Making Healthcare Access Truly Borderless w/ Dr. Sarah Matt, MD, MBA

Healthcare access is often treated as a technology problem, but the real barriers run much deeper. Geography, cost, culture, trust, and digital readiness all shape whether patients can actually get the care they need. Without addressing the system as a whole, even the most advanced tools risk leaving people behind.

Sarah Matt, Author of The Borderless Healthcare Revolution, joins the HealthBiz Podcast to discuss what it truly takes to break down geographic barriers in healthcare, why access must be designed into systems from the start, and how technology can support care without replacing the human connection at its core. 

🎙️⚕️ABOUT DR. SARAH MATT
Sarah Matt, MD, MBA, is a surgeon turned health technology strategist, author, and speaker. Her work focuses on how digital tools, from remote surgery to telemedicine to AI, can expand access to healthcare and eliminate the traditional boundaries that separate patients from care.

With over two decades of experience at the intersection of medicine and innovation, Dr. Matt has held leadership roles at Oracle Health, NextGen, and multiple health tech startups. She has designed and deployed systems that reach patients around the world, including hard-to-serve and underserved populations.

A practicing physician, Dr. Matt continues to treat patients in rural and charity-based settings, keeping her closely connected to the human side of healthcare access. She speaks widely at healthcare and technology conferences and has appeared on national panels about artificial intelligence, care delivery reform, and digital transformation.

A graduate of Cornell, SUNY Upstate Medical University, and UT Austin’s McCombs School of Business, she blends clinical acumen with deep technical knowledge to challenge the status quo and to reimagine what healthcare can look like when geography no longer dictates your care.

🎙️⚕️ABOUT HEALTH BIZ PODCAST
HealthBiz is a CareTalk podcast that delivers in-depth interviews on healthcare business, technology, and policy with entrepreneurs and CEOs. Host David E. Williams — president of the healthcare strategy consulting boutique Health Business Group — is also a board member, investor in private healthcare companies, and author of the Health Business Blog. Known for his strategic insights and sharp humor, David offers a refreshing break from the usual healthcare industry BS.

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Transcript

David: 0:00

Does digital health expand access or widen the gap? It depends. Not on the technology, but in how we use it. Hi everyone. I'm David Williams, president of Strategy consulting firm, health Business Group, and host of the Health Biz Podcast, where I interview top healthcare leaders about their lives and careers. Today I'm joined by Dr. Sarah Matt, surgeon, digital strategist and author of. The Borderless Healthcare Revolution, the Definitive Guide to Breaking Geographic Barriers through technology. She's worked at Oracle Health Next Gen and Startups. We're going to discuss how to make care borderless and what it takes to make technology serve people and not the other way around. Do you like this show? If so, please subscribe and leave a review. Dr. Matt, welcome to the Health of this podcast,

Dr. Sarah Matt: 0:51

David. Thanks for having me. Excited to be here.

David: 0:54

Sounds great. Well, you know, you were a surgeon first before moving into digital health, and I'm wondering, you know, why'd you make the leap and what's it like, you know, as a surgeon working in digital health as opposed to maybe a technologist that you, you may see around you?

Dr. Sarah Matt: 1:08

So I made the transition a long time ago, right after my training, which is unusual for most folks that are clinical. But what I'd say is that I actually felt rather confined at the bedside. You know, when you're taking care of patients every day, especially in a hospital setting, you can see maybe 20 patients a day, maybe 40 if you're really jumping through hoops hoop. But I really thought that I could make a bigger impact, and it wasn't at the bedside. How could I scale myself and be able to impact hundreds, thousands, millions? Billions of people every day.

David: 1:39

That sounds good. And do you have, would you say you have a different perspective than folks that came to it just from the technology side, perhaps without having had a clinical or certainly surgical background?

Dr. Sarah Matt: 1:50

I would say that, um, you know, I've worked with great, the major engineers and technologists over the years, and they're great at what they do. And I've also worked with folks that have been a hundred percent clinical and they're great at what they do too. But what I'd say is that being able to see both sides is a secret sauce that not many of us have. And so when you can actually translate properly between the realities of clinical practice, the realities of a healthcare system, not just as a patient, then you can understand what the true problems are, what solutions will work and won't work, and what the right questions are to ask.

David: 2:24

Now, I know that you stepped away from, uh, clinical practice for the most part, but I understand that you still practice perhaps. Part-time in certain settings, charitable rural settings, and I'm wondering if that's the case and how does that continued hands-on work influence how you're designing or evaluating technologies these days?

Dr. Sarah Matt: 2:42

Yeah, so throughout my career, while surgery is on or off, you can only really do it or not because it's a volume practice. Um, I've always done charity medicine, internal medicine, or urgent care. And so I still do charity internal medicine here in upstate New York, and I work at a free clinic. Several times a month seeing poor whites in the middle of the opioid crisis, migrant workers, Amish, you name it. And so it's a free clinic, which is interesting because I essentially get to do third world medicine and I get to work on paper, which is also an interesting experience as well. And what I'd say is that I think that especially on the tech side, we forget how different the rest of the world is, even if they're our neighbors. And so I think it keeps me humble and it keeps me grounded for sure.

David: 3:27

I have a lot of insights in your new book and perhaps you brought them from before. And I just wanna, maybe we'll pick on a couple of them, uh, throughout the course of this interview. But one of the things that you say is that access is a system, not a widget. And I'm wondering what do you mean by that and what are the implications?

Dr. Sarah Matt: 3:44

So I do a lot of startup advising and I can't tell you how every day I have a new founder telling me about their new amazing AI solution for healthcare, and their expertise is really a hundred percent clinical. They haven't really done the homework, unfortunately, into the system to ask those questions like I mentioned before. And what I'd say is that I don't care how amazing your one tool is, we have a system that we have to work within. And so when we think about. The realities of today. Whatever tools we're bringing to that have to solve an urgent, pervasive problem, first of all, and they can't solve it in some way that's not gonna work with the existing system. So until we take that system, which is unfortunately working as designed perfectly, and continue to change it and mold it over the course of time, anything that we bring into it, any tools we make, any other solutions we're bringing into the system, they have to work with what we have today. Otherwise, they're a little bit too far fetched in a lot of. You know, scenarios and they're not gonna get the adoption that you're hoping for.

David: 4:50

So another one you talk about is that the five pillar framework for healthcare access. And I wonder what that is and what makes it different. And the first thing before I let you answer that, that I noticed is that, you know, we need like really strong, robust frameworks in healthcare. And I thought, you know, like five pillars is probably about enough. You know, like two or three is not enough. Normally people might have four, but it's like, yeah, five, you know, for extra. But what, what is it and, and, and what does it do for us?

Dr. Sarah Matt: 5:15

I think this is the first time I've considered my five pillars, maybe a five pillar knuckle sandwich for access. But when you think about it, you know, especially having worked at Oracle and some of the largest tech companies in the world. It's funny because when I was working at the top levels, oftentimes we'd hear, oh, well, the technology's the easy part, because that was a core competency at that tech company. And I actually think that's the case too when it comes to healthcare and when we think about why it's hard to get patients the care they need, why it's hard to understand healthcare, why it's hard to get our children, our parents, et cetera, into the places and specialists they need. I break it down into not just oh, tech with a tool. I break it into the five pillars like you mentioned. And so to me that's geography, financial, cultural, digital, of course, just like we were talking about. And then trusted knowledge. And if we're having a problem in the healthcare system, often one of those barriers, at least one of those barriers is the reason why we're having a hard time with adoption, a hard time with, um, one of the areas here. Whether it's bringing patients to care, whether it's bringing providers to care, um, whatever that. Issue may be

David: 6:25

so as I mentioned upfront in the, in the start of the episode, you know, digital health, it can close the access gap, but it's not automatic. And, and I could widen it, um, as well. I think it's easy to point to, Hey, this is great. You know, you can bridge the divide, et cetera. But can you provide maybe an, an example of where digital health is doing what we might hope it would do in terms of closing that gap, but also where it actually may inadvertently, inadvertently widen it.

Dr. Sarah Matt: 6:50

So you'll notice that of the five pillars, one of the barriers I bring up is digital. So it's absolutely a solution, but also a true barrier. So when COVID hit, you know, we've all made that big change to telemedicine, virtual visits, you name it. And so if we think about the. I'd say the privileges for those of us who have health insurance to see a provider like this, just basically on Zoom. Um, that's great. I don't have to leave my office. My kids can see a doctor in between, whatever. But imagine that your cell phone didn't have a lot of data. Imagine that your internet was not so great. Um, so when you think about the amazing tools that are being brought to bear. Do they work in low tech areas? Are they in the languages of people that need to use them? Are they at the reading levels of folks who are gonna use them? And so while we might have the most amazing solutions, who are they leaving behind? Maybe they're not leaving you and I behind, but maybe they're leaving specific populations behind because the technology they have today doesn't. Meet the basic requirements of what's necessary to use that amazing tech.

David: 8:04

So another thing that you talk about is the digital divide becoming the new waiting room. I think I have an idea of what you mean, but, uh, where that, where do you come up with these things, first of all, and, uh, what does this one mean specifically?

Dr. Sarah Matt: 8:17

Well, I have no idea where I come up with them, at least it's not another Taco Pun, because those are usually my, my go-to. But what I'd say is that right now. A lot of the solutions are being put in place for patient engagement for, you know, how are we gonna reach this next population? They tend to be digital by default. Um, what I'd suggest is that in a lot of places all over the world, there's some very non-sexy ways to engage patients and. Unfortunately, if you're stuck in what I call that digital waiting room, um, you may have those barriers like we mentioned before, um, or you may have others. And so you're stuck there because the system unfortunately has probably decided it provided a solution. Why aren't you using it? And they've washed their hands clean of it. And unfortunately that's where I think we end up in that waiting space for lots of different patients.

David: 9:14

You mentioned that when you were at Oracle you talked about how technology was the easy part. I don't think it's that easy, but maybe they've got it covered. Um, but I'm curious what you learned there, going beyond that, about creating a sustainable digital models, not just something that's kind of a whizzbang to show at a conference.

Dr. Sarah Matt: 9:33

So I worked with lots of great engineers over my career, but I think that when I was especially. OCI and after we acquired Cerner, working with some of the most topnotch engineering staff, um, in the world was a great opportunity for me. And the reason I say tongue in cheek, that the technology is, the easy part, is that if you and I could dream it, someone can build it. And the way that we're moving forward from a technical perspective, whether it's ai, remote, patient monitoring, you name it. That part is on a fast track to daily improvement. Um, I used to be able to make plans for 10 years from now. Now six months seems like a long time, as an example, but no matter how fast we're improving these technical pieces. Like I mentioned earlier, the reason the tech is the easy part is 'cause once you actually have to adopt this and implement it into a hospital system, bring it into someone's actual home, use it every day and make sure this wearable is gonna work for someone. Or figure out how on earth you're gonna get a therapeutic be used by anyone four times a day. That's where it becomes really messy, and I'd suggest that the messiness of. Unfortunately, our clinical reality is why things are so difficult, and trust is a big part of that right now. Sometimes the technology is accelerating so fast that hospital administrators, providers, patients, consumers, they may not understand it enough to automatically say, oh yeah, let's do that. And so we ultimately have to build that trust now as a foundation before we can even get into their hands.

David: 11:11

So, as you say, trust is a big deal, and I see it in healthcare, but also just more generally, uh, in society, there's a real, uh, awareness of that and it's a real, you know, it's a real concern. So are there specific things that either the, on the technology side, the developers can do or the healthcare providers can do to make the digital care feel personal and reliable and, and therefore trustworthy?

Dr. Sarah Matt: 11:36

So I think that everyone is a patient at some point in their life, and when we consider how we could get our care, everyone has their preferences. So there's gonna be a spectrum no matter what. But I think universally, when people go and see a provider, they're expecting a attention listening. Response information and understanding. And so if you are able to have that authentic experience, whether it's a gazillion miles away via virtual visit, whether it's right here in front of me, um, it depends on how you can meet those needs of that interaction. So what I'd say is that the tools can sometimes get in the way.

David: 12:19

So if we put trust aside, that's a hard one. Another hard one is cost. And I think healthcare costs are going up, you know, like crazy. Uh, we're in a period right now where, you know, nevermind whether there's a CA subsidies or not for next year, costs are just going way up for privately insured for everybody, and digital health has become a bigger factor. So is digital health helping to drive those costs up? Is it constraining them or is it, like we said, with access before, it could go either direction.

Dr. Sarah Matt: 12:48

I, I'm a firm believer that I can go in either direction. Um, some of the digital tools that we're putting in place can allow for more automation for our providers, administrators, et cetera, to work at the top of their license and therefore have some of those mundane tasks that they're taking a lot of time doing. Being done in a fashion, whether it's AI automation or by lower level providers. And I think that's helpful for the system. Um, one of the things that's a big problem, not just on the technology side, is that we have a shortage of nurses. We have a shortage of doctors. We can't seem to make them fast enough, and it's a very difficult profession. And so as we move forward. I think that the digital tools we're bringing to bear will help extend the existing staff. It will help extend the knowledge base of those coming through the ranks. But we're gonna have to find new ways to retain the people that we have in the healthcare system so that they don't decide to go into a different industry, decide to retire early, decide from the get go that healthcare is not even worth entering. And so how can we make this profession? Not just better for patients, but better for the workforce, the providers, the people working in a hospital, nurses, all of them.

David: 14:05

So what do you see in terms of people working alongside some technologies like AI and also robotics, uh, in care delivery? Is that something we should be enthusiastic about or is it, is it scary?

Dr. Sarah Matt: 14:18

For me, it's exciting, but at the same time, I've been building my whole career. So I've been seeing this come to bear over several years. So I don't think, for me it's scary. It's a calculated risk and ultimately, if you understand what we're. Taking data from what we're doing with it, how it's going to improve things. It has built trust with me in certain circumstances. What I'd say for patients and for providers for that matter, is that ultimately a lot of the AI is not what I'd call explainable. Um, there's a lot of black boxes and if you're a provider putting your license on the line to take care of patients, ultimately you're gonna wanna know where those tools are coming from, how they're being utilized, and. Where your liability starts and ends, and as a patient, you're gonna want information and we need to show patients that there's value in their data, but by giving us their data, they gain value from it. As an example, I give Google Maps my information all the time. I'm sure you do too. And I find value in giving them that data. On the healthcare side, I don't think we've been providing true value to patients by utilizing their data just yet.

David: 15:29

You know, you mentioned a, a black box, um, from some of the earlier times when AI is starting to be used, there's an awareness that some of the training data is coming from. You know, from bias data sets. And then, so on the one hand you may naively, naively go and say, Hey, we're gonna get rid of bias because, you know, the, the AI could be objective in a way that maybe humans can't. But they say, well, wait a minute, how did the ais learn? And you could actually potentially echo in the AI world, what's in the real world, or even entrench. Even further, where are we? How big of a problem is that, uh, algorithmic bias? And are we doing anything to correct it or make it worse

Dr. Sarah Matt: 16:09

right now? One of the things I think is interesting is that by creating these algorithms, we're finding our existing biases within the system. That data that's been collected has probably been collected in a fashion that maybe wasn't the best in the first place, but it was taken as you know. This is our, our central database. This is great. We've done this. Um, but people are biased. Systems are biased. Processes are biased. I think right now, because of the ability of these new technologies to use so much information and do it so quickly and change and evolve so quickly, folks are getting a little bit more, I'd say, anxious about the fact that. They can't put their finger on how it's done. They can't put their finger on all the training data. What I'd suggest is that most of the data we've probably collected over the course of, you know, we'll say US history in terms of healthcare, has probably been taken in fashions that weren't ideal. And so if we can identify why things might be swayed one way or the other. I think that's a great first start because it shows a switch. Population should be included now that we know that they aren't, or that perhaps scoring or other diagnostics are not working well for specific populations. So what are we using these for? Who are they working for best? What populations perhaps we need more data on, and let's work to fill that gap.

David: 17:34

You mentioned a little earlier on that everyone's a patient at some point, and I, I saw from your bio, I think you once, uh, broke your leg. Something about a roller derby or something like that and where a patient is at. Do I have my, a little birdie told me that. Is that, is that accurate? Uh, what happened and how does that affect, you know, how you look at the system?

Dr. Sarah Matt: 17:51

It is accurate. So I do play roller derby and earlier this year I had a spiral T fib and I broke it playing roller derby. Um, and. It's interesting being a patient and doctors are pretty much the worst patients ever. So I had this, you know, terrible multi bone fracture and it was a Sunday night when I had practice and had this break and I literally had my husband pick me up and I said, I am not going to the emergency room. Give me a couple Tylenol and we will deal with this tomorrow. He said, why aren't we gonna go now? I literally told him, I know the system and I know that the emergency room is not gonna get us what we need and we'll be there all night. And so the next morning I literally called up my mother and had her bring me to the ortho urgent, you know, walk-in clinic, um, that's nearby and got everything taken care of. And the PA said, are you serious? This happened last night. We have 300 pound grown men have this injury and pass out. What are you doing? And I said, well, I knew that if I got here. It would be treated appropriately and I'd get what I needed. I probably wouldn't have gotten that if I went to the emergency room. And unfortunately, even I have a hard time dealing with the healthcare system and I'm in it. I'm creating it. I'm contributing to it. And the fact that even with all that knowledge, accessing the things that I need is so difficult, really shows that anyone who's not in that healthcare system, who is not in it. Navigating all the time, it's gotta be absolutely impossible instead of almost impossible, which for patients in the US is not a great place to be.

David: 19:29

So, Sarah, you've got a new book coming out now. It's the Borderless Healthcare Revolution. And I'm wondering, um, kind of what went into it and then what reaction you already getting or what you're expecting, uh, as it as it makes its way out into the public.

Dr. Sarah Matt: 19:45

As I created this book, I really wanted to bring people together. We mentioned already that everyone has a terrible access story, so no matter where you come from, no matter how you grew up, or what your situation is today. I could ask you about your parents, your kids, your friends, yourself, and we all have an access story that has not been ideal, and I think that's one of the things we can all come together on today in such a polarizing time. So my book, I wanted to be a well researched but not a textbook, and I wanted to have real stories so that it was. Accessible, if you will, for readers. And so I did tons of interviews from executive patients, providers, you name it all across the system. And then I did a ton of great research, and so I put this all together and really crafted this book as a way to aim at. Leaders in healthcare delivery on how everyone from the C-suite down to the lead nurse on the floor can improve access today, whether it's via KPIs, changes in patient care, you name it. But then also my entire career has been in building and creating, and so how can we build in access from the get go? And so I'm really talking to those creators, builders, founders, you name it, who. Are now in the space and making these solutions. Um, to me, access is foundational and it's gonna be really great for your business and almost imperative. So I brought those two worlds together and so far I've had a lot of great reaction to it. It's been interesting to touch both delivery systems, academic organizations, technology companies, because everyone recognizes that healthcare access is a huge issue. They don't all know how to hit it hard, and because things are changing so fast in the economy politically and from a tech perspective, they're looking for ways. To look at a different fashion. I think this is that way.

David: 21:39

Well, that's it for yet another episode of the Health Business Podcast. I'm your host, David Williams, president of Health Business Group, here with Dr. Sarah Matt, author of the Borderless Healthcare Revolution. If you like what you heard, please subscribe on your favorite service. And Sarah, thanks so much for joining me. Thanks, Dave. Did.