January 20, 2026: Dr. Sarah Matt, Healthcare strategist and national best-selling author of “The Borderless Healthcare Revolution," joins Sarah Richardson to explore how business becomes the common language for nonpartisan healthcare progress. Dr. Matt shares why America's multi-payer system works exactly as designed, and why that's the problem. From roller derby injuries to rural fire departments, her unconventional portfolio keeps her grounded in the real-world challenges of healthcare delivery while building technology solutions that actually serve people.

Key Points:

• 00:33 Dr. Sarah Matt's Book
• 04:22 Redesigning Healthcare Systems
• 19:11 Building Resilient Teams and Embracing Chaos
• 26:01 Balancing Personal and Professional Life
• 37:18 Final Thoughts and Takeaways

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Flourish: The Healthcare System Isn't Broken, It's Just Not for Patients - with Dr. Sarah Matt

GMT20250714-172930_Recording: I'm Sarah Richardson, a principal here at this week Health where our mission is healthcare transformation powered by community. Welcome to Flourish, where we share the human stories behind healthcare leadership because thriving people build thriving systems.

Let's begin

Sarah Richardson: Welcome back to Flourish. Today's guest defies boundaries. Dr. Sarah Matt is a physician, technologist, volunteer firefighter, mother of four, and a roller derby competitor who embraces her inner chaos goblin.

Her new book, the Borderless Healthcare Revolution, is a field guide for building access driven systems where technology, design, trust, and execution work together to serve people, not the other way around. In this conversation, we're gonna look at how business becomes a common language for nonpartisan progress and why the system we built works as designed, and that's what part of the problem is and how we make access profitable, equitable, and scalable.

Sarah Matt: Thank you. Happy New Year's you two.

Sarah Richardson: Before we jump into the questions, I just have to ask. How much traction the book is getting, how excited people are to hear this story. And my goodness, everything that went into getting there, you gotta be really happy that it's resonating with so many people.

Sarah Matt: It's been a wonderful experience and. Like we mentioned before on some of our previous calls, the response has been absolutely amazing. It's not just folks in healthcare delivery, but technology innovation strategy. You know, this is not just for folks in hospitals, it's for people who are building in this market, and the best market to be in right now is healthcare life sciences.

Sarah Richardson: Well, and you said you wrote the book because you couldn't stop seeing the gap between what healthcare could be and what it still is. What was the moment when you knew you actually had to write the book?

Sarah Matt: I'd say that. Maybe December 24. You know, we were in a very polarized time that was very palpable at that point.

And healthcare access is just that. It doesn't matter where you come from or who you are. Everyone is struggling with access to healthcare, and that was the time when I decided we have to do something, and that's why this book came to fruition.

Sarah Richardson: Well, and you've worked in so many settings. You've been in operating rooms, free clinics, startup war rooms, and big tech.

How do those vantage points shape your definition of what access actually means?

And a lot of folks make those decisions in boardrooms, and I've seen that happen. A lot of folks do proper product management and actually speak to the people who are gonna be using and buying the solutions. And to me, that has made all the difference. So whether you are a patient, whether you're a builder, it's all about actually solving those pervasive and urgent problems that.

Aren't going anywhere. They need to be solved. So I think that's where, for me, it's really about kind of bringing those two worlds together.

Sarah Richardson: You have so many identities, which I love. Surgeon strategist, firefighter mom, derby, skater. I love that one. How do those roles influence how you lead through both chaos and care?

And so for me it's about. Bringing those teams along, building them, creating, and then not just putting a finger in a dike when it comes to solving problems, but actually digging in and figuring out how we can solve it best,

Sarah Richardson: except that the system we built is failing. I mean, you've said in several conversations we've had that.

It's working exactly as designed and therein lies the problem. Where does the design breakdown most for patients and clinicians?

Sarah Matt: There There's so many ways I could answer that, Sarah, and I don't think we have time for that today. But what I will say is that, you know, we are. A healthcare sector that is based on reimbursement.

And reimbursement is done. It impacts every single part of healthcare. So nothing can be serviced or produced without that in mind. So it's working exactly as intended for a multi-payer system. You'll see around the world in different countries, as an example, where their systems are more single payer esque.

Their system works differently. They have different priorities. People are incentivized in different ways, and their healthcare system works in a different flow. So our system is built in this multi-payer space, and unfortunately, or fortunately, depending on who you are at the moment, that's working.

What does that signal about medicine today?

Sarah Matt: A lot of people going into the healthcare professions are determining that maybe bedside care is not the best. Suggestion for them. What I've seen is I teach med students right now, it's in the upstate where I am, and I'm actually seeing lots of med students come into their first year having already gotten a master's degree or two.

And I think that's really them trying to decide which part of medicine do I wanna be a part of? Do I wanna be in straight public health? Do I wanna be in straight administration? Or do I wanna go and be an actual doctor? The students I teach have decided to go the doctor route. I think others will reach residency, understand what it's then like to be an actual provider day in and day out.

Sarah Richardson: No. But if we were to redesign it from the ground up, what are the first two constraints you'd remove or rewire?

Sarah Matt: That's an interesting thought process right there. Two things I would remove. First, I'd remove the financial barrier to all of it. So right now, when we think about the reasons people don't get care, a lot of it has to do with cost.

When you think about the people that are going into the medical professions, nursing, medical assistant, pharmacist, you name it, the amount of money they have to put in and self-fund to get that education is also. Astronomical. Now, back in the eighties, it seemed like a good deal because doctors were, you know, well compensated, et cetera.

Easier. How can we make it easier for patients to get the care, prescriptions, medical equipment, et cetera, that they need easier? If I could take that financial barrier away from all of it, that's what I would do.

Sarah Richardson: So if access was treated as a growth strategy, what would be some of the near term ROI that leaders could expect?

Would it be. Reduced of WHI utilization, earlier intervention, workforce productivity, what would that actual business case look like?

Sarah Matt: There's so many ways you could measure it, and I think that's the trick is right now we measure healthcare in different ways. Oh, length of stay, oh, how many times people were treated.

They would've been taken care of from a preventative perspective. We would have less people with certain diseases 'cause they would've been vaccinated in the first place. So if we think about today, we have all these emergencies. That are not just from traumatic car accidents and other accidents. Instead we have emergencies of chronic health.

Those chronic health emergencies could be prevented and dealt with in a much, I'd say less expensive fashion in that proactive fashion.

Sarah Richardson: When you saw an article come out in December about the access initiative, the acronym, but it's starting with Medicare, and I'm thinking if it's about the reimbursement modeling, that has to get down to the commercial side of payments as well, because waiting to treat some of these chronic care conditions, once someone hits Medicare is kind of like.

Sarah Matt: So from an access perspective, in December when that came out, you know one thing that the.

Centers of Medicare, Medicaid have control of is our Medicare patients. And oftentimes this is where we see these new policy changes. Start and then it trickles to commercial insurance. So is this how it usually works? Eh, kind of. These are the patients who need care right now and that's tricky because again, like you mentioned, if they had been seen 10 years, 20 years before, we wouldn't be in perhaps such a mess.

As we think about just getting children vaccinated, getting children, their unusual checkups to make sure that they're growing properly, there's a lot of programs that help, you know, mothers and children. Early in life. But when we think about kind of those big years where people need to get care and they don't, it's those times after they're passed all the childhood programs and before they actually have jobs that can pay for health insurance.

The trick is showing them value. It's hard when you're 25 to think about. Alzheimer's. It's hard when you're in your twenties to think about wrinkles. I mean, think about how poor our sunscreen use was when we were kids. So, you know, we had to figure out the best value messages to show folks why it's so important, because it really is hard to think that far in advance.

Sarah Richardson: Well, and you paint a, a picture where geography never limits care. It could be rural robotics, it could be curbside street medicine. I mean, heck, we're already going to an every minute clinic in Costco and Teladoc that's out there. The multilingual records, the hybrid models, what do you believe is actually blocking the ability to scale those solutions today?

Have those proactive steps be skipped. So at this point, the reimbursement models are the reason why healthcare as a business, as a technology sector is the way it is. You can't fund projects. You can't fund businesses that don't have a sustainable reimbursement strategy.

Sarah Richardson: I feel like I know how you're gonna answer this next question then, because your framework of the book highlights five pillars of access, physical, financial, cultural, digital, and the trust knowledge space.

Which pillar is ripest for breakthrough this year and which one's gonna be the most stubborn as you look ahead?

and Digital access could be improved. I think that one, we can make a nice roadmap, trust and knowledge is gonna be the hardest. Because we have hundreds of years of historical mistrust based on real events and things that have occurred in our healthcare system. You can't just wipe that away.

And so even if we think about the last five years. During the COVID-19 crisis, there was so much confusion. People didn't know who to trust. There was lots of different stuff on TV or podcasts or whatnot, and it was very confusing. Even today, it's hard to watch, you know, straight up news and understand what's real and what's not.

So if we think about the trust and knowledge piece, healthcare is no longer trusted by default. If someone says, oh, well you're gonna just do what your doctor says, you're probably gonna say, eh, I'm gonna probably research that. And so I'd say some of those pieces where we can make a clear roadmap.

Sarah Richardson: Well, we used to say that, you know, no physician wanted you bringing, you know, Dr. Google into the mix and now you're bringing Doctor AI into the mix. Because if you're wired to question things or wired to not go to the doctor and just be querying whichever engine you are using, you don't know if that's hallucinating information.

I mean, you're gonna believe it because it's right most of the time. And at some point. That misinformation and it'll tell you, I'm not a doctor. Don't give me these prompts. Or do you want this information out there? So how do we ensure that? Innovation and policy and just all of this fast forwarding of the tech that people are so comfortable with to a degree.

How do you really believe innovation can be more inclusive?

Sarah Matt: It has to be intentional. So if your goals for your product solution business don't include access. You're not going to build access into your solutions. I actually think that building healthcare access into our solutions is actually good for business.

So if you are a pharmaceutical company and now you're doing new clinical trials on different groups of people, now I can market to these different groups of people and I know it works and I have the data. Amazing. If you are a technology vendor and you're building out applications or other solutions.

However, if access isn't part of your vernacular for your business. You're not gonna care about it, you're not gonna be intentional, and therefore you are not gonna see the rewards that access can give to your p and l.

Sarah Richardson: But you can get an appointment, but it's six months down the road. Mm-hmm. And if you have a chronic condition, and the best access you can get is six months from now, that's basically.

Eroding all of your faith and trust, which we talked about earlier, what are some options that healthcare systems have to say, Hey, I need this kind of appointment and my goodness, I might need to extend my capability even outside my state lines so that the patient locally with me, but we can get he or she the care that they need.

Sarah Matt: I think it's gonna be unlikely partnerships. So today we have hospital systems that are kind of constantly buying for territory, pushing up against the next market and the next market.

But I think that in order to actually care for people, we're gonna have more co-opetition. These two markets are gonna be hitting each other, but there's gonna have to be some overlap so that they can actually. Care for their constituents, if you will. And that might mean saying, oh, you know what? We're gonna give you all of our burn patients because we know you can do that better.

We don't have to be the best at every single thing if we partner appropriately and let others help us with some of that as well.

Sarah Richardson: you've described yourself as a chaos goblin. I absolutely love that term, by the way. And ever since we first chatted, I'm like, what a great way to describe the ability to work through the human element.

So how does embracing that identity help you build resilient teams and systems that address what you've shared in the book?

Sarah Matt: Some folks see difficulty, see complexity, and shut down and walk away. I'd say that for me, I see the complexity and I see a problem be solved. And so when we think about our teams, there's a difference between building your teams to do the same thing every day and expect the same result.

Because it's not gonna be the same. It's 2026 now. And ultimately we are in a time and era where business as usual. Is not usual. We have to be very comfortable with things changing every moment. So I'd say you can have a team that's gonna be great at one thing, or you can have a team that is in a spot where they're expected to do new stuff every day.

And also, as a leader, give them the ability to make those changes, to take those risks because we are moving so fast and the expectation that sometimes we're gonna win and sometimes we're not gonna hit it right off the bat.

The last couple of years have been such a whirlwind, maybe even since COVID to a degree because it just reshaped. So when you say it's 2026, I'm like. It is 2026, and yet ever since 2020 there's been this like gap in sort of my ability to understand the, you know, time continuum. How do we bring all these generations together to appreciate what technology can and can't do?

And I say this, Sarah, because there's people who are ditching their phones as a constant form of communication or getting wearable fatigue or just the constant onslaught of a digital world. And yet you actually can't do most things. You can't. Get a reservation at a restaurant or read the menu in some cases without your phone.

Sarah Matt: First, we need to assume. People are not a hundred percent in the loop all the time. And so again, in the technology sector, if we assume everyone has the latest iPhone is on broadband, internet nonstop, always has access.

We would design a certain way if you design. For someone who has none of that, that's very different. So if we think about our populations. There's gonna be a big ebb and flow on who has access to internet, who has access to the latest and greatest technology from a phone perspective, who has enough data on their phone to utilize it for a video.

Contact us for 24 hours. How does that even work? And I think that we need to just be more realistic about what people's reality is. And unfortunately, especially from a tech exec perspective, my reality is probably not the same as many patients realizing that is half the battle. The other battle is actually going into those communities and figuring out what that really looks like and what can be done, because there's some really not sexy solutions that actually work.

Maybe we call people on the phone. If someone calls me on the phone, I am not gonna answer. That is not gonna happen. No, but there's certain populations where a phone call makes a big difference. So I'd say like we have to really think about what the demographic is, what the group is, and what's the best mechanism for them to engage.

Sarah Richardson: Well consider logging into a portal today. And it may say, text me or call my phone. What if your phone's a landline? And not all of the technologies that are being produced to create these doors into these digital arenas have the ability to actually call the landline and give the code to the person.

That was actually a hurdle I discussed with a partner recently and I was like, how many of your patients have landlines? And it's. Probably a question most people can't answer. And yet landline still exists, especially in some of those rural populations and all these demographic shifts of people moving to smaller communities because they don't wanna be in the big city, or the onslaught of all of this technology has actually wanted people to create more human connections and more human community.

And that reset was very intentional. But it's hard to get out there and do that.

Sarah Matt: It is, and it's actually expensive. So from a product management perspective, having built product development teams all over the world, you have to invest. In actually talking to real customers. And a lot of people will say that, oh yes, we have to do that and talk a good game.

But you have to have to actually invest to send your teams to those communities to go and actually speak to real human beings that are gonna be using your solution. And oftentimes that's the first thing to get cut when budget cuts end up happening.

Sarah Richardson: Yeah, no more patient focus groups for you. In fact, 25% or just, hey, five to 10% of your budget gone.

Sarah Matt: I would

Sarah Richardson: agree. You do. I mean, you have firefighting, you do the roller derby, you're a doctor and you have four kids.

When you think about these practices that you have, balancing them, what keeps you grounded and energized? How do all those things coexist, and how important was that when you decided to say, Hey, I'm gonna write a book as one more thing to do? Because it's not like you just go and sit down for four hours and write a book.

Sarah Matt: No, it's definitely not like that. Well, I like to think of what I do and my life in general as a portfolio now. Back in the day, you know, we probably had parents or grandparents who worked at the plant. Their friends were at the plant, their life was at the plant. The plant was their life.

Everything you need, you got it from the plant. Today, that's not the case. And I've worked remote for a long time, even before COVID and before it was cool. And so sometimes you don't get those relationships. That are in person like Sarah, you and I have met maybe a handful of times in real life, right.

Sarah Richardson: Mm-hmm.

Sarah Matt: And so, you know, when we think about making these relationships, they, some of them are only gonna be virtual and some of them are gonna be, you know, never in person ever. You may never meet someone. So for me, those in-person pieces of engagement are really important.

And when I. Think about how I like to live and what I do. How can I get those different pieces of my life as part of this portfolio instead, you know, my kids and my dogs are a whole bunch of circus all over here all the time, but how do you fill those other wells? And so, you know, a lot of my intellectual curiosity and work is really around the great work I do with health tech, with advisory.

And I think that that service piece has gone lots of different directions, including for the fire department. I've been a firefighter for 20 years on and off back in college, med school. And then after COVID I came back and started from scratch again. Even after breaking my leg this past year, I'm back doing public education and I'm re-certify 'cause I do a lot of the CPR classes here in my town.

So when you think about giving back to those people that are really. What the heartbeat is of this entire place. That's what I'm here to support. So I do in lots of different ways.

Sarah Richardson: So was the broken leg byproduct of roller derby or was it unrelated and then how long before you get back into derby?

So. Back to it, making it happen. But you know, it takes a little bit longer to get, up to speed on these things. So stronger than ever, but working back through it,

Sarah Richardson: I just love that even doing something you love, got you injured and you still went back to the thing you love. 'cause there's gotta be just that sort of an endorphin rush and the community,

Sarah Matt: the community

Sarah Richardson: that's created from just that type of fun.

I mean, I've been to a few roller derby events and everyone's having such a good time.

Sarah Matt: It's a great group of people. And again, like a bunch of healthcare professionals, like a bunch of tech folks, like a bunch of roller derby people, you know, they all have their, you know, their unique flavor and they're definitely a fun bunch to be with.

You just, it's a whole nother space where community is being created based on the shared love of something and not any kind of, I say economic or political or policy gain. It's just people getting together to do something they love to do.

Sarah Matt: I'd agree, and I think especially for executives, and I hope you appreciate this too.

I am not amazing at roller derby. I am okay and I could do better, but it's also kind of nice to take that step and try these new things where you are not an expert. I am not an expert in roller derby and I have a long way to improve and I am humbled on a daily basis when I go out there and play and have folks that have been skating for a decade more than I have.

You know, help me out. And I think that that's part of the community there is helping other people grow and also instead of being in charge or being, the best at something, I think that's a good place to be too. 'cause it keeps me learning.

So whether it's. Roller derby or scuba diving, both, which have a bit of a risk associated with them. You and I may say, go join your local gardening club, but whatever that is, making sure that you're creating those spaces around you, especially where you live. I have to ask this other question too. What advice do you have for women leaders?

Who have to navigate constant ambiguity while protecting their own capacity, and I especially this being the first of the year, how many people use January as a reset? It falls off by March. How do you navigate it and how do you keep it going all year?

Sarah Matt: That's a really hard one because I don't even think it's all year long.

And so finding that tribe, whether it's one person or 10 or a gazillion, is really important. Sometimes it's hard to find mentors when you are a leader already, and the best thing you can do is mentor others and start building your tribe from the bottom up instead.

Sarah Richardson: And ask for the introduction or ask for the connection.

You and I met through Bluebird and literally people saying, you two need to know each other. And it was less than five minutes when we were like, I feel like I've known you a really long time, and how important that conversation those moments were and what led us to be able to do a book review and the podcast.

Sarah Matt: Agreed. And I think the trick there is making that ask. You don't get things you don't ask for, but you have to be confident enough to make the ask in the first place

Sarah Richardson: and be okay with some nos that get thrown in.

Sarah Matt: Absolutely.

Sarah Richardson: Even if we're the one delivering the no. 'cause sometimes you just have to say, wow, I'm so sorry, not right now. But you don't abandon that person who's asking. 'cause if they're asking, there's a reason why.

Sarah Matt: Agreed.

Sarah Richardson: Okay. Are you ready for speed round?

Sarah Matt: I think I'm ready for speed round.

Sarah Richardson: I'm gonna call this, borderless in 60 seconds. That's the best I can do. All right, so, uh, one border you have broken, that changed everything.

Sarah Matt: Medicine to tech.

Sarah Richardson: Any elaboration on that one?

Sarah Matt: So moving from full-time surgery into the tech sector has been a huge, I'd say pivot in my career, but has also made all the difference because I bring both worlds together.

Sarah Richardson: What is the most underused tool in healthcare right now?

Very simple things can cause great impact for simple problems.

Sarah Richardson: I don't usually answer the questions that I ask guests, but I, you're the first person that said common sense recently, and I love it because everything else is focused on this critical thinking aspect. So imagine if critical thinking and common sense, which really is probably how the ethos we were raised in were the, were a couple of the factors now, Sarah, that were able to be utilized in healthcare beyond this analysis of too much information.

For sure.

How would I feel about this? Would I feel the same way if my mother was a patient, my grandmother was a patient, et cetera. So those are those common sense moves that I think need be added to the critical thinking, maybe as a first person.

Sarah Richardson: Yeah. It also goes back to what you said before about if you can manage the ambiguity space and you can be an advocate, then asking that question on behalf of yourself.

If it does not sit right, then just ask the question. Someone's gonna help you find the answer for sure. Okay. What is one word that defines access for you?

Sarah Matt: Oof, man. I wrote a whole book on this and Sarah, you're killing me here.

Sarah Richardson: Like, pick one of the words,

So I would say simple.

Sarah Richardson: And I'm hopeful that every single listener takes that to heart and says, as a leader in healthcare and technology, how can I simplify healthcare for people? And you're right, we're all inside of it, so it's a little bit easier for us. But it's still not easy.

Sarah Matt: It's not.

Sarah Richardson: All right, and the very last question, I promise that I'm going to ask you your go-to reset ritual after a chaotic day,

Sarah Matt: Mike and Ikes and reality tv.

Sarah Richardson: Mike and Ikes are still made.

Sarah Matt: They are so good. Mike and Ikes are the thing. Mike and Ikes call me. I am absolutely on board, Mike and Ikes.

Sarah Richardson: I need to now go and look for them at the store, because I don't think I've even heard that in a couple of decades now. I'm like, huh? They're like right next to the hot tamales, aren't they?

Sarah Matt: They're made by the same brand.

It's almost like, it's like fake vitamin.

Sarah Matt: With vitamins. I like

Sarah Richardson: that. Mike and Ike, if you're listening, Sarah wants to make a commercial with you via plug for your product and some reality tv for sure. All right, Sarah, thank you for sharing with us, access is proximity to need and systems.

They can be rebuilt to deliver it. As Sarah has reminded us in this conversation, business is a common language that aligns incentives across politics and priorities. When access works, people live healthier lives, miss less work, and organizations create durable value. Again, Sarah, thank you for your clarity and your conviction and for writing this book.

Sarah Matt: Thanks Sarah for having me. Appreciate it.

GMT20250714-172930_Recording: Thanks for joining Flourish. Remember that every healthcare leader needs a community to learn from and to lean on. Find your people at this week, health.com/subscribe. Share this episode with someone who needs encouragement today. Keep flourishing. That's all for now.