about the mounting problems and inefficiencies that we face each day, but how do we start developing meaningful solutions?
For me, I’ve always been someone who tries to find unconventional solutions. The consolidation of health care into corporate-run entities has forced us to work within the confines of rigid walls. I’ve always believed health care can learn a lot from other industries’ successes. This curiosity drew me into the world of mobile health, digital applications, health care economics, and performance optimization.
Social media started as a fun way to test ideas and share thoughts but quickly became a platform that opened doors to so many other opportunities. Building a network allowed me to pursue non-traditional passions in a way that’s still related to my “work.” I didn’t know what I was doing early on, but I think you have to be willing to take a risk and just “try it” for a bit. I have learned so much from my own mistakes and awkward leaps of faith.
“Balance” is a tricky concept. Deep down, we are all workaholics to a certain extent. Side gigs serve as a burnout antidote — I’m still “working,” but in a very different capacity than the daily grind of clinical practice. In fact, side gigs provide opportunities to impact patients outside the confines of my “day job.” This variety is incredibly rewarding, and I try to integrate lessons from both sides to drive progress.
I stay active in the academic world because I believe translating these outside-the-box ideas — whether products or thought-based solutions — into academic and real-world clinical settings is critical for meaningful change. What I once worried might stretch me too thin has instead energized me. The overlap between my clinical work and these innovative pursuits creates a synergy that has reinvigorated me on both fronts.
You bring up a very relatable experience with your first 10 years in practice. Do you feel there’s a stigma within the surgical community around pursuing non-clinical interests? How do you address it? Also, you mentioned that many traditional health care innovations add cost without significant ROI. How do you define success for the innovations or side gigs you pursue?
Ben: Loaded questions, lol! I’d say most of my partners and colleagues are at least peripherally aware of my side gig interests. The reactions range from indifference to mild curiosity. Everyone is busy with their own practices and personal lives, and we’re hardwired to follow established pathways. (On a side note, I suspect many of my colleagues, co-workers, and hospital staff are secret readers of my social media posts and blog!)
Traditionally, orthopedics has been all about innovation in the operating room, like new techniques, implants, devices. We love our widgets and adding a personal spin to procedures. But when it comes to VBC programs like BPCI or CJR, many surgeons see these as annoyances rather than opportunities. That’s a mistake. If we want a seat at the table and to influence the direction of health care, we can’t keep burying our heads in the sand and pretending innovation starts and ends in the OR.
Orthopedics has historically been somewhat insulated from economic pressures because our procedures reimburse well, and we’ve had access to ancillary revenue streams. But those days are changing too. I believe we must embrace unconventional thinking around care delivery if we want to stay ahead of the curve.
As for your second question, you’re right—many traditional health care innovations add cost without delivering meaningful ROI. Surgical robotics, injectables, and newer implants/devices often add cost, but unbiased data doesn’t always show improved outcomes. The era of using the “newest toy” in the OR without considering its economic impact is ending.
Success, in my view, is about value: lowering costs, improving outcomes, or ideally, both. In joint replacement surgery, the most impactful innovations have been surprisingly low-tech: using tranexamic acid to reduce blood loss, multimodal pain management with inexpensive medications, improved anesthetic techniques, rapid recovery protocols, patient health optimization, and transitioning to lower-cost settings like ASCs.
My side gigs and angel investments have supported this “thesis” of a value-focused approach. I’d say the biggest opportunity for the future lies in evolving care models that improve outcomes, engage patients, reduce costs, and offer transparency.
That said, VBC models come with challenges, especially when it comes to measuring what I call “soft ROI.” Reduced complications, fewer readmissions, improved patient-reported outcomes (PROMs), and better long-term results are harder to quantify than metrics in fee-for-service models. Some of the ROI isn’t purely financial or easy to capture on a balance sheet, but it’s no less important.
Technology will play a critical role here, too. Health tech is particularly interesting because it often contributes to this “soft ROI” by improving efficiency, patient experience, and care coordination. The challenge is figuring out how to deploy tech effectively and define its economic value.
The pendulum seems to be swinging away from (or against) VBC. The term has been thrown around so much that it’s essentially lost its meaning—if it was ever clearly definable to begin with. So many innovative solutions were built on the assumption of a VBC future that never fully materialized. While CMS and CMMI haven’t abandoned the concept, traction among commercial payers has been slow and difficult.
When it comes to tech, the hesitation is even more pronounced. Doctors, hospitals, health systems, and payers are reluctant to pay for solutions unless the ROI is obvious. How do we overcome the challenges of making VBC a reality? And Phil, how do we embrace a tech-enabled future that may not provide immediate or easily measurable ROI?
Phil: I love these questions, Ben—absolutely love them. They’re at the heart of why I’ve developed such a strong interest in side gigs beyond clinical care. In fact, these questions are part of what motivated me to start an executive MBA program this year.
First, let’s talk about VBC. You’re right—the term has entered “cringeworthy” territory. It’s been overused to the point where it not only lacks meaning but actively rubs people the wrong way. Large organizations, including CMS and CMMI, have been pushing the concept aggressively, but they’ve struggled to clearly define what it means for each stakeholder.
On paper, the value equation is simple: Value = Quality / Cost. But in practice, defining “quality” and “cost” has become overly complicated. Everyone wants to deliver the “right care at the right time” and be compensated fairly for it, but the specifics of what “value” means vary widely depending on who you ask. It feels like we’re all running the same race but sprinting toward different finish lines.
The next step, in my view, is to get stakeholders — patients, providers, payers, and others — to articulate their priorities and “values.” What does “value” mean to each group? Once we have that, we can start building models that reflect a shared understanding of what we’re aiming for. There have been some successes, but far more failures, especially with CMS’s frequently rebranded initiatives.
Now, on to the question of ROI in a tech-enabled future. The biggest challenge is that value and ROI mean different things to different people, even in the same situation. We all like to think we share the same values, but in reality, we’re often speaking past one another.
One of my goals over the next two to three years is to tackle this issue head-on, specifically from an enabling-technology perspective. I’m working on developing a universal, comprehensive, and efficient framework to evaluate enabling technologies—a sort of “Consumer Reports” or “Kelley Blue Book” for health care tech.
The idea is to create a reproducible starting point: a standardized evaluation that summarizes the most critical factors for each stakeholder group. This framework would provide an initial, universal assessment of a technology’s value based on its alignment with the priorities of multiple stakeholders.
Of course, it won’t be a panacea, but it could serve as a practical tool to bridge the gap between stakeholders and create a shared language around ROI. That’s the kind of foundation we need to move the conversation—and VBC—forward.
One of the areas I struggle with in the ROI discussion is that the impact is often long-term. Whether we’re innovating within our hospital system or with an external group, we’re frequently up against leadership incentivized by short-term gains — leaders who may not be in their positions long — or investors and founders who are focused on exit strategies.
How can we innovate and invest toward longer-term outcomes while still demonstrating sustainable short-term wins? And how can we formally tie ROI to “value” in a health care model that often seems split between corporate and clinical viewpoints?
Ben: There’s a lot to unpack here! I’ve never been a fan of the “carrot-and-stick” model that tries to use upside and downside risk as a blunt tool to drive value. It feels like a crude approach to achieving goals we all share: better outcomes, higher quality, lower costs, and improved engagement for both clinicians and patients.
The greatest value will always be the byproduct of well-designed processes. Incentives shouldn’t drive value. Instead, we should reward those who consistently prove their value. Long-term impact comes from building care pathways from the ground up with quality embedded in their design. The same principle applies to technology and ROI. Retrofitting technology onto broken processes leads to uneven results and makes it much harder to justify the costs.
Resistance to change is another issue. Disrupting the status quo is risky—if your tech threatens established workflows, you’ll face pushback. That’s why these elements — pathways, technology, and workflows — need to be integrated from Day One.
What excites me is the opportunity to align advanced care pathways, enabling technologies, and innovative care delivery models to achieve these goals. It’s a long process, but I think we’re on the cusp of seeing short-term thinkers turn their attention away from health care. Success in this space — whether clinical, financial, or otherwise — requires a long-term commitment. Health care innovation isn’t for tourists; you need to pitch a tent and plan to stay a while.
Second, I love that you’re pursuing an executive MBA. I completed the Quantic online program a couple of years ago and found it invaluable for building my knowledge base. While I don’t think an MBA is essential to getting involved in side gigs, starting a company, or pursuing health care leadership, it helps to speak the language and understand the business side of health care. In my opinion, being able to straddle the line between clinical medicine and health care economics is a superpower. I’m excited to hear more about your experience!
This has been a fantastic conversation, and as usual, we’ve surfaced more questions than answers. But that’s the point: having these discussions and beginning the process of finding solutions is critical. Even more so, it’s vital that other physicians recognize the value of leading these conversations. I hope our exchange here inspires others to get involved in health care innovation.
To anyone reading this, I invite you to reach out to me directly—through the blog or on LinkedIn—if you’re interested in these topics. There’s a lot of negativity and frustration in health care right now, but innovators see these challenges as opportunities—a call to action. Let’s work together to move the needle.
How about you, Phil? Any parting words of wisdom to wrap up?
Phil: First, let me say how much I’ve enjoyed this conversation. I’m one of many who deeply appreciate your work in bridging the gap between clinical medicine and health care economics. Your ideas and writing have educated and inspired so many of us—thank you for that!
In our world of orthopaedic surgery, we navigate a complex and demanding specialty that thrives on the coordination of resources, multidisciplinary collaboration, and enabling technology. Meaningful investments aren’t just nice to have—they’re essential. They drive improvements in patient care and safety, help us achieve the outcomes we aim for, and ensure financial responsibility and sustainability (including fair compensation).
We need to be at the forefront of leadership teams to ensure strategic decisions are grounded in the realities of our clinical work! If we passively complain and watch, I think that we ultimately risk losing the essence of value-driven-patient-centered care to profit-driven or shortsighted agendas.
It’s easy to commiserate and dwell on the challenges — we all face them — but the real opportunity lies in getting educated, collaborating, and taking action as a community. Let’s build a movement that brings clinicians together to drive meaningful change. In the end, the process of working toward these goals may prove just as rewarding as the results we achieve.
Many thanks to Phil for sharing his insights and participating in this exchange! If you’re not already following him on LinkedIn or subscribed to his blog, Measured Scalpel, you should be. His thought leadership and commitment to innovation in health care are inspiring.
While the answers to these complex challenges aren’t always clear, conversations like this help move us closer to solutions. It’s critically important that more physicians, surgeons, and clinicians step forward to take active roles in driving change—both in the clinical and non-clinical spheres.
If you’re interested in writing a guest post, participating in a similar exchange, or joining us for a webinar, we’d love to hear from you. Let’s keep the conversation going and continue working together to shape the future of medicine.
Ben Schwartz, MD, MBA
Editor-in-Chief, The Surgeon’s Record
Commons Clinic Senior Clinical Fellow
Another great column Ben! Enjoyed it very much!
I very much enjoyed the eloquent discussion on very important issues by two like minded forward thinking individuals, thank you.
I feel I have something to offer, stemming from a very different perspective, that began in an unlikely pathway of basic arthritis research (with unexpected major knowledge gains that had some major clinical beneficial impacts for surgery, and has come now, many, many years later, to be re-acquainting myself with value, patient perspectives, outcomes and costs.
Thank you for the opportunity to read and comment. I would love to delve deeper with some thoughts for change towards better care should either of you or others wish to engage some.