Converging Forces, Co-Evolution: Could Utah be Approaching a Tipping Point?

David Caldwell

Okay, let’s kick things off with a quick disclaimer here. You’re listening to us, the AI hosts of "It’s Time," but behind the scenes, Dr. Chad Swanson is the real force behind this episode. You can find him on LinkedIn, TikTok, and YouTube if you wanna connect or have questions.

Sofia Ramirez

And just to be clear, David, Dr. Swanson practices medicine in Utah, but he’s not, you know, directly involved in any statewide healthcare transformation activities.

David Caldwell

Got it. So while he’s not in the thick of systemic changes there, he has a pretty unique perspective on how things could evolve, given his background and expertise in public health, complex systems, and the history of medicine. And today, we’re going to explore just that, right?

Sofia Ramirez

Exactly. What we’ll be discussing are six converging forces that could push Utah into a better paradigm. Think of it like a phase shift in complex systems—a point where everything changes in a fundamental way. Like from water to ice in physics.

David Caldwell

Hmm, like a tipping point?

Sofia Ramirez

Yeah, exactly. It’s a shift from, you know, the typical primary drivers—things like episodic treatments, profits, and even elitism in healthcare—to a new model where health status, fairness, and efficiency drive the system. It’s transformative, not incremental.

David Caldwell

Whoa... that’s a huge leap! And these six forces that we'll discuss are kind of the catalysts for this, right?

Sofia Ramirez

That’s the idea. So, we’re going to be exploring what those forces are, how they align, and what they could mean for Utah’s healthcare landscape.

David Caldwell

So, Sofia, as we dive into these systemic shifts you mentioned, it’s hard not to think about the broader landscape. How does the national political picture play into all this? I mean, we’re in 2025 now, and, well, it feels like a whole new ballgame.

Sofia Ramirez

That’s definitely one way to put it. The new Trump administration has introduced, let’s call it, a disruptive energy into healthcare policy. And that's the first force we'll discuss. Whether it’s through rhetoric or actual policy proposals, the federal landscape seems to be shifting rapidly. It’s creating a ripple effect down to the states.

David Caldwell

Right, and—uh—disruption doesn’t exactly sound comforting, you know? Like, what does that even mean in practice? More chaos? Less regulation? Or—or is it more about shaking things up for innovation?

Sofia Ramirez

It’s probably a mix of all of those, honestly. Under this administration, you might have people like RFK Jr., high-profile figures like Dr. Oz, and even voices like Dr. Marty Makary who are pushing for changes in how we think about everything from public health to individual autonomy. These figures bring unconventional ideas, some of which resonate deeply with specific audiences.

David Caldwell

Wait, wait. Dr. Oz? From daytime TV to shaping healthcare policy? That... feels surreal.

Sofia Ramirez

It does, doesn’t it? But his platform has always been about healthcare—for better or worse. And figures like him have a significant public following, which can translate into influence in shaping the narrative around policy. Whether it’s evidence-based or not, their ideas are on the table now, and that’s worth paying attention to.

David Caldwell

Okay, but what about actual changes at the state level? Are we at risk of a standardized system falling apart, or could this lead to something better?

Sofia Ramirez

Well, one potential scenario here, given the Republican party's increase in power, is that states could gain more autonomy to decide their own healthcare policies. Utah could use that flexibility to innovate and advance their systems.

David Caldwell

Right, like it depends on the leadership and priorities in each state. That sounds risky but also kind of exciting. It could really push Utah, for example, to—

Sofia Ramirez

—to advance quickly, right. And that’s where it gets really interesting.

David Caldwell

You know, Sofia, we’ve been talking about advancement—and thinking about that, it feels like we can’t skip over AI. It’s not just healthcare policy that’s evolving, right? AI seems to be moving faster than ever. So, what’s the latest in the AI and healthcare space?

Sofia Ramirez

Great question, David. So as of late 2024, we’re seeing AI tools move beyond just diagnostics or administrative tasks. They’re now being integrated into actual decision-making workflows. For instance, there’s data showing that in some trials, AI assistance in cancer detection improved accuracy rates by around 15%. That’s a pretty significant leap.

David Caldwell

Wow, 15%? So, like, these tools are kinda stepping in as co-pilots for physicians?

Sofia Ramirez

Exactly. And it’s not just cancer care. In radiology, AI models are already being used in places like Stanford and the Mayo Clinic to review scans faster than humanly possible. They’re cutting average analysis times in half while catching anomalies that might’ve been missed.

David Caldwell

Wait, so they’re faster and more accurate?

Sofia Ramirez

In some cases, yes. But it’s important to keep this in perspective. AI isn’t replacing doctors—it’s enhancing their capabilities. Think of it as augmenting human expertise, not replacing it.

David Caldwell

Right, but—I mean—how’s that changing the way healthcare systems actually operate? Like, are there ripple effects?

Sofia Ramirez

Oh, absolutely. One big implication is how decision-making becomes more data-driven. You see, when you have AI analyzing millions of data points in real-time, you’re suddenly able to identify patterns that weren’t visible before. This could shift healthcare from being reactive to proactive—predicting health crises before they happen.

David Caldwell

That sounds incredible, but also kinda... intimidating. I mean, are healthcare workers, like, ready for this kind of, uh, change?

Sofia Ramirez

Funny you mention that. Adoption is actually one of the biggest challenges. There’s a learning curve, and trust in the technology isn’t automatic. You need training initiatives and—frankly—a cultural shift within healthcare institutions to embrace these tools fully.

David Caldwell

Okay, and what about, like, the systemic side of things? Does AI change how resources are allocated or—or managed across the board?

Sofia Ramirez

It could, eventually. AI could help optimize resource distribution geographically, predicting where personnel or supplies are needed most. But you also need safeguards so we don’t, you know, automate inequities or exacerbate disparities by relying too heavily on biased algorithms.

David Caldwell

Yeah, that whole bias issue—we hear it all the time, right? So how do we even begin to deal with that?

Sofia Ramirez

That’s where collaboration between computer scientists, ethicists, and healthcare professionals comes in. It’s not just about designing good AI; it’s about asking the right questions, like whose data is being used, and how outcomes are evaluated. This intersection is where real accountability starts.

David Caldwell

Alright, so we’re in a Goldilocks zone—AI isn’t there to take over but needs to be—uh—handled carefully for maximum impact. It’s like we’re building a scaffolding for something way bigger?

Sofia Ramirez

Exactly. And what’s fascinating is how top institutions are already paving the way. Their commitment to innovation and excellence kind of sets the stage for what’s possible.

David Caldwell

You know, Sofia, talking about those pioneering institutions, it feels like Utah has its share of real innovators in that space. Would you say they’re contributing to this shift in healthcare too?

Sofia Ramirez

Absolutely. The state is home to organizations like Intermountain Healthcare, SelectHealth, and the University of Utah. These institutions aren’t just delivering quality care—they’re actively pushing for innovation and transformation. For instance, Intermountain is known nationwide for its pioneering work in value-based care, where the focus shifts from volume to outcomes.

David Caldwell

Value-based care... okay, I hear that term a lot, but can you break it down a little? Like, what does it mean in practice?

Sofia Ramirez

Sure. It’s about aligning incentives so that providers are rewarded for keeping patients healthy, rather than just treating illness. Think of it like a shift from selling car repairs to, you know, promoting regular maintenance to prevent breakdowns in the first place.

David Caldwell

Ah, got it. So instead of racking up fees for every single service, the goal is to deliver better outcomes for a fixed cost?

Sofia Ramirez

Exactly, and Intermountain has been a national leader in demonstrating how this model can work. Their integrated approach—combining hospitals, clinics, and their insurance arm, SelectHealth—allows them to streamline care in a way that’s efficient and patient-centered.

David Caldwell

Wait, SelectHealth is their insurance company?

Sofia Ramirez

Yes, and it’s a critical piece of why their model works so well. By having both the care delivery and the insurance side under one roof, they can monitor costs, coordinate care better, and—most importantly—focus on prevention. It’s all part of this bigger system they’ve built to prioritize health outcomes over services provided.

David Caldwell

That sounds, uh, kinda like a dream setup. But what about the University of Utah? How do they fit into this picture?

Sofia Ramirez

The University of Utah is a powerhouse in both medical education and cutting-edge research. They’re training the next generation of healthcare providers while also contributing to advancements in medicine and public health. And, David, they’ve been recognized as one of the best hospitals in the country, which speaks volumes about their commitment to excellence.

David Caldwell

Okay, so we’ve got these three power players—Intermountain, SelectHealth, and the University of Utah—all doing big things. But are they working together, or is it more of each doing their own thing?

Sofia Ramirez

There’s definitely collaboration. For example, Intermountain and the University of Utah often partner on research initiatives and clinical trials. And when you have institutions like these aligned even loosely, it creates, you know, this fertile ground for innovation and systemic improvement.

David Caldwell

Right, so it’s not just about being great individually—it’s how they kind of amplify each other’s efforts. Like a shared mission?

Sofia Ramirez

Exactly. The shared focus on health improvement and innovation helps build a stronger ecosystem overall. When you have organizations like these leading the charge, it sets a standard for what’s possible in transforming healthcare systems. But they haven't even scratched the surface. Even leading institutions are stuck in a paradigm that's over 100 years old.

David Caldwell

Sofia, hearing about Intermountain, SelectHealth, and the University of Utah working together really got me thinking. Now with the addition of the new BYU Medical School, could that potentially add another layer to Utah’s healthcare innovation?

Sofia Ramirez

It definitely has the potential to be, David. BYU could frame this medical school as a way to directly address health systems transformation. That would be a pretty bold approach for a new medical school. They wouldn't be just about training doctors—they’d be embedding this broader mission into their curriculum and their institutional culture.

David Caldwell

Wait, wait, health systems transformation? Most med schools are focused on, like, anatomy and, uh, pathology, right? This sounds like a whole other layer. What does that look like in practice?

Sofia Ramirez

Great question. It would have to be about more than just the medical school. For one, they could create an entire institute focused specifically on health systems transformation. This means they’re not just looking at how to treat patients, but also at how to design better healthcare delivery models, improve access, collaborate with the community, and improve health outcomes. They could bring in faculty who specialize in these areas and offer students pathways to study subjects like public health or health policy alongside traditional medical training.

David Caldwell

Okay, that... that sounds pretty progressive. Is it kinda like what Johns Hopkins did back in the day, turning medical education into, like, a science-driven enterprise?

Sofia Ramirez

Exactly, David. Hopkins’ model in the late 19th century transformed medicine by integrating rigorous scientific research into training. BYU could position itself to play a similar catalytic role, but for the 21st century. Instead of just focusing on clinical skills, they could emphasize things like collaboration, innovation, and building a health ecosystem that supports whole communities.

David Caldwell

A community health ecosystem... that sounds ambitious. What does that even mean on a practical level?

Sofia Ramirez

It means creating a network where healthcare providers, community organizations, and even businesses work together to improve health outcomes. Say you have a new diabetes intervention—this ecosystem ensures that patients not only get treatment but also access to nutrition programs, affordable medications, and even support for lifestyle changes. Imagine a university with a medical school that serves as a hub for fostering those connections, not just in Provo but potentially across the entire state.

David Caldwell

Wow, so break down those silos that, uh, kind of plague traditional health systems?

Sofia Ramirez

Exactly. They would need to emphasize community health as a cornerstone. Training future doctors to think beyond the individual patient and consider the broader context—like social determinants of health or systemic barriers—sets the stage for transformative change.

David Caldwell

And you think that could ripple out into Utah as a whole?

Sofia Ramirez

It has a strong chance, yes. A medical school like this doesn’t just produce graduates—it influences how care is delivered, how policies are shaped, and even how communities view health and wellness. It could be a critical piece in accelerating Utah’s transition to a more integrated and efficient health system.

David Caldwell

This feels like one of those “watch this space” kind of moments. I mean, if BYU did pull this off, it could set a precedent for how new medical schools approach their role in society. Imagine the ripple effects.

Sofia Ramirez

Exactly. It would be an ambitious vision, but with the right leadership, funding, and community buy-in, it could become a model that other states and institutions might look to replicate. A new medical school is a unique opportunity, to start from scratch.

David Caldwell

Speaking of ambitious visions, Sofia, we’ve been talking about innovation in healthcare, but what about Utah’s reputation as a tech hub? People are calling it the Silicon Slopes. How does all that tech innovation tie back to healthcare?

Sofia Ramirez

Well, David, Utah’s entrepreneurial culture is a big part of what makes it so unique. It’s not just about creating startups or new technology—it’s this mindset of disruption and problem-solving that spills over into healthcare. The same principles that drive tech innovation can really transform how we think about and deliver care.

David Caldwell

Okay, but like, in what ways? Are we talking about apps and gadgets, or something bigger?

Sofia Ramirez

Definitely bigger. Sure, there’s been an explosion of health tech startups in Utah, but the real impact comes from their approach. For example, they’re reimagining traditional systems—seeing inefficiencies, asking tough questions, and proposing entirely new ways of handling things. It’s that willingness to challenge the status quo.

David Caldwell

Right, Utah’s not exactly shy about shaking things up.

Sofia Ramirez

Exactly. And this culture of “Why not?” is what drives forward-thinking projects. Imagine applying that same drive to things like patient care pathways or even how health data is shared across providers—innovation at the foundational level.

David Caldwell

Hmm, it kinda sounds like there’s this energy to build something from scratch instead of just patching up what’s broken.

Sofia Ramirez

That’s a great way to put it. There’s a sense here that improvement doesn’t have to be incremental. Why not leap ahead to a system that truly works for everyone? And that mindset attracts innovators, not just locals but from all over the country.

David Caldwell

You mean, people are actually moving here to be part of this?

Sofia Ramirez

Exactly. Utah’s becoming a magnet for talent. And when you’ve got visionaries in both tech and health coming together, well, you get this really fertile ground for new ideas. Suddenly, solutions don’t look so far off anymore.

David Caldwell

Okay, but let’s zoom in a bit. Like—is there a specific project or approach coming out of this that really stands out?

Sofia Ramirez

One example is how startups are collaborating with larger healthcare institutions here. They’re leveraging data in ways that streamline processes—like predicting patient needs before they even walk into a clinic. It’s efficient, personalized care, driven by that same tech mindset the state’s known for.

David Caldwell

Wow, so we’re talking about a complete shift in how care is delivered?

Sofia Ramirez

Exactly. And it’s not just delivery; it could be the infrastructure itself. Imagine this culture of disruption influencing everything—from medical education to public health policies. It’s a whole ecosystem that could be reshaped by innovation.

David Caldwell

Speaking of ambitious projects, Sofia, let’s talk about the One Utah Health Collaborative. Just hearing the name, it sounds like it’s trying to take everything we’ve been discussing to the next level. What’s the story behind this initiative?

Sofia Ramirez

It is ambitious, David, and that’s kind of the point. The One Utah Health Collaborative is this statewide effort bringing together players from across the health ecosystem. We’re talking healthcare providers, insurance companies, tech innovators, community organizations—you name it. The goal is to align everyone toward a shared vision of health and well-being for all Utahns.

David Caldwell

Okay, so we’re talking big tent kind of stuff here. But, like, how does that work in practice? I mean, getting these groups to agree on anything sounds like herding cats.

Sofia Ramirez

It’s definitely a challenge, but that’s what makes it so groundbreaking. What they’re doing here is creating a shared framework—common goals, metrics, and strategies—to make sure everyone’s pulling in the same direction. One focus has been addressing systemic inequities by prioritizing health outcomes instead of, you know, just treating symptoms at the surface level.

David Caldwell

Hmm, so everyone’s trying to get on the same page. But what kind of outcomes are we talking about? Like, is there a specific problem they’re aiming to solve?

Sofia Ramirez

It’s a mix, David. One big priority is managing chronic conditions better—things like diabetes or cardiovascular disease that really drive up costs and lower quality of life. But they’re also focusing on prevention, improving mental health access, and even reducing barriers like food insecurity or lack of housing stability, which we know are tied to health outcomes.

David Caldwell

Okay, hold up. Lack of housing stability? You’re saying housing’s connected to healthcare?

Sofia Ramirez

Absolutely. Think about it this way—if someone doesn’t have stable housing, they’re less likely to make it to their doctor’s appointments, afford medication, or even prioritize things like nutrition. Addressing those root causes upstream prevents worse health outcomes down the line. It’s all connected.

David Caldwell

Wow, so this collaborative is tackling the whole iceberg, not just the tip we normally see in healthcare. That sounds... overwhelming, honestly.

Sofia Ramirez

It can be, but the collaborative is taking it step by step. They’re focusing on building trust among the stakeholders first—sharing data transparently, setting realistic goals, and piloting smaller-scale projects to show what’s possible. It’s about proving the model works before scaling up.

David Caldwell

And is it working? Like, do we have any results so far?

Sofia Ramirez

It’s still early, but there are promising signs. For example, one pilot program streamlined care for patients with multiple chronic conditions, reducing hospital readmissions by 20% within a year. And that’s just one piece of what they’re working on.

David Caldwell

That’s impressive. It kinda sounds like Utah’s becoming this sandbox for testing out what a reimagined healthcare system could look like.

Sofia Ramirez

Exactly. And the collaborative’s approach is really about creating a model that could be replicated elsewhere. It’s not just about Utah—it’s showing what’s possible when everyone comes together with shared purpose.

David Caldwell

Huh, shared purpose... that feels like a game changer in itself. So often it seems like healthcare’s just everyone doing their own thing in silos.

Sofia Ramirez

And that’s what makes the collaborative so unique. By breaking down those silos, they’re not just improving individual outcomes—they’re transforming the system as a whole.

David Caldwell

Sofia, with promising signs like the pilot program reducing readmissions, it sounds like a good start. But let’s be real—how do we even begin to organize and execute something this massive in practice?

Sofia Ramirez

Well, that’s the thing, David. With something as complex as health, you can’t just follow a pre-drawn blueprint. Transformations like this don’t happen linearly. You have to create the right conditions for change and then let new systems, new ways of working, emerge over time.

David Caldwell

Wait, so you’re saying there isn’t, like, a master plan somewhere? Like, no step-by-step guide?

Sofia Ramirez

Exactly. It’s more about setting the vision and creating an environment where people can innovate and collaborate freely. But I do have a few ideas about what this environment could look like, if that helps.

David Caldwell

Oh, absolutely. Hit me with it.

Sofia Ramirez

Alright. First, we need a shared vision—a real focus on health and well-being for everyone. Think of it as something baked into every decision, whether it’s a clinical visit or a collaboration between organizations. It has to become part of the culture, not just something talked about in boardrooms.

David Caldwell

Okay, that... makes sense. But doesn’t that sound kinda, I don’t know, lofty? Like, easy to say but hard to act on?

Sofia Ramirez

It’s definitely ambitious, but culture shifts always are. The key is keeping the vision clear and visible so every stakeholder—from policymakers to, you know, clinicians, even community members—knows exactly what they’re working toward.

David Caldwell

Alright, so that’s the first idea. What’s next?

Sofia Ramirez

The second idea is about changing incentives, and it goes beyond just healthcare. Imagine scrapping fee-for-service entirely.

David Caldwell

Wait, wait, like... everywhere? Gone?

Sofia Ramirez

Right! Instead of rewarding volume—like the number of procedures or visits—we’d focus on outcomes. And not just for doctors. You would extend incentives across the whole health ecosystem—educators, public health, even the food industry. Anyone who plays a role in improving health outcomes gets rewarded financially or otherwise.

David Caldwell

Whoa, that is a massive shift. I mean, that’s basically flipping the whole system on its head.

Sofia Ramirez

It is. But if you want people to think holistically about health, the incentives have to align with that bigger picture, don’t you think?

David Caldwell

Yeah, I—I mean, that would definitely push people to approach health differently. What about the last idea?

Sofia Ramirez

The third idea is all about collaboration. We’d form these collective impact partnerships—connecting healthcare providers, public health agencies, and non-governmental organizations. Basically, creating a framework for cross-sector collaboration.

David Caldwell

Okay, but didn’t we just talk about how hard it is to get these groups on the same page? What makes this different?

Sofia Ramirez

Good question. What makes it different is having a clear, measurable goal that everyone rallies around—something big enough that it transcends individual interests. It’s not easy, but when it works, the results can be transformative.

David Caldwell

Hmm, a shared mission. That does sound powerful. But...

David Caldwell

Alright, Sofia, so you talked about creating a shared, transformative mission. That got me wondering—are we really looking at an entirely new paradigm here? I mean, something so revolutionary that it changes the way we approach the whole system?

Sofia Ramirez

I think we are, David. What we’re seeing is not just innovation within existing systems, but a shift toward building entirely new ones. It’s a transformation where health status, fairness, and efficiency become the primary drivers, rather than episodes of treatment, profits, or exclusion.

David Caldwell

Wow, so you’re saying Utah could actually create a system we’ve never seen before? Like—a health system that’s... unique in human history?

Sofia Ramirez

Exactly. If these forces align the way they could, Utah could become a model for solving problems that have plagued health systems for decades. It’s a chance to move beyond what we’ve always done and imagine something truly different. And different in a way that actually works—for everyone.

David Caldwell

That’s such a hopeful vision. It’s kinda inspiring, honestly. But also, like, it feels... daunting.

Sofia Ramirez

It is. But daunting doesn’t mean impossible. History has shown us that transformative change often comes when big challenges and big ideas converge. And right now, Utah is holding both in its hands.

David Caldwell

Well, if Utah actually pulls this off, it could redefine what we even think of as healthcare. That’s a legacy worth chasing.

Sofia Ramirez

Absolutely. And, David, this episode has been a real reminder that no matter how complex the system is, change starts with vision—and the willingness to act on it.

David Caldwell

Well said. And that’s all for today, folks. Thanks for joining us on this journey through, honestly, what could be the future of healthcare. Sofia, always a pleasure.

Sofia Ramirez

Likewise. And to everyone listening, thank you for being part of the conversation. Until next time—stay curious and stay engaged.