Driving Value-Based Care by Putting Patients First

This transcript has been edited for clarity and length.

Pamela Sullivan, MD, MBA, CPE, has built one of medicine's more unconventional careers — moving from physical therapy to emergency medicine, urgent care leadership, and now a national role in value-based care. As national medical director of High-Risk Programs at P3 Health Partners and founder of National Health Care Solutions, she has spent decades proving that putting patients first is both the right thing to do and good strategy. Dr. Sullivan is the author of the new book, Career Prescription Guide: A Physician's Guide for Career Transformation or Advancement . She recently joined SoundPractice to share what she's learned along the way.

Mike Sacopulos: Your career path has been described as a "unicorn path." How did it unfold?

Pam Sullivan, MD, MBA, CPE: It really has been. I started as a physical therapist, then decided I wanted to go into medicine. My plan all along was to become an orthopedic surgeon — I had no doubt about that. But once I got into medicine and completed my residency in internal medicine, I took what I thought would be a one-year position in the emergency room while I finished my applications for orthopedic surgery residencies. That one year turned into more than 20 years in a trauma center. I fell in love with emergency medicine, and it really matched my personality well.

Eventually, because I wasn't emergency medicine board-certified in the traditional sense, I transitioned into urgent care. I got deeply involved in that space and became the first — and for a time, only — female president of the Urgent Care Association of America. From there, I moved into private equity, and I earned my MBA when I was age 50, recognizing that the direction I wanted to go required it.

Being a woman in medicine also shaped the path significantly. Doors to leadership were often closed in ways they wouldn't have been for others. I was also the sole financial provider for my family — my husband was a remarkable stay-at-home dad who built our house and held everything together — so career decisions carried real weight. It wasn't until I earned that MBA and found a mentor in Dr. Greg Daniel that things genuinely opened up for me.

Sacopulos: Tell us about P3 Health Partners and your current work there.

Sullivan: P3 Health Partners is a private equity-based, publicly traded company — a combination that was new territory for me. Our mission is to help primary care physicians thrive in the value-based care world by giving them tools and support systems, and we also operate senior wellness centers where I focus on our highest-risk patients.

The core of my work is keeping chronically ill patients as healthy as possible — ideally at home. We know that when a medically complex patient ends up in the emergency room, it can set off a downward spiral: deconditioning, hospital-acquired infections, unnecessary procedures. My goal is to prevent that by addressing the factors that drive hospitalization for each individual patient and by managing as much as possible in place. We've also just launched a 24/7/365 access center, so patients always have someone to call — reducing the pressure on their primary care physicians and giving patients an alternative to the emergency room for issues that don't require it.

Sacopulos: P3's website talks about patients who are "less likely to utilize high-cost services." How does that actually happen?

Sullivan: It goes back to the fundamentals of value-based care. If you do the right things for the patient — and I've always kept patients as my North Star — the financial outcomes tend to follow. You don't have to chase the numbers.

We supplement, rather than replace, each patient's primary care physician. Because we can spend more time with patients, we can really understand their personal goals, walk them through their advance care directives, and make sure they understand their disease processes well enough to reach out before a crisis. I'm a firm believer — especially after two decades in the emergency room — that everyone 18 and older needs to have advance care directives in place. Knowing what patients want, and making sure their families know too, changes how care unfolds in profound ways.

Sacopulos: Does this model only benefit patients who stay with the program long-term?

Sullivan: Patients who are with us longer do tend to see compounding results, because we're able to work progressively down the list of factors driving their health challenges. But someone who's just joined still benefits — absolutely. And what we've observed, both here and at the previous company where I did similar work, is that patients value the services so much that they choose to stay with their health plan rather than risk losing access. They make that decision themselves, which tells you something about what the program means to them.

Sacopulos: What did 20-plus years in emergency medicine teach you about people?

Sullivan: Honestly, it was more about what I learned about myself. Early in a career like that, it's easy to become jaded. You're exhausted, working long hours, raising a family — and it becomes tempting to just see the task in front of you rather than the person behind it. There was even a phrase that got popularized in those days: "Gomer — get out of my emergency room." That kind of thinking crept in.

Over time, I came to understand that no one chooses to have a substance use disorder or alcohol use disorder. Those conditions arise from circumstances, family history, environment, and lack of options. I always believed in treating everyone the same — whether it was the hospital CEO or someone who was homeless — but the depth of that belief genuinely changed over the years. I saw it most clearly just last week, when a former ER colleague posted about a patient with alcohol use disorder who had been in our emergency room almost every day for years. Incredibly intelligent man — on slow nights you could have a real conversation with him. He recently passed, and every one of us felt the loss. He had become part of our family in a way.

Sacopulos: Many guests on this podcast have noted declining public confidence in healthcare. Do you share that concern?

Sullivan: I do, and I've experienced it personally in a way I hadn't before. When I moved between positions and temporarily lost employer benefits, I found myself paying a substantial amount out of pocket every month — and still facing $800 in out-of-pocket costs just for basic immunizations like the flu shot, a COVID vaccine, and pneumovax. It was a genuine eye-opener.

I've long believed that everyone deserves equal access to healthcare. But when you live it yourself — putting off dental appointments, skipping things you know you should do — it becomes real in a different way. There are so many layers to this: the litigiousness of our society, defensive medicine, the complexity of navigating the system. I practiced in a trauma center for 20 years and never had a lawsuit against me — and I'm proud of that — but I've watched colleagues do everything right and still end up in litigation. It's a hard system to reform. But I think the foundation has to be universal access: making sure healthcare is not only available to everyone but genuinely navigable.

Sacopulos: What's making you optimistic about where healthcare is headed?

Sullivan: Programs like the ones at P3 give me real hope — the idea that we can meet patients wherever they are, literally and figuratively. Just last week I had a patient who couldn't make it to her appointment because she could barely move through her own home. Her walker was too wide for the paths she had cleared to get from her bed to the bathroom. Our response was: we'll come to you. That kind of care feels right.

I'm also encouraged by what I saw at Nest Health, a company I consulted with that serves Medicaid patients in their homes in the New Orleans area and in Arizona. Think about a single mother with several children at different ages trying to get everyone on a bus to take one child to a doctor's appointment — the cost, the logistics, the sheer effort of it. Nest Health goes to the home. And once one person in a household qualifies, they extend care to every Medicaid-covered member under that roof. They're providing immunizations, primary care, the works. It's a model that actually meets people where they are.

Sacopulos: What advice do you have for physicians who are early in their careers?

Sullivan: Give yourself grace. Medicine is only one piece of what you need to learn when you're starting out. You also have to learn the culture of the organization you're joining, the workflows, the electronic medical record systems — all of it takes time, and none of it comes perfectly at first.

Surround yourself with great mentors. Treat everyone on your team — nurses, environmental staff, every single person — with dignity and respect, because every one of them has something to contribute to patient care. And resist the temptation to be narrow in your focus. Look at everything around you. I had to learn that the hard way, and it took me longer than I wish it had.

Sacopulos: What's next for you as a physician leader?

Sullivan: I'm genuinely excited about what I'm building at P3. This high-risk program has real potential to improve the lives of patients who are chronically ill or approaching later stages of life, and getting to do work that brings me joy is something I don't take lightly.

I've had positions that paid extremely well. I've also taken a role that was about a 40% pay cut — and that turned out to be one of the happiest periods of my career. That experience taught me that success looks different at different stages of life. Right now, success for me means happiness: helping a company grow, helping a patient navigate their healthcare journey, making things a little easier for a caregiver. If I can do those things, I can sleep well at night. And that's enough.

Listen to this episode of SoundPractice .