Microdosing

The US healthcare system is privatized and built around a capitalist model. Within that framework, one flaw stands out: unlike nearly every other high-performing health system in the world, the United States lacks a true backbone. There is no layer that reliably guides people, connects decisions over time, or helps them confidently take the next step. The solution is the backbone it never built, and that backbone is primary care.

Healthcare does not lack workers; it lacks a work model capable of supporting them. Modern care assumed infinite elasticity from clinicians, but that model has reached its limit. What comes next is not incremental change; it is reconfiguration: team-based, patient-centered, digitally enabled, and economically aligned with value. When the work is redesigned, the workforce stabilizes. This necessary reconfiguration is not a trend; it is an inescapable reality.

The complexity of the U.S. healthcare system is magnified by inconsistent, fragmented naming of care locations. Terms such as hospital, medical center, and institute may appear interchangeable, but in practice they introduce confusion, increase the risk of surprise billing, and fuel costly administrative errors. 

Every healthcare organization operates within a web ofoverlapping experience maps, including clinical, administrative, payer, patient, and policy maps. These maps shape every decision, workflow, and outcome. In healthcare, a customer experience (CX) map traces the steps, systems, and emotions that patients, clinicians, and staff move through as care is delivered and supported. Each map makes sense on its own, but the real complexity begins where they overlap. Most improvement efforts focus on a single map, yet few consider how these maps interact or depend on one another.

Every industry has a process that looks small on paper butshapes everything around it. In healthcare, that process is priorauthorization. It is the quiet monster that hides between doctors, payers, and patients, invisible to most until it strikes. When it does, it does not just delay care; it unravels trust, burns out staff, and corrodes the very idea of a coordinated patient journey.

Hospitals were once the epicenter of healthcare food service. One kitchen fed thousands, one cafeteria served everyone from physicians to visitors, and one model defined the experience. That era is ending.As care moves beyond the hospital walls into outpatient clinics, ambulatory centers, imaging hubs, and patients’ homes, food service needs to move with it. What once was a static operation is becoming a dynamic, distributed network designed to keep up with an always-on health system.

For years, the story of American healthcare has read like an obituary for small, independent medical practices. Faced with shrinking reimbursements, staffing shortages, and rising administrative burden, many physicians traded autonomy for stability, selling to health systems or private equity. Yet beneath the consolidation headlines, a quiet rebellion is taking shape. Across the country, small specialty and multi-site practices are not only surviving but posting strong margins. They’re lean, tech-forward, and operationally disciplined, proving that small can be powerful when run like a high-performing business.

All around you, Healthcare leadership continues to lean on familiar solutions: more education, more empowerment, more reminders to improve adherence. It sounds polite,nonthreatening, and promising. But it’s also a comfortable excuse that obscures a deeper, systemic failure. Because the truth is: medication adherence—our most basic measure of patient engagement—remains stubbornly low. Despite decades of well-meaning interventions, the problem persists. This isn’t a patient failure. It’s a system failure. 

Modern Primary Care Diagnostic Sequences; Why the Future of Care Hinges on Faster, Smarter Diagnostics. Traditionally, and still in many practices today, some of the most important parts of a primary care visit happen after the patient leaves the exam room. Diagnosis is often delayed, follow-up decisions are disconnected from the visit itself, and early opportunities for intervention can be missed. The diagnostic sequence may be the least celebrated yet the most essential part of a primary care visit. Whether it’s a healthy 25 year old seeking reassurance or a 45 year old at risk for diabetes, the pattern is the same: see the doctor, get the labs, wait for results, then discuss what it all means. This four step routine isn’t just tradition, it’s the structure payers recognize, the basis on which health system workflows are built, and the process clinicians rely on to deliver care.

As demand for GLP-1 drugs like Ozempic and Wegovy soars, a parallel market for compounded versions has emerged — one that’s largely unregulated and increasingly risky. This episode examines how gaps in oversight, aggressive marketing, and blurred lines between compounding and manufacturing expose patients to safety concerns and strain the health system. We explore why compounded GLP-1s are more than a niche issue, highlighting how they fit a recurring pattern where regulation lags behind fast-moving markets.