Elizabeth Holmes is the face of America’s broken healthcare innovation culture. She is far from alone.

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I want to reflect on the broken culture of innovation in U.S. healthcare delivery—and its nefarious impact on the system.

We declare success prematurely.

We obscure failure.

And we move on without inquiry.

Within the delivery system, the same organizations whose basic and clinical researchers perform rigorous, thoughtfully designed controlled trials of medicines will tout the success of delivery and financing innovation without requisite evaluation.

In the broader innovation ecosystem, we too casually equate funding, valuations, and transactions with success—and we too often elevate and declare success without applying appropriate skepticism.

Many believe this culture of salesmanship and hucksterism is harmless.

But on the other side of it are patients whose care is not getting better and an industry with misplaced conviction about progress when there is none.

I’ve seen this firsthand throughout my career.

To make this less abstract, I’ll focus on my own area of work over the last decade: leading and operating Medicare Advantage plans and care delivery organizations.

It is a sector that has birthed many venture capital darlings.

But with the benefit of hindsight, many of those companies had clinical outcomes that were, at best, thin—

And whose primary innovation was exploiting arbitrage opportunities in risk adjustment.

And yet, in retrospect, these “innovators” were platformed.

They were celebrated on the stages of major national forums.

And while Medicare Advantage is now a space where some of these behaviors are more widely understood, it is not unique to Medicare Advantage.

Rather, some of the distortions we see there are a window into a broader cultural problem.

One that, in a different form, was on display in the case of Elizabeth Holmes and Theranos.

We might like to believe that was an exceptional story in exceptional circumstances.

I don’t.

I think we have many Theranoses among us—just less visible, and more socially accepted.

Why?

I believe there are two root causes.

First, expert and funding bias.

We believe that startups revered and validated by experts are worthy of celebration.

And if they are richly funded, we assume they have been appropriately vetted.

Commercial success—often driven by relationships and the favor economy—is prematurely equated to clinical success.

Second, optimism bias.

We have such a strong desire to believe that things are getting better that the first hint of progress is met with celebration—rather than the skepticism we typically reserve for results that seem too good to be true.

This is how many of us have convinced ourselves that American healthcare delivery is improving—while most consumers, patients, and clinicians tell us otherwise every single day.

So how do we move forward?

Especially in an era of artificial intelligence, when there will be even more so-called innovation activity.

How do we re-establish credibility in the healthcare innovation ecosystem?

First, we must raise the bar for rigor.

We should demand clear hypotheses.

Real comparators.

And transparently reported results—positive and negative.

If we can’t answer a basic question—did this actually improve outcomes?—we shouldn’t be calling it success.

Vivek Garg, the new CEO of the NCQA has observed that CMS sits atop a treasure trove of performance data, yet conducts relatively few comparative analyses of delivery system performance.

What if a next-generation CMS began systematically analyzing performance—and sharing those insights transparently with the American public?

Second, we must demand longitudinal evidence.

Six or twelve months is rarely enough—in a field where reversion to the mean is often disguised as progress.

We should be looking at two, three, five years.

Especially for models serving complex populations.

Insurance and clinical products should be built with a longer time horizon—and evaluated accordingly.

Value-based care cannot credibly be delivered or measured in one-year increments—and the next phase of new payment and care delivery models should be built cognizant of this fact.

Third, we must practice retrospective honesty.

Let’s go back to the companies and models we celebrated.

What actually worked?

What didn’t?

Right now, both success and failure disappear without a trace—and without learning.

In 2001, I had a front-row seat as an intern working on the Pursuing Perfection program—a now forgotten partnership between the Institute for Healthcare Improvement and the Robert Wood Johnson Foundation.

Eight organizations were funded to build and scale “prototypes of perfect care.”

Twenty-five years later—and far before then—those prototypes have disappeared.

Did the program work?

What was its real impact?

We should be discussing Pursuing Perfection and programs like it often.

How many of us can clearly articulate the outcomes of Haven—the JPMorgan, Amazon, Berkshire Hathaway joint effort?

Or Steve Case’s Revolution Health before it?

Or all the so-called moonshots that have found themselves grounded on Earth?

The sophistication of future reform efforts will depend on honest reflection about past ones.

Fourth, we must be more reserved in who and what we elevate.

Not every startup founder—no matter how likable—is a genius.

Not every pilot is a breakthrough.

Not every company is a model worth replicating.

We should be far more cautious about platforming innovation without durable evidence.

And we should reserve our applause for demonstrated impact—not just plausible hypotheses.

And finally—all institutions matter.

The payers, the providers, the analysts, the policymakers.

Because what we choose to elevate shapes what comes next.

If we reward narrative over evidence, we will get narrative instead of progress.

This is not an argument against innovation.

It is an argument for taking innovation seriously.

Because in healthcare, the cost of getting it wrong is not abstract.

It’s time.

It’s money.

It’s trust.

And, most importantly, it’s the lived experience of patients who have been promised progress—and are still waiting to see it.