In this episode of the Clinicians in Leadership podcast, host Zach McConnell sits down with Karan Gill, a current medical student and the CEO of OneLine Health.
We dive deep into the paradox of modern medicine: while clinical treatments are highly advanced, physicians are drowning in administrative tasks, leading to massive burnout. Karan shares his unconventional journey from stem cell biology to health-tech leadership and explains how his company is changing the game.
OneLine Health acts as
Healthmap Solutions' CEO Eric Reimer and Chief Growth Officer Tom Gaffney return to The Strategy of Health for a 2025 year-in-review. They discuss how the company delivered record savings rates amid industry headwinds, the integration of the Carium, and why chronic care management is finally getting the scrutiny it deserves. The conversation covers their expanding comorbidity strategy, plans to grow spend under management by 30-40% in 2026, and how AI is making their clinical teams more effectiv
The narrative surrounding traditional healthcare systems is shifting from stability to precariousness. For decades, large health systems, the “incumbents”, have relied on a perceived moat of high capital costs, regulatory complexity, and geographic dominance to protect their market share. However, recent discourse, sparked by industry observers like Dr. Rashmee Shah, suggests this moat is drying up. As digital health disruptors and agile startups nibble away at the ambulatory market, hospital executives are left asking: Are we doomed?
The numbers lend credibility to this anxiety. Bain & Company projects that nontraditional providers will capture 30% of the U.S. primary care market by 2030, with payer-owned primary care alone reaching 20%. Optum now employs over 90,000 physicians—roughly 10% of the entire U.S. physician workforce—and manages 4.7 million patients in value-based care arrangements. CVS Health‘s $10.6 billion Oak Street Health, part of CVS Health acquisition added more than 200 primary care centers across 25 states, with plans for 50–60 new clinics annually. Yet 2024 delivered a plot twist that complicates the disruption narrative. Walmart shuttered all 51 health clinics. Walgreens wrote down $12.7 billion on VillageMD. Teladoc Health‘s stock fell 98% from its 2021 peak. The American Hospital Association captured this reversal with a pointed headline: “The Disruptors Are Getting Disrupted.”
In a recent discussion with Cole Lyons for the American Journal of Healthcare Strategy, Roger Kerzner, MD, MBA of Heartbeat Health argues that doom is not inevitable; but survival requires a radical shift in business modeling. The days of treating ambulatory care as merely a funnel for inpatient volume are over. To survive, incumbents must decouple their acute care excellence from their ambulatory strategy, embracing a transition from episodic visits to continuous, tech-enabled care. This episode explores Dr. Kerzner’s insights on why the old models are failing, the necessity of partnerships, and the leadership courage required to navigate this decade-long transformation.
Why the Incumbent “Moat” Is Evaporating
The incumbent moat is drying up because the traditional model of episodic ambulatory care is no longer the most effective or efficient way to manage patient health in a digital age. For years, health systems have operated on a premise where value is generated through office visits and subsequent hospitalizations. Dr. Kerzner points out that this structure is fundamentally misaligned with what modern technology now allows.
The breakdown is driven by a capability gap. Disruptors: tech-forward companies unburdened by legacy infrastructure are leveraging virtual care, remote monitoring, and continuous touchpoints to manage chronic conditions better than a quarterly fifteen-minute office visit ever could. Traditional systems rely on patients coming in every few months; disruptors monitor patients daily. Incumbents measure success by how quickly they can room a patient and turn over an exam room, while disruptors measure success by longitudinal health outcomes. The performance data from vertically integrated disruptors is striking. Optum reports its primary care practices achieve 33% more preventive cancer screenings, 23% fewer avoidable ER visits, and 30% lower hospitalizations compared to traditional hospital-based practices. Each Oak Street Health center is projected to generate $7 million in adjusted annual earnings—margins that traditional primary care clinics struggle to match.
As Dr. Kerzner notes, the current standard of care is becoming obsolete:
“Waiting every three months, four months, whatever the time interval—you see your doc and then everything happens there, and then you wait till the next one. It just doesn’t make sense. We can do so much better now.”
The Disruptor Shakeout: Lessons from 2024’s Failures
Before health system executives surrender to despair, however, they should examine why several high-profile disruptors failed spectacularly in 2024, and what those failures reveal about the durable advantages incumbents retain.
Walmart’s complete exit was the most dramatic collapse. On April 30, 2024, the world’s largest retailer announced closure of all 51 health centers and its MeMD telehealth platform, just weeks after announcing expansion to 75+ locations. Walmart’s official explanation cited a “challenging reimbursement environment and escalating operating costs,” but experts identified deeper structural issues. Dr. Zeev Neuwirth observed that when measuring revenue per square foot, “primary care does not cut it” for a retailer. Professor Robert Field at Drexel noted healthcare “is different from selling products, like toothpaste and breakfast cereal, and requires different kinds of expertise.”
Walgreens suffered even larger losses. The company closed 160 VillageMD clinics nearly triple the original 60 planned; recorded a $12.7 billion impairment charge, and saw full-year FY2024 operating losses reach $14.2 billion. CEO Tim Wentworth stated VillageMD is “not a crucial part of our future” a stunning admission given Walgreens invested over $6 billion in the venture.
Teladoc’s collapse illustrates virtual care’s profitability challenges without integration into broader care delivery. The stock has fallen 98% from its February 2021 peak, accompanied by a $790 million goodwill impairment, CEO departure, and multiple layoff rounds.
The common thread across these failures: companies lacking insurance integration struggled to make primary care economics work. As a Vizient, Inc analysis concluded, “Both Walmart and Walgreens lack a major component that can make a primary care business model more successful: neither owns an insurance company nor has real access to premium risk.” This distinction matters enormously. The disruptors that are succeeding: Optum, CVS/Oak Street, and to some extent Amazon, share vertical integration combining insurance risk-bearing with care delivery. Standalone retail health ventures cannot replicate these economics. For traditional health systems, this suggests the competitive threat is real but concentrated in a specific class of competitor, not a universal displacement.
The Bifurcation of Business Models: Acute vs. Ambulatory
Health systems must recognize that acute inpatient care and ambulatory services require two fundamentally different business models. A major error incumbents make is applying the same operational logic to a primary care clinic that they apply to an operating room. Dr. Kerzner emphasizes that hospitals are often excellent at acute care: managing the ICU, performing complex surgeries, and handling emergencies. This is high-stakes, episodic work that requires centralization. Ambulatory care, however, is evolving into a decentralized, continuous service that demands a different P&L approach and leadership mindset.
Many health systems have begun recognizing this reality. Northwell Health CEO Michael Dowlingnoted that “only about 46% of our business is from our hospital sector today. The more you expand ambulatory and grow in the right locations, the more you increase market share.” Health systems now account for 46% of medical office building leases and added 16,000 employed physicians between 2022 and 2023.
Major systems are investing accordingly. Hackensack Meridian Health committed $500 million to two dozen outpatient expansion projects. HCA Healthcare allocated approximately 25% of its $5+ billion capital budget to outpatient facilities. Sutter Health announced a $1 billion ambulatory expansion adding 27 ambulatory care sites, 27 urgent care centers, and 22 surgery centers. Joseph Cacchione MD CEO of Jefferson Healtharticulated the mindset shift required:
“We’ve got to get away from this idea of heads and beds and being a hospital system. That’s sick care. We need to truly be a health system.”
Incumbents that fail to separate these strategies risk losing their ambulatory volume to competitors who offer a superior user experience, leaving the hospital with only the highest-cost, highest-acuity cases without the supportive outpatient network. To succeed, executives must stop viewing ambulatory networks solely as feeder systems for the hospital and start viewing them as independent platforms for population health management.
The Strategic Pivot: Partnering with Disruptors
Rather than attempting to build competing proprietary technology stacks from scratch, incumbent systems should consider partnering with disruptors to handle specific segments of ambulatory care. This is a “buy vs. build” decision at the strategic level. If a startup has mastered virtual cardiology or remote diabetes management, an academic medical center might achieve better results by integrating that partner rather than trying to replicate their agility. The Amazon One Medical partnership model offers instructive lessons. Rather than positioning itself as a direct competitor to health systems, Amazon has established specialty care referral agreements with 19+ health systems including Cleveland Clinic, Duke Health, Baylor Scott & White, and Hartford HealthCare. The model treats One Medical as a primary care access point that feeds patients into traditional systems for complex care—co-opetition rather than pure disruption.
Early results are promising. Virginia Mason Franciscan Health’s partnership is yielding 350 net new patients monthly with minimal cannibalization. SVP Thomas Kruse described One Medical as a “growth engine” that increased Seattle primary care capacity by more than 25%. Hartford HealthCare operates three One Medical sites averaging 750 visits monthly across virtual and in-person care. Cleveland Clinic is opening hybrid primary care offices, with CEO Tom Mihaljevic calling it “a shared commitment to meet the needs of our patients.”
Dr. Kerzner suggests that mid-sized institutions and non-academic centers, in particular, should look to these partnerships as a lifeline. By offloading continuous monitoring and “low-end” disruption tasks to capable partners, the health system can double down on what it does best: complex acute care. Successful partnerships require defining excellence (identifying exactly where the health system struggles and finding a partner who excels there), avoiding ego (admitting that an external entity might provide better ambulatory experiences), and ensuring true integration so the partner becomes a seamless extension of the care team rather than just a vendor. Health Catalyst recommends an “80/20 approach”: partner for 80% of foundational digital capabilities, build 20% for differentiation. The average hospital now operates six patient apps simultaneously, creating integration complexity that favors platform consolidation over point-solution proliferation.
The Call for Leadership Courage
Modern healthcare executives must possess the courage to pursue a ten-year vision that may negatively impact financial performance for the first several years. This is perhaps the hardest pill to swallow for boards and C-suites beholden to quarterly or annual margins.
True transformation, moving from an episodic, fee-for-service-dependent hospital system to a continuous, value-driven health ecosystem is a long game. Dr. Kerzner estimates that this pivot could “hurt” for four to eight years before the vision fully matures. Leaders must be willing to weather the storm of initial investment and potential revenue dips to secure the institution’s relevance in the 2030s. Research on healthcare transformation reveals strikingly low success rates: only one in three top-down change efforts succeed versus four out of five collaborative approaches. McKinsey found 75% of health system executives report digital/AI investments falling short due to budget constraints and legacy systems, with only 13% having GenAI implementation plans established.
Successful transformations share common elements: clear strategic vision cascading from board to front line, early physician involvement in decision-making (cited by 47% of executives as the most effective tactic), integrated measurement dashboards providing comprehensive performance visibility, and governance structures that enable “generative thinking” rather than reactive oversight. The Chartis 2025 CEO/CSO survey reveals how executives are responding to competitive pressure. When asked how they would invest a hypothetical $1 billion, majorities prioritized expanding outpatient services and sites of care. The top challenge cited: physician recruitment reflecting both workforce constraints and the strategic imperative of building aligned ambulatory networks.
Conclusion: A Window of Opportunity, Not a Death Sentence
The competitive landscape between incumbents and disruptors has evolved beyond simple narratives. The evidence suggests traditional health systems face genuine competitive pressure but also possess durable advantages that retail and digital entrants have failed to replicate.The disruptor threat is real but concentrated. Vertically integrated payer-provider models (Optum, CVS/Oak Street) are gaining share, while standalone retail health ventures cannot make the economics work. By 2030, 30% of primary care may flow through nontraditional channels—but this leaves 70% with traditional systems that adapt effectively.
The incumbent moat has limits but substance. Complex care coordination, deep clinical networks, community trust, and payer relationships provide advantages that, as industry analysts note, “cannot be easily replicated by point solutions.” Health systems handling sicker, more complex patient populations perform functions disruptors have not demonstrated capacity to match. The strategic imperative is ambulatory expansion with digital integration. Health systems investing heavily in outpatient networks, partnering strategically with digital health companies, and building value-based care capabilities are positioning for a landscape where convenient primary care access determines downstream specialty and inpatient volumes.
Introduction
For many early-careerists, the Administrative Fellowship is viewed as a one-to-two-year crash course in hospital operations.1 But for Jeffrey Butler, it was the launching pad for a 17-year ascent to the top of one of the nation’s premier health systems. Starting as an Administrative Fellow at UCLA Health in 2008, Jeff has navigated the complex landscape of academic medicine to become the Chief of Operations for the Community Clinic Network, where he now oversees more than 280 clinics, 5,500 employees, and a budget exceeding $1.5 billion.
In this episode, we sit down with Jeff—now a dedicated preceptor himself—to discuss the evolution of healthcare leadership. We move beyond the resume to explore the mindset required to thrive in such a high-stakes environment. As Jeff reveals, the secret to longevity and innovation in healthcare isn’t just about mastering spreadsheets; it’s about maintaining a spirit of “continuous discovery” both inside the boardroom and out in the vibrant city of Los Angeles.
How does the location of a fellowship impact long-term career growth?
A dynamic city acts as a “secondary classroom,” preventing burnout and fostering the cultural agility required to lead diverse patient populations.
When choosing a fellowship, applicants often weigh prestige against geography. Jeff’s career trajectory proves that at UCLA, you don’t have to choose. The sheer variety of Los Angeles has kept him engaged for nearly two decades, fueling a career that has spanned everything from Radiation Oncology to the massive expansion of the Primary Care Network. Jeff emphasizes that the diversity of the environment is a critical tool for resilience. Even after 17 years, the capacity for surprise remains high, which mirrors the ever-changing nature of healthcare operations.
Cultural Immersion: Access to world-class museums and events keeps leaders intellectually stimulated.
Lifestyle Balance: The ability to take “day trips” to mountains or beaches offers vital decompression from high-pressure roles.
Professional Inspiration: Living in a city of innovation encourages leaders to think differently about care delivery.
Jeff notes, “My favorite thing is 17 years in, I am still discovering this city… It’s so interesting and so varied.” This sentiment is more than just appreciation for a city; it is the hallmark of a leader who refuses to stagnate.
Can a mindset of discovery lead to operational innovation?
Absolutely; leaders who actively explore their environment are more likely to pioneer innovative care models, such as retail clinics and integrated behavioral health services.
Jeff’s approach to his personal time—constantly seeking the unknown—directly correlates to his strategic successes. During his tenure, he has played a pivotal role in advancing innovative delivery models, including UCLA Health’s mall-based retail clinics and the expansion of mental health services through the Behavioral Health Associates program. These are not the ideas of a leader who stays inside the hospital walls:
When discussing his weekend plans, Jeff illustrates this enthusiasm for the unknown: “On Sunday night, I’m going this to this event at this museum with that I’ve never even heard of… I’m like, I, it’s amazing.”
For fellows, this is a crucial lesson. The transition from student to executive requires a willingness to venture into the unknown. Whether navigating a complex $1.5B budget or exploring a new neighborhood, the skill set is the same: curiosity, adaptability, and the confidence to say, “It’s so much to discover that you can never… fully know it, which I love about it.”
What is the unique value of the mentor-mentee relationship in this program?
A mentor who has “walked the path” provides invaluable context, bridging the gap between theoretical coursework and the political realities of a massive academic health system.
Jeff is uniquely positioned to mentor because he was in the fellow’s seat in 2008. He understands the pressure of the role and the intricacies of navigating a career at UCLA Health. Host Vrushangi Shah, MHA, reflects on this connection, noting, “I know that this, um, this episode is very special to me… being that you’re my mentor.” A mentor with Jeff’s experience helps the fellow:
See the Big Picture: Understanding how a single clinic decision fits into a system-wide ambulatory strategy.
Navigate Growth: Learning how to scale operations, as Jeff did when growing the Primary Care Networks.
Build Confidence: Providing a safe space to ask questions and fail forward.
Why is UCLA Health considered a premier destination for administrative fellows?
UCLA Health offers an unmatched combination of scale, prestige, and lifestyle, allowing fellows to train in a top-4 national health system without sacrificing personal well-being.
Candidates often fear that choosing a high-intensity fellowship means pausing their personal lives. Jeff argues that at UCLA, the environment supports the professional. The integration of a top-tier academic medical center within a world-class city creates a magnetic pull for top talent.
Jeff sums it up succinctly: “Absolutely LA and UCLA are the places to be.”
With a network that includes four hospitals and over 280 clinics, the operational playground for a fellow is vast.4 You might be working on a project for the Community Clinic Network one day and strategizing for Radiation Oncology the next. This scale, combined with the vibrant backdrop of Los Angeles, ensures that fellows are constantly growing, both as executives and as individuals.
Actionable Insight for Aspiring Healthcare Leaders:
Treat your curiosity as a professional asset. Jeff Butler didn’t become a Chief of Operations by doing the same thing every day. He embraced “continuous discovery.”
Next Step: In your current role or studies, identify one “museum you’ve never heard of”—metaphorically speaking. Is there a department, a technology, or a community partnership you know nothing about? Schedule a 30-minute coffee chat or site visit this week to learn about it. That habit of exploration is the seed of strategic innovation.
Welcome to Strategy of Health by the American Journal of Healthcare Strategy! In this episode, host Cole Lyons sits down with Dr. Matthew Montoya—professor of Systems Engineering at Johns Hopkins and veteran systems thinker—to discuss:
-What “systems engineering” really means in healthcare
-Dr. Montoya’s career path: from math and engineering to health systems and executive leadership at Johns Hopkins
-How systems thinking brings clarity to organizational chaos—and why that matters for patient
Angela Adams, RN, CEO of Inflo Health, joins the Strategy of Health podcast to share her journey from critical care nursing at Duke University Medical Center to founding a groundbreaking healthcare technology company. Angela discusses her experience in intensive care, her shift into medical-legal consulting and medical device startups, and how personal tragedy inspired her mission: solving the epidemic of missed radiology follow-ups in health systems.
She explains how Inflo Health leverages AI
In this episode of the Strategy of Health podcast, Cole Lyons from the American Journal of Healthcare Strategy engages in a conversation with Joe Vattamattam, co-founder and president of Healthmap Solutions, a company focused on improving outcomes for chronically sick populations, especially those with chronic kidney disease. Joe shares insights into the company's journey, the importance of changing human behavior, and how Healthmap Solutions uses a blend of advanced predictive analytics and cli
Discover how synthetic data is transforming the future of healthcare in this insightful episode featuring Dr. Trushar Dungarani, Director of Clinical and Data Science at MD Clone. Join host Zach McConnell as they dive into the core challenges clinicians face in accessing and utilizing high-quality patient care data—and how innovative solutions are helping bridge the gap between clinical teams, administrators, and data scientists.
Dr. Trushar Dungarani draws on his deep experience in hospital me
Most U.S. veterans receive their care in civilian hospitals—not the VA—and our systems are failing them.
In this insightful episode of the Clinicians in Leadership podcast, host Zach sits down with Ali Tayyeb PhD, RN, a U.S. Navy veteran, nurse, educator, and founder of RN Mentor Consulting. Drawing from his unique background in both military service and nursing leadership, Dr. Tayyeb explains how civilian healthcare systems routinely overlook the needs of veterans—many of whom are ineligible f
In this powerful and timely episode, we sit down with Rep. Arvind Venkat, emergency physician and Pennsylvania State Representative for the 30th Legislative District, to explore the growing need for healthcare professionals in political leadership. Drawing from his dual roles in medicine and policy, Rep. Venkat discusses why frontline clinicians are uniquely positioned to drive healthcare reform—especially in areas of access, affordability, and system-level accountability.
Topics include unioni
From navigating the transition from Wisconsin to Alabama for her MHA at UAB, to securing an internship at the Mayo Clinic, and now serving as a fellow at Apex Health Solutions in Houston, Mahee Patel shares an inspiring journey through healthcare administration and value-based care. In this episode of The Fellowship Review from the American Journal of Healthcare Strategy, host Vrushangi Shah explores Mahee’s decision-making process, the importance of cultural fit in graduate programs, and how st
What does it take to move from bedside nurse to tech innovator at one of the world’s largest healthcare technology firms? In this episode of the Clinicians in Leadership podcast, Catherine Robison, MBA, RN, shares her compelling journey from med-surg nursing to becoming Director of Healthcare Strategy at Oracle.
Drawing from her experience in nursing administration and innovation, Catherine dives into how frontline clinicians can bridge the gap between patient care and executive decision-making
00:00 Introduction and Welcome
00:50 Meet Trent Garrett
01:41 Graduate Experience at UAB
03:17 Internships and Early Career
07:49 Navigating Fellowship Applications
13:26 Michigan Medicine Fellowship Structure
16:19 Mentorship and Leadership Access
19:44 Highlight Projects and Experiences
23:22 Living in Ann Arbor
26:42 Final Advice and Reflections
Join Cole Lyons on the Strategy of Health podcast from The American Journal of Healthcare Strategy as he interviews Dr. Howard Shaps, Chief Medical Officer at Healthmap Solutions. Dr. Shaps shares lessons from his career in emergency medicine, health insurance, and consulting—and explains his transition to Healthmap Solutions.
They tackle the real-world complexity of chronic kidney disease (CKD), especially when combined with diabetes and hypertension, and discuss how Healthmap uses AI-driven r
In this episode of the American Journal of Healthcare Strategy Fellowship Review Podcast, host Vrushangi Shah interviews Rachel Gerhardt, MPH, a post-fellowship professional with an accomplished career in healthcare. Rachel shares her journey from starting her career at Boston Children’s Hospital to completing an MPH at Boston University, her fellowship at Johns Hopkins Medicine, and her subsequent roles at UPMC and Beth Israel Lahey Health. The discussion highlights the importance of being auth
We sit down with Gwendolyn Williams M.D., FHM—hospitalist and associate professor at Virginia Commonwealth University Health—to explore how clinicians can drive change and rebuild trust within healthcare organizations.
Dr. Williams shares candid insights from her decade-plus leadership journey, spanning roles as Chief of Medicine, president of a medical executive committee, and president of the Society of Hospital Medicine’s Hampton Roads chapter. Key topics include bridging the gap between cli
In this episode of The American Journal of Healthcare Strategy podcast, we sit down with Brandon J. Robertson, Founder and CEO of UCP Merchant Medicine and in Televisit Solutions, to explore how clinical concierge models and lean design principles are transforming urgent care delivery at scale.
Brandon shares how his team applied operational science—including queuing theory, the Theory of Constraints, and AI-driven clinical decision tools—to eliminate handoffs, slash visit times, and achieve an
Join host Cole as he sits down with Keeley White, Director of Community Health Programs at the Regional Food Bank of Oklahoma, to explore the real-world challenges and successes of bringing nutritious food directly to patients through innovative clinic partnerships.
Keeley White shares her unique journey from clinical dietitian to public health leader, offering firsthand perspectives on addressing rural barriers, transportation issues, and health equity for vulnerable populations. Listeners wil
On this episode of Clinicians and Leadership, host Zach sits down with Dr. David Wilcox—a DNP-prepared nurse, author, and health IT leader—to discuss innovative strategies for tackling clinician burnout, navigating the complex American healthcare system, and empowering both patients and staff. Drawing from decades of bedside and executive experience, Dr. Wilcox shares how his personal journey began as a teenage father advocating for his daughter in a broken system—and how that experience shaped
Discover how MultiCare saved $7.5 million on pharmacy costs through innovative supply chain strategy and data-driven leadership. In this episode, Cole from the American Journal of Healthcare Strategy interviews Tyson Frodin, VP of Clinical Pharmacy, Supply Chain, and Technology at MultiCare, for an in-depth discussion on transforming pharmacy operations in a large health system.
Tyson Frodin shares practical strategies for centralizing purchasing, leveraging pharmacy automation, and partnering
