In the fall of 2004, everything changed. I became a father for the first time. I had completed four years as a practicing primary care doctor at Kaiser Permanente in Northern California in the Department of Adult Medicine. I had my first op-ed piece published – “How to make your health insurance count as if your life depended on it” – as I was working hard on a book educating patients on how to navigate the health care system. More than once, the health care system failed to provide the care we would expect and that I would have been completely oblivious to had I not been a doctor, and the only doctor in my family.
Though the book was ultimately self-published, a few other op-ed pieces followed. The blog posts (does anyone remember Blogger?) I wrote over the years have been forgotten. It was this foray into making the health care system and the care provided more accessible and of higher quality, so everyone could get what they needed, that became my life mission. Their care should not be a consequence of whether they knew a doctor, their zip code, or their education. Through all of those writings and introspections, I have developed a sharper focus on what needs to happen, something I could not have envisioned two decades earlier.
As we end 2024, and as I reflect on how change has been slow and uneven, my values and perspectives have remained the same. Although the titles of the blog posts may not have aged well as they were written between 2011 and 2019, the core principles remain consistent.
Vision of what is possible is vital
Having a vision of what the future should look like is critical to creating the world we want to see. It became apparent that organizations like Apple, which valued providing a seamless experience for something that could be complicated, were something to strive for. Patients want hassle-free, worry-free care that saves them time and money. They should not have to navigate fragmented systems or endure bureaucratic hurdles only to find out their care and coverage are not adequate.
We need to ask ourselves if the “Iron Triangle,” where we can only optimize for two of these three elements: quality, access, and cost, applies to health care. Other industries seem to innovate and bend this triangle. What insights might we have? While virtual-first platforms, like those I’ve worked with, show us that technology can simplify care while expanding access and maintaining quality, this is just the beginning. With the introduction of generative AI, a vision of a patient-centered system—one not dictated by geography or privilege—is achievable if we dare to imagine it.
Teamwork in health care matters
One of the most profound lessons from my time at Kaiser Permanente is the power of teamwork. I witnessed firsthand the potential of physician-led groups, enabled by technology and united around a common purpose, accomplishing extraordinary things. Health care, like any successful system, requires collaboration across disciplines. It thrives when everyone—clinicians, software engineers, product designers, and AI specialists—works together with shared goals.
Teamwork is what transforms fragmented care into a coordinated system. I talked about how the most effective and impactful health care organizations might resemble high-performing teams like the New England Patriots (when they were consistently excellent for decades), where each member understands their role and works toward collective success. Solving the challenges in American health care requires this same spirit of collaboration and common purpose, where expertise across diverse fields converges to address inefficiencies and improve patient outcomes—and then does it again.
Importance of leadership
Leadership is often needed to turn a vision into reality. In an increasingly VUCA world (volatile, uncertain, complex, and ambiguous), having thoughtful leaders matters. I believe physician health care leaders are uniquely positioned for these roles because of their deep understanding of patient care. What many find challenging is that for health care, it requires even more than excellent clinical expertise. It requires strategic thinking and the courage to advocate for necessary change in a way that many have not been trained to do. That being said, throughout my career, I have seen how physician leaders can holistically grapple with the goals of clinical care and operational excellence. Embracing the business school teachings of psychological safety, removal of unnecessary friction, and a focus on “jobs to be done”—and doing so at scale—will be critical. Without strong leaders, change will remain incremental and insufficient.
Use of technology to improve service, quality, and personalization
Technology has the potential to transform health care, but only if it is applied thoughtfully. The digitization of health care—coupled with advancements in AI—can make care more accessible, personalized, and efficient. However, we must ask the right questions: “What is the job to be done?” Technology is not an end in itself but a means to remove barriers and empower both patients and clinicians.
Electronic medical records are one example of how technology, when used wisely, can enhance care by improving coordination and access to information. Yet, the gap between promise and reality has not been closed. Virtual care platforms, like those I helped create, demonstrate what’s possible in how technology can deliver fast, convenient, and high-quality care. The goal is not just to modernize workflows but to reimagine health care as an intuitive, patient-centered experience.
Looking ahead
As I reflect on two decades of work, the pace of change in health care remains frustratingly slow. Yet, the principles that emerged in those early years—bold vision, teamwork, leadership, and thoughtful technology—continue to guide me. They are the foundation for building a system where care is accessible to all, no matter their circumstances. As we approach 2025, I wonder: Will the next five to ten years bring the transformation we have long sought? I am cautiously optimistic. We seem closer than ever.
Davis Liu is a family physician.
