Un-HLTH-y
The talk I would have given
The speaker's list at this year's HLTH conference is impressive. Scheduled to appear are celebrities involved in health care ventures like Lenny Kravitz, Halle Berry, and John Legend. Heavy-hitting political luminaries including Dr. Robert Califf, Kyrsten Sinema, and first lady Dr. Jill Biden will be there too. Not to be forgotten, the traditional health care system will be represented by the CEOs of Johnson & Johnson, Kaiser Permanente, and The Cleveland Clinic. High-level executives from Big Tech, pharma, and insurance companies will take their turn at the lectern. There will be doctors too, many of whom serve in executive roles at large companies. I assume some of them are still practicing medicine. Maybe not. In any event, the list is long and impressive.
(There are also apparently multiple “stages” that carry names like “Evergreen Stage,” “Rocket Stage,” “Bold Stage,” and “Everest Stage.”)
In fairness, I've never attended HLTH. The agenda looks engaging, and I'm sure the talks will be insightful. Not to overstate the obvious, but health care is a large, complex industry that encompasses many moving parts. Representing each equally is challenging, and conferences like HLTH are a unique opportunity to bring representatives of the disparate pieces together.
I still believe the physician voices are important, especially at meetings like this. It's great to hear from docs who have successfully made the transition to administrative roles. But the voice of frontline clinicians (and their patients) is critically important too. In theory, all health care roads lead back to one core element: the clinician-patient relationship.
I applied to speak at HLTH this year but wasn’t accepted. Here’s the talk I would have given — a simple message from the frontlines.
Hello, and thank you for this generous opportunity to speak at this year's event. HLTH is quite the show — our orthopedic meetings are very tame by comparison. I just saw Lance Bass signing autographs over by the Bold Stage. If you're wondering who I am, you're probably not alone. My name is Ben Schwartz — I'm a community orthopedic surgeon practicing on the North Shore of Massachusetts. I've been in private practice for 15 years and still see patients and perform surgeries. (In the interest of full disclosure, my practice partnered with a private equity-backed MSO a few years ago.)
The first 10 or 11 years of my career were pretty standard. See patients, do surgeries, take call, go home. About five years ago, I started to wonder if there was something more. Taking care of patients is incredibly rewarding and impactful. I became a joint replacement surgeon because "curing" arthritis through arthroplasty was something I could understand. It's life-changing for many patients. But, as my practice matured, I grew increasingly frustrated by a system beset by inefficiency, lack of common sense, and increasing bloat. I sought an opportunity to make a deeper, broader impact — not just on patients, but the system as a whole.
It's been a long, methodical journey. I've learned a lot about innovation, entrepreneurship, health tech, and health care policy. I've become an investor, adviser, and mentor. My modestly successful blog and MSK VBC experiences grew into a valued partnership with Commons Clinic. I developed a social media following and built an extensive network.
It's been a blast. But...there's still something missing. Specifically, there's a disconnect between what happens in C-suites, Silicon Valley, VC boardrooms, and conferences like HLTH and what's happening on the front lines. I've intentionally positioned myself to exist in this gap. My goals are to call attention to it and help close it. That's who I am — and why I stand in front of you today.
Things on the front lines are challenging. As I speak, we are experiencing a shortage of IV fluids, caused by hurricane damage to manufacturing facilities. Some hospitals have had to pause elective surgeries. Yes, our medical supply chain is that fragile. We're used to these "inconveniences." Health care workers adapt on the fly and remain resilient. We have staff shortages, burnout...all the things you've heard about. I don't think it's quite as dire as it's often made to seem. But there are certainly opportunities for improvement.
It’s an interesting time for health tech. High interest rates pumped the brakes on investments. Exits remain difficult. Rate cuts may help. Digital health — however you choose to define it — has given way to artificial intelligence as the apple of investors’ eyes. I’m bullish on AI. The more I use them, the more I see the healthcare potential of ChatGPT, Claude, and other models. It’s not just about generative AI. Machine learning and neural networks will make us better diagnosticians. They’ll help us personalize care and engage patients. Causal AI will deepen our understanding of the relationships between diagnoses, diseases, and outcomes. Artificial intelligence will allow clinicians and tech developers to work together, solving problems collaboratively at the point of care.
One small request for everyone in the room — let's not repeat the mistakes of ZIRP-era health tech. I get the excitement around AI. But we've seen what can happen when reality doesn't match hype. The pressure to justify valuations and tendency to overpromise and underdeliver hurt digital health and health care technology in general. In some cases, it led to unethical behavior and playing fast and loose with medical ethics. AI is expensive to implement. I hope ROI doesn't come from using AI tools to extract value from the system but rather from leveraging tech to make things better for doctors and patients.
Speaking of value, there's a growing backlash toward value-based care. VBC used to be everywhere. It was the magic elixir that would save the American health care system from itself. But like digital health, hype never matched reality. Despite splashing it all over pitch decks, no one could really define value. VBC never delivered, and people got tired of constantly hearing about it. Value-based care now exists in health care's uncanny valley — so close to reality as to become revolting. We gave VBC a good go, but it's time to move on.
Or is it? Did we really try that hard? Despite all the talk of value, payers and health systems never really embraced it. Health tech companies never proved their products could provide it. The government overcomplicated it. Whenever possible, physicians ran away from it. Talking heads abused it in their crusade to vilify fee-for-service. VBC became everything and nothing. Now the focus has shifted to “patient-centered care” — perhaps a more palatable buzz phrase.
Rather than rebranding value-based care, let's reframe the discussion. VBC isn't a payment model; it's a philosophy on how care should be delivered — better patient engagement, personalization, high-quality, cost-efficient care. Value delivered not by carrots and sticks, but as a byproduct of doing things the right way. It's time to stop using value-based care to shame the current system. It's time to admit Medicare Advantage arbitrage isn't VBC. Neither is a one-sided approach that seeks to shift as much risk as possible to providers. We can do better.
I didn't come here to make this another protectionist, stick-in-the-mud, physician gripe-fest. I believe in technology and the power of value-focused care delivery — I really do. I believe the future of medicine depends on collaboration between stakeholders across the health care spectrum. Clinicians, patients, payers, regulators, health systems, tech companies, retailers — true innovators and those who support them (financially or otherwise).
We don't have enough collaboration. We talk about it, but our actions paint a different picture. We can have value-based care, if we really want it. AI and other technologies can have a lasting impact that goes beyond whipsawing from one FOMO-fueled investor hype cycle to the next. Collaboration starts with understanding and acceptance.
Home Depot recently announced a program that requires corporate employees to work a full day at one of its retail stores once a quarter. CEO Ted Decker explained the program — "We need to stay connected to the core of our business, so we can truly understand the challenges and opportunities our store associates face every day." It's a brilliant initiative.
If Home Depot can do it, health care can do it too. I challenge every single one of you to spend time — at least one week per quarter — in a front-line health care setting. Shadow a physician in clinic. Volunteer in an ER. Become a patient transporter. Help turn over ORs. Restock ASC supplies. I guarantee you'll learn something. Your perspective will change, and you'll be better for it. You’ll make smarter, more informed decisions that improve patient outcomes and deliver value. (Open invitation to hang out with me. That includes you, Lenny and Halle!)
Bridging the gap isn’t just important, it’s essential for the future of healthcare. The success of health tech, AI, and value-based care depends on a deep understanding of the real challenges we face on the front lines. Thank you for this opportunity and taking the time to listen. At the very least, I hope my talk has given you food for thought as you head over for some roasted barramundi with herb chimichurri and tomato confit.
Ben Schwartz, MD, MBA
Editor-in-Chief, The Surgeon’s Record
Commons Clinic Senior Clinical Fellow
Amen, Ben. Sorry you couldn’t deliver this message. Keep up the good fight.