Fireside Chat: Bernd Montag

Session Focus

The conversation covered imaging’s expanding role beyond diagnosis, the gap between AI’s promise and its deployment, healthcare consolidation and what economies of scale should mean, and why professional identity determines whether technology gets adopted.

Imaging as More Than Diagnosis

Montag pushed back gently on the framing of imaging as a radiology story. The medical image sits at the core of progress in many directions, and imaging transforms care well beyond diagnosis.

His reasoning runs through disease biology. Cancer, Alzheimer’s, stroke and cardiovascular disease, together accounting for roughly 75 percent of deaths, are all processes. There is a first calcification, a first amyloid plaque, a first cancer cell.

That makes imaging a matter of early detection and potentially prevention, then diagnosis, then therapy selection, and frequently an integral part of the therapy itself. He cited image-guided radiation therapy, left atrial appendage closure devices that only work with good imaging, and spine surgery requiring integrated imaging.

The underlying purpose is personalization: identifying where an individual patient sits in the disease process and what the best next step is. Delivering that personalization at scale is the global challenge, and AI is essential to making it affordable, because there are not enough personalizers of care and what can be automated must be.

Why the AI Gap Is Not Technological

Asked about the worldwide gap between AI’s promise and actual implementation, Montag was clear that better technology is not the missing ingredient.

He framed it as a question of identity, and said he meant the philosophical word seriously. What is the role of a company like his, of a health system, of a physician, in this process?

For his own company, the implication is that it cannot see itself simply as the provider of photon-counting CT, seven Tesla MRI, cath labs and linear accelerators. The role is partnership in making healthcare delivery efficient rather than a transactional supply relationship, including creating signature procedures performed at high quality repeatably.

On the receiving end, he identified two gaps. First, process capability as an organizational muscle. In industry, people grow up understanding that part of their role is optimizing the process. In medicine, one grows up to become a better physician, which is right and necessary, but health systems also need the process discipline.

Second, and more important to him, the change in how physicians see themselves. Institutions discuss deploying technology extensively and rarely discuss how it changes professional self-conception. Automation is often perceived as a threat rather than as something that elevates the role and frees a physician for more meaningful work. Without a rollout for the change in role, the effort gets stuck.

He returned to an analogy from a book he read thirty years ago about the pocket calculator. Every technological advance first looks like a threat, and then helps people find the actual core of their job. A CFO is not a calculating machine. A radiologist, he suggested, is not a pattern recognizer.

What Consolidation Should Deliver

Montag prefaced this section by describing himself as the German observer of American healthcare, then made a pointed argument.

When companies merge or systems combine in any industry, the purpose is economies of scale. In healthcare, that should mean care gets better because the system is bigger, and more efficient, cheaper and more accessible because it is bigger.

He suggested that is not currently the driving force. The considerations tend to be keeping patients within the system and improving negotiating power against payers, which arguably makes care more expensive. The original paradigm, getting bigger in order to do better things for patients, is not necessarily what is operating.

He noted the pattern differs internationally. In markets where healthcare is profitable, adding a hospital simply produces more hospitals, not a better chain.

His company’s ambition is to act more as a consultant and partner to the C-suite and to radiology leadership on exactly this problem. He suggested the field should not be shy about learning from private equity-owned radiology chains, which come from an economy-of-scale background and drive efficiency and standardization.

The people he wants to work with are those who can answer a specific question: I now have 65 radiologists in my network, so how am I better than 65 individual radiologists? Not everyone in a leadership role genuinely feels that way.

In Defense of the Silo

Asked how to shift physicians toward standardization when they are already delivering good care, Montag offered a corrective on language.

The people called silos are typically doing exactly what they were asked to do, which is to be excellent at hand surgery, and then focusing on hand surgery. When they do not cooperate elsewhere, they get labeled. He suggested resistance often starts with the word.

He was careful to distinguish healthcare from industry. Physicians carry an ethos, expertise and responsibility that he believes has no real equivalent in a company. Attending a professional congress produces a loyalty to being a radiologist or radiation oncologist that a marketer does not feel about marketing.

What health systems need to develop is the understanding that an expert sits both inside a specialty and inside the institution’s overall agenda. Companies achieve that through explicit KPIs and explanation. Building that identification with a shared agenda is the step that makes technology deployment possible. Dumping technology in without creating the mindset first, he said, is difficult.

Key Takeaways

1. Imaging spans detection through therapy. Framing it as diagnosis understates its role in cancer, Alzheimer’s, stroke and cardiovascular care.

2. The AI implementation gap is about identity, not technology. Deployment stalls when professional self-conception is not addressed alongside the tools.

3. Automation should elevate rather than threaten. The pocket calculator analogy: technology helps people find the actual core of their job.

4. Scale should lower cost and raise quality. Negotiating leverage against payers is not the economy of scale that benefits patients.

5. Silos are usually doing what they were asked to do. Resistance often begins with the label rather than the behavior.

6. Vendors need to become partners. A transactional equipment relationship does not produce process improvement.