SAD principal in Healthcare by Lyle Berkowitz - Simplify, Automate, and Delegate!

In the latest episode of Digital Health Interviews, host Alex Koshykov sat down with Dr. Lyle Berkowitz—internist, digital health entrepreneur, and CEO of KeyCare—for a wide-ranging conversation that spans nearly three decades of healthcare innovation. From the rise of electronic health records to the current explosion in ambient AI tools, Dr. Berkowitz offers an insider’s view on why change is hard, how incentives often misalign, and where the future of virtual care is headed.

Three Decades of Change: What’s Better, What’s Not

Having worked across clinical, executive, and startup roles, Dr. Berkowitz has seen healthcare from every angle. In his early years, he recalls a healthcare system experimenting with value-based care models—but eventually returning to fee-for-service. Then came the widespread rollout of electronic medical records (EMRs), which promised transformation but burdened doctors with increasing documentation requirements. “The EMRs aren’t the problem,” he explained. “It’s how the payment systems evolved and what they demanded.”

Still, EMRs laid the technological foundation for population health and longitudinal patient data. “Without them, we wouldn’t be where we are today regarding potential,” he noted. “But to really unlock that potential, we need to rethink how we pay doctors, what we automate, and what we delegate.”

Why the System Doesn’t Reward Good Innovation

A central theme of the interview was one Dr. Berkowitz returns to often: misaligned incentives. Entrepreneurs frequently pitch products that reduce long-term costs or improve care quality, but fail to show who benefits financially in the short term.

“When I evaluated startups as Head of Innovation at Northwestern Medicine, I always asked three questions,” he said. “Who uses your product? Who pays for it? And who financially benefits?” Too often, founders couldn’t answer all three clearly. “If you bring something that takes doctors more time and doesn’t give them or their systems any direct value, they won’t adopt it. Period.”

According to Berkowitz, the health tech industry often assumes that doing “the right thing” is enough. But healthcare is a complex, multi-stakeholder ecosystem. “If your solution helps the payer but burdens the doctor, don’t expect the doctor to love it.

The KeyCare Playbook: Workflow First, Tech Second

KeyCare, Dr. Berkowitz’s current venture, is built around a simple but radical principle: make virtual care seamless by embedding it directly within the systems clinicians already use. The company operates a national virtual medical group using a fully integrated, virtual-care-optimized instance of Epic, allowing physicians to co-manage patients in close coordination with existing providers and workflows.

Instead of offering a stand-alone platform, KeyCare uses Epic’s Care Everywhere and other interoperability tools to allow real-time data sharing, scheduling, and secure communication between their virtual doctors and brick-and-mortar teams.

“It’s about distribution,” Dr. Berkowitz emphasized. “From day one, we focused on making KeyCare part of the system, not an outsider to it. If your solution isn’t integrated, it doesn’t matter how beautiful it is.”

COVID’s Catalyst—and What Comes Next

Dr. Berkowitz credits the COVID-19 pandemic for accelerating the acceptance of telehealth among health systems, clinicians, and patients alike. Before the pandemic, health systems were reluctant to engage in virtual care, often leaving that space to third-party vendors. But when lockdowns hit, they had no choice.

“Overnight, we saw 60–70% of care shift online,” he recalled. “It proved that the model could work. And crucially, insurance began paying for it.” That reimbursement shift was what ultimately made telehealth a viable model long-term.

Yet, even after the COVID boom, telehealth today accounts for only 5–10% of total insurance claims. Why hasn’t it gone further? Dr. Berkowitz argues that it's not due to a lack of interest, but a matter of operational strategy. “If we want to expand access while keeping quality high, we need to virtualize routine care and refocus office-based clinicians on complex cases.”

Toward a New Care Model: The Rise of Virtualists

Berkowitz envisions a future where primary care evolves into two professional tracks: office-based “officeologists” and online-first “virtualists.” He believes that supporting physicians with virtual teams could double their patient panel size, without sacrificing care quality or burning doctors out.

“We’ve already seen this in other specialties,” he pointed out. “Surgeons, dermatologists, even dentists, all use teams. Why not primary care?” Office visits are expensive and limited. Virtual care can help manage low-acuity conditions, freeing up in-person visits for patients who truly need them.

AI That Doctors Actually Want

Turning to artificial intelligence, Dr. Berkowitz expressed cautious optimism. While some AI tools are overhyped, others—especially ambient scribes—are already delivering real value. “We’re seeing fast adoption because these tools make life easier for doctors. They simplify, automate, and delegate—the core principles I believe in.”

Still, not all AI tools are living up to their financial promise. “Some health systems were disappointed when scribes didn’t allow doctors to see more patients. But what they got instead was happier doctors, less burnout, and lower attrition. That’s a real value too.”

He sees two main categories where AI will shine: 1) tools that improve efficiency and 2) tools that improve clinical accuracy, for example, by surfacing rare but important patterns or diagnoses.

Final Advice for Founders: Stop Guessing, Start Watching

When asked what advice he would give to digital health founders, Dr. Berkowitz was direct. “You need to understand your end user—not just what they say, but how they act. Watch them. Shadow them. Feel their frustrations.”

He cautioned against over-indexing on product perfection. “Too many founders obsess over building the perfect solution. But without a distribution channel, it’s just a beautiful orphan. You need to spend just as much time figuring out how to get your product into people’s hands as you do making it.”

In a system where incentives are tangled, attention is fragmented, and every minute counts, Dr. Berkowitz’s message is clear: healthcare transformation requires not just brilliant ideas, but operational humility, strategic integration, and an unwavering focus on the clinician’s reality.