Transforming Diabetes Care: Innovation, Value-Based Models, and Empowering Patients with Dr. Andy Lee (Los Angeles General Medical Center)

In the latest episode of The Hard Things About Healthcare, we sat down with Dr. Andy Lee, an endocrinologist and industry leader who’s reshaping how one of the country’s largest safety net systems delivers care to patients with diabetes and other chronic conditions.

As Director of Specialty Care at Los Angeles General Medical Center and a key leader in LA County’s shift from volume-based to value-based care, Dr. Lee brings a candid, unfiltered view into the real-world obstacles—and breakthroughs—of modernizing public health infrastructure.

Why Endocrinology? A Love for Systems and Impact

Dr. Lee didn’t choose endocrinology for instant gratification—it was the complexity that drew him in.

“I really love systems... the fact that the body has so many different hormones and systems that we commonly don't really understand that's keeping us healthy... once you start kind of understanding the inherent system that nature has provided for us, that is really fascinating.”

He was also inspired by endocrinology’s track record of real, tangible impact.

“Through the history of endocrinology, there's been a lot of success in actually treating disease. So that's what interested me.”

From Volume to Value: Fixing a Fragmented Safety Net

In 2010, Dr. Lee was brought in to help transform Los Angeles County’s massive healthcare network, which serves many of the region’s uninsured and underinsured.

“Los Angeles County is the second largest municipal network, health network, in all of the United States... And what value based means is that per dollar, what are we doing to improve the health outcomes of these patients?”

One of the biggest hurdles? Government inefficiency.

“Imagine if you're getting healthcare from a DMV, right? That's what government healthcare is, right?... How do you change the structure of government so you deliver better healthcare, which in this country should be a right?”

Aligning Incentives to Drive Real Outcomes

Dr. Lee emphasized that effective chronic disease management—especially diabetes—requires aligning financial incentives with patient outcomes.

“The dollars have to be tied to what the patients need. And that type of sophisticated alignment of incentives in the program did not really exist in a complex healthcare system.”

Instead of reactive care driven by ER visits, the focus shifted to proactive, continuous management:

“You're not seeing patients just once when they hit the emergency room, but actually they're paneled early and you see them through the entire life cycle.”

Laying the Foundation: Data Systems and E-Referrals

A core pillar of LA County’s transformation has been establishing a unified electronic health record across hospitals and clinics.

“We needed one of the initial things we had to transform was just the base level informatics across the entire county... Now the patients can come to LA General for their highly sophisticated diabetes, and I have all their records.”

Dr. Lee also helped build an electronic referral system to flip the default model from specialty-driven to primary care-led:

“The culture now is who is your primary care doctor once they hit an emergency room?... Primary care now has set expected practice where they themselves can manage base level diabetes.”

The Power (and Pressure) of Primary Care Teams

With limited endocrinologists covering the entire county, empowering primary care was essential.

“There's no way that I can manage 50,000 within my cluster of diabetes. So the fact that we have primary care physicians that's knowledgeable in diabetes... is already a big game.”

Dr. Lee champions team-based care, emphasizing non-physician roles like community health workers and PharmDs:

“You do not need to see a physician to refill your medications... They are providers. They prescribe medications. They give them detailed understanding of medications, newer medications like ozempic.”

And increasingly, patients are becoming empowered advocates in their own care.

“There's now a lot of resources... to help them understand the chronic disease well enough to pull the care into their own domain.”

Innovation in Government Healthcare: A Reality Check

Dr. Lee was frank about the limitations of innovation in public systems.

“Health care is really, honestly, it's not a very innovative field... we're generally the last to adopt some new technology.”

Privacy, security, and legacy tech systems—especially EHRs like Cerner—often stifle progress.

“Our healthcare system has become technologically complicated... The folks that own the technology... don’t make it easy when we like something out there.”

Even when new tech is piloted, scaling it system-wide is rarely seamless:

“You bring something new in and knock off 10 other technologies in a big connected system.”

Advice to Innovators: Know Your Curve

For those looking to bring innovation into healthcare, Dr. Lee had this to say:

“You have to build, you have to understand how innovation happens at your organization or hospital... For most, know, C-suite or executive team, many within the healthcare industry... are either late adopters or laggards.”

To succeed, innovators must find major adopters within their system—champions who can validate new solutions before taking them to executive leadership.

“If you have laggards... you need partners that's in the major adopter category... That’s gonna convince the laggards.”

And above all: start small, prove value, and show feasibility.

“Any major organization has to allow some level of tinkering, okay, before you fully commit to a full big launch.”

Final Thoughts: A Vision for Smarter, Human-Centered Care

Dr. Lee’s long-term vision for healthcare doesn’t center on disease—it centers on patients and their real lives.

“What their goal is, look, they wanna be healthy, taking care of their family, going to work without having to take too much time off because they have to adjust their medications.”

That means building systems where technology, teams, and trust empower patients to lead the life they want—without being buried in the bureaucracy of broken infrastructure.

To hear the full conversation, tune into this episode of The Hard Things About Healthcare with Dr. Andy Lee, Matt Faustman, and Ginger Vieira.