It’s a question that looms over Pete McCanna, CEO of Baylor Scott & White Health.
In Texas, where everything is bigger, his organization is no exception. Baylor Scott & White is the state’s largest nonprofit health system, with 52 hospitals and more than 1,300 sites of care.
Mr. McCanna has served at the helm of the Dallas-based organization since 2022. He spent nearly 40 years shaping health systems across the U.S. before then, from academic medical centers to safety-net hospitals, with leadership roles at Northwestern Medicine in Chicago, Presbyterian Healthcare Services in Albuquerque, UCHealth and Denver Health. In 2017, he was recruited by former Baylor Scott & White CEO Jim Hinton to join the system’s executive team, becoming his successor five years later.
Mr. McCanna shares the same paradox as many other health system CEOs: the blessing and curse of scale. Long heralded as the competitive advantage in healthcare and solution to many woes, scale can offer operational efficiencies, financial leverage and capacity to deliver more services to more people. Yet, as health systems grow larger, they risk becoming impersonal — more anonymous and frustratingly complex for the patients they serve.
Mr. McCanna understands this tension not just professionally, but personally. “I think what’s most driven how I lead today and the goals for Baylor Scott & White has been my personal experience over the last several years, particularly with helping my brothers and my sister care for my mom and my dad — particularly my dad.”
His father’s battle with Parkinson’s disease in recent years forced him to confront the health system’s blind spots beyond the traditional executive dashboard.
“The health system he was in was failing him and he had good technical care, but every other aspect that he needed was incredibly difficult and caused unnecessary suffering for him,” Mr. McCanna said. “And we wouldn’t be surprised by it.”
As one of seven siblings, Mr. McCanna was part of a family unit managing his father’s care. Each of them saw, up close, the pain points embedded in the system — like the neurologist appointments that required an all-day logistical effort for a conversation that lasted barely 20 minutes. There was the cardiologist managing his father’s blood pressure problem, a neurologist for his Parkinson’s, then an injury suffered from a fall, adding need for primary care coordination (“That was a disaster,” Mr. McCanna recalls).
For Mr. McCanna, a veteran healthcare leader, these experiences made for candid conversations with his father.
“He would ask me continually, ‘Why is it designed this way? Why can’t my neurologist come to me?'” Mr. McCanna said. “I really saw through his eyes how our health systems have evolved over time, where they’re falling down and how impersonal they are. Health systems generally, and this is a criticism of all health systems, are episodic, reactive, very impersonal and — in many respects — paternalistic.”
Mr. McCanna’s experience is far from unique — and it’s only going to become more common as Baby Boomers age. By 2035, the number of Americans age 85 and older is expected to surpass 9 million, a 35% increase in just 15 years, signaling a sharp rise in the need for intensive caregiving. “We’re already seeing it,” Mr. McCanna said, “but over the next 20 to 30 years, the ability of family members to manage and coordinate someone’s care will be crucial.”
Yet even in its growing commonality, the experience of caring for his father left Mr. McCanna with an even stronger conviction: healthcare must shift from a provider-centric model to one that is truly demand-driven — one that adapts to the needs of patients and families, rather than forcing them to navigate a system built for the convenience of hospitals and clinicians.
Finding leverage points
But what does that look like in practice? Baylor Scott & White is trying to answer that question in real time.
The system’s vast brick-and-mortar network and digital platform serving over 3 million connected customers is testing what it means to be demand-driven, attempting to reshape care delivery at scale. The system also has the financial strength — it posted nearly $1 billion in operating income with a nearly 8% operating margin in 2024.
“We are committed to reinvesting every dollar we earn back into our communities,” Mr. McCanna said. That reinvestment fuels a steady stream of patient-driven improvements. Now in their eighth iteration of the MyBSWHealth platform, the system has made more than 100 enhancements based on customer feedback. The focus isn’t just on building technology, but on ensuring patients actually use and benefit from it.
Mr. McCanna describes his approach to transformation as “inside-out,” focused on maximizing the system’s existing strengths while layering in new technologies and services to elevate the customer experience. His focus runs counter to much of the steady attention healthcare can often pay to outsiders coming in, be it Amazon, Walmart, Apple or other tech-retail behemoths that — so far — have yielded mixed results and limited staying power. He maintains health systems are uniquely positioned to transform healthcare because of their proximity to the customer and patient.
“There are disruptors, but the complexity of their connection to the overall ecosystem is a big hurdle,” Mr. McCanna said. “We’ve got 3 million connected customers on our app. If we’re going to transform the way that we allow them to access, navigate and receive care and manage their health, it’s on us. And we need to do that.”
Partners play a central role in this work, which currently focuses on reimagining solutions to common customer pain points — whether by eliminating traditional clinic check-ins or creating seamless and immediately accessible care pathways for conditions like chronic headaches and postpartum recovery.
The aim is to dismantle the everyday frustrations that patients have come to accept as inevitable. In fact, Mr. McCanna notes, one of the greatest barriers to improvement is the widespread belief that such friction is normal — a mindset shaped by years of navigating inefficient systems. (“That level of friction shouldn’t be there,” he said. “It really shouldn’t be there.”)
Baylor Scott & White is applying consumer research techniques borrowed from retail and other industries — conducting focus groups, studying patient behavior, and analyzing real-time data to pinpoint navigation and access issues and design solutions that respond directly to them. One new patient-first tool is the system’s “Help Me Decide” feature within the MyBSWHealth app. It’s a first-contact navigation tool that blends AI and human support, allowing users to describe their symptoms and be guided to the most appropriate site of care.
Based on thousands of interactions, the data revealed that 70% of users would have selected the wrong care setting if left to decide on their own. Roughly 85% of users who were ultimately directed away from the emergency department had originally planned to go there. “That kind of misrouting adds cost, adds friction and often goes unnoticed in broader conversations about healthcare spending,” Mr. McCanna said.
The system is looking to pressure-test its digitally enabled health solutions in the real world, too. Baylor Scott & White is testing and commercializing a portfolio of products under a new brand called Levanto, launched in December 2024. The system is seeking feedback from large employers and payers — not just its own internal stakeholders — on tools for care navigation, virtual health, chronic condition support, headache care, maternal health support and musculoskeletal care. External scrutiny, Mr. McCanna says, will sharpen the products, accelerate consumer benefit, and guard against the common trap of falling in love with in-house solutions simply because they were born inside the system.
Workforce development is also a top priority. The system currently employs more than 57,000 people, including 3,200 physicians. Another 4,000 physicians are credentialed at its facilities. To add more depth, Baylor Scott & White is taking an upstream approach and focusing on growing talent rather than just shifting it around.
In 2024, it was one of about a dozen health systems selected by Bloomberg Philanthropies to co-develop healthcare-focused high schools. The result: Uplift Heights Healthcare Institute, which opened in West Dallas that same year. Designed in partnership with Baylor Scott & White, the school offers a specialized curriculum, mentorship from health system professionals, hospital-based internships, and immersive summer camps — all aimed at preparing students for meaningful careers in healthcare.
Mr. McCanna said the future healthcare workforce requires many roles and must include more than those roles requiring traditional four-year or graduate degrees.
“Why not create a pipeline for energetic, motivated kids who want to be trained and get a good job? We’ve got thousands of those within healthcare. Why not go upstream and give them the opportunity in that pathway? That’s the goal,” he said.
Size is not strategy
With Texas on track to rival California as the most populous state by 2045, Baylor Scott & White has no choice but to grow alongside its communities. But as it expands, Mr. McCanna’s vision remains clear: bigger is not better unless it’s paired with a radically customer-centric health system built for convenience, personalization and proactive care.
“We haven’t solved healthcare yet,” Mr. McCanna admits. “But if we stay focused on the customer and commit to bold action, we will achieve our mission of improving the well-being of our patients and communities.”
It’s a vision shaped by data and design, but also by something quieter and more personal. If Baylor Scott & White can eliminate the friction that defined his father’s healthcare experience, Mr. McCanna believes the system won’t just work better. It might finally feel a little smaller in the biggest of ways.
