Most mornings, as the sun rises, Dr. Clay Johnston is already miles into a long run. It is a daily habit of physical discipline and a mental clearinghouse, but the ritual offers time to focus on a rebuilding project far more complex than any marathon.
As the inaugural dean of the University of Texas Dell Medical School, Johnston became known in Austin for building a world-class institution from the ground up. Today, he has swapped the classrooms for the front lines of care, serving as the Co-Founder of Harbor Health. He is on a mission to redesign the entire healthcare system to actually keep people healthy while saving everyone money.
A Design Journey to Better Health
Johnston’s path to medicine was not a straight line. Despite coming from a long lineage of physicians, he initially rebelled against the family career to study architecture. Though he eventually followed his love for science to Harvard Medical School and a neurology residency at the University of California, San Francisco, that "design" talent never left him.
He brought that talent to Austin in 2014 as the architect of Dell Medical School. He pushed back against old models of care and prioritized positive patient outcomes over the sheer volume of doctor visits and services.
“The U.S. spends nearly $15,000 per person each year on healthcare,” said Johnston. “That’s significantly more than any other high-income nation, yet no one is concentrating on improving health outcomes. We need a system that removes wasteful spending and focuses on true wellness.”
His team at Dell Med successfully improved patient outcomes by rethinking care delivery. However, they hit a wall when they could not get insurance companies to pay for the new, more efficient models. So Johnston left academia and transitioned from building a medical institution to building a clinical model that would eventually integrate health insurance plans.
Rebuilding the Health System Will Require Endurance
To fix the system, he had to fix the way we pay for it. Alongside insurance entrepreneur Tony Miller, Johnston co-founded Harbor Health in the fall of 2022 as a primary and specialty clinic group in Austin. The company quickly expanded into Dallas, San Antonio, and El Paso and started offering doctor-designed health insurance plans to employers and individuals. Having more control over the payment side along with care delivery is vital in Johnston’s vision of healthcare transformation.
“By offering care and coverage together, our model allows clinicians to take better care of people through every step of their journey,” explained Johnston. “We integrate AI technology we developed that helps us align insurance benefits with what people truly need, not just what generates a bill.”
Johnston is quick to dismiss accolades about his most recent “design” work at Harbor, crediting the clinicians, staff, and investors who share his vision. From the moment he decided to follow in his father’s and grandfather’s footsteps in medicine, he knew there were challenges to overcome in the system. He also knew it would take continuous innovation and endurance to get the system better aligned with what people truly need. Better health. He remains committed to this journey for the long run.
“I don’t want it to be about me,” said Johnston. “But leaders will need to keep stepping up, taking risks, and being accountable for their actions. Rebuilding the system will take time and perseverance, but the health of all people depends on it.”