Who Benefits from a Broken System?

Matthew Holt on the Healthcare Status Quo, Data Access, and the Power Struggle Behind Digital Health

“If you want to change the system, you have to change who benefits.”

That was one of the first things Matthew Holt said in our conversation—and he didn’t back down from it once. A longtime media pioneer and vocal advocate for reform, Matthew has spent the last 30 years creating platforms that spotlight the people, policies, and technologies shaping the future of healthcare.

We talked about misaligned incentives, the politics of data access, and why the next generation of health tech needs to stop repeating the same policy mistakes. Below are some of the biggest insights from our discussion.

[00:00:00] Healthcare Is Doing Exactly What It Was Built to Do

Matthew didn’t hesitate when I asked what he thought the biggest issue in American healthcare was.

“The wrong people are benefiting, and the money’s in the wrong place.”

Hospitals profit more when people are sick. Health plans spend more on administration than care. And the result is a system where meaningful innovation is often either co-opted or sidelined.

What makes Matthew’s perspective so urgent is that he doesn’t see these as failures—they’re features of a deliberately designed structure. If you want to disrupt that, it’s not just about building new tech. It’s about changing who profits when people get better.

[00:02:17] The Early Days of Health Tech Media

Before "digital health" became a billion-dollar category, Matthew launched The Health Care Blog, followed by Health 2.0—two outlets that would go on to define the public conversation around healthcare and technology.

What started as a community for open discussion became a stage for some of the first companies pitching cloud-based EHRs, consumer apps, and care delivery innovations. Eventually, Health 2.0 was acquired by HIMSS.

“It got so big it became hard to bite off,” Matthew said. “But the goal was always the same—bring people together and force the conversation to happen.”

[00:05:48] “Digital Health” Isn’t About Doctors and EMRs Anymore

One of Matthew’s main critiques is that we keep misusing the term “digital health.” Most of the time, it’s not about improving traditional medical workflows.

“Digital health is everything that isn’t medicine. It’s about communication, monitoring, logistics, data exchange. That’s where real opportunity lies.”

Too many startups are still pitching themselves as EHR replacements or doctor productivity tools. Meanwhile, the real future may lie in ambient monitoring, AI-based logistics, or patient-centric behavioral tools—things that reshape care from the edges inward.

[00:09:31] The Real Fight Over Data Access Is Just Getting Started

We dug into the lawsuit between Particle Health and Epic—an important case about who gets access to health data and under what terms.

Matthew’s position is clear:

“We need to open up the data. We should prosecute people who abuse it, not block people from using it.”

He believes we’re missing out on transformative opportunities—like smarter clinical trial recruitment, population-level analysis, and truly personalized care—because we’re still stuck in fear-based policy modes. And the system rewards incumbents for keeping it that way.

[00:16:10] Hope at the Edges: Remote Monitoring, SMACK, and AI

Matthew coined the term SMACK—Social, Mobile, Analytics, Cloud, and Kindness—as a counterpoint to clunky enterprise IT.

That’s where he sees the greatest promise today: – Remote monitoring of chronic disease – AI tools that can support triage and translation – Platforms that integrate social and behavioral insights with medical data

But these tools only work if the system adopts them with intent. Right now, we’re still retrofitting innovation into a legacy reimbursement and regulatory model—and it's not sustainable.

[00:23:24] Two Futures for Federal Health Tech

When I asked what he sees for the future of federal innovation, Matthew described two competing trends:

1. A future where AI tools accelerate trials, care delivery, and health system responsiveness

2. A reactive future where regulation becomes overly cautious, innovation slows, and public trust erodes

“I don’t know which one will win. I know which one I hope wins.”

Which way we go depends on how boldly policymakers act—and whether they’re willing to build regulatory frameworks that incentivize openness, safety, and collaboration over control.

[00:27:00] Final Thoughts: If You’re Building in Health Tech, Ask Bigger Questions

I often close each episode by asking what my guests would change if they had a magic wand.

Matthew’s answer was practical: put patients at the center of access, open up the data, and let innovation follow where it’s needed most.

“We’re not going to fix everything overnight. But if we make the system just 10% better, that’s still a massive win for millions of people.”

🎧Listen to the full episode with Matthew Holt on Inside MedTech Innovation: Open on Spotify

This content was repurposed from the original podcast discussion by a genAI prompt.