EPISODE
08

Wonderful and Broken: Fixing Primary Care in America

Dr. Troyen Brennan discusses ideas from his new book, Wonderful and Broken, about what links primary care to medicine's value-based future.

Our Guest

Troyen Brennan, MD ,

Troyen A. Brennan, MD, has served as an adjunct professor of health policy and management at the Harvard T. H. Chan School of Public Health; professor of medicine at Harvard Medical School; and Chief Medical Officer of both CVS Health and Aetna. He is the author of several books, including the October 2025 release,  Wonderful and Broken: The Complex Reality of Primary Care in the United States.

Episode Description

In this episode of Quality Talks with Peggy O’Kane, Peggy welcomes Dr. Troyen Brennan, adjunct professor at the Harvard School of Public Health, former Chief Medical Officer at CVS Health and Aetna, and author of Wonderful and Broken. 

With decades of experience spanning academic medicine, hospital administration and retail health care, Troy brings candor and clarity to the challenges facing American health care and the promise of primary care reform.

Troy’s insights are both sobering and hopeful, pointing to a future where coordinated, data-driven primary care can finally fulfill its promise.

Highlights:

  • Diagnosing a System Under Pressure: The limits of fee-for-service payment and why employer-sponsored insurance is reaching a breaking point. 
  • Building the Foundation for Better Care: The critical role of primary care in medicine’s value-based future. 
  • Spotlighting Innovation Across the Map: Real-world examples of successful primary care transformation, including Catalyst Health in Texas and Southcentral Foundation in Alaska. 
  • Reimagining Accreditation for Modern Needs: Reflections on NCQA’s Patient-Centered Medical Home and future redesigns. 
  • Clearing the Policy Bottleneck: Observations on policy inertia and how policymakers can accelerate change.

This episode is a timely and thought-provoking update for healthcare executives, policymakers and clinicians committed to building a more sustainable, efficient health care system.

If we believe what most people write about these things, we’ve got 25 to 30% waste as a result of the fee-for-service system. 

If we move to a value-based approach, that’s money that’s going to fund the system, that extra third that we can put back into real health care. So you need a value-based approach.

Troyen Brennan, MD

Timestamps

(3:12) Employment-Based Health Care is Unsustainable

(7:29) The Value-Based Future and Primary Care

(10:00) Payment Disparities and Policy Inertia

(22:00) Technology and Data Analytics in Advanced Primary Care

(28:18) Peggy’s Reflection

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