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The U.S. health care system desperately needs reform to rein in costs, improve quality, and expand access. Federal policy changes are essential, of course; however, top-down solutions alone cannot fix a wasteful and misdirected system. The industry also needs transformation from the bottom up, by entrepreneurs and intrapreneurs—the kind of trailblazers we’ve been studying over the past several years. In our work, we’ve seen innovations championed by CEOs of start-ups who understand that needed reform is not going to come anytime soon from government regulators.

The blood-testing startup Theranos is now firmly in disgrace. Founder Elizabeth Holmes was indicted Friday on federal wire fraud charges and has resigned as the company’s CEO. But whatever happens with Holmes and Theranos, the episode has changed the conversation around biotech investing. Michael Greeley is general partner of Flare Capital Partners in Boston, which specializes in funding health care technology companies. He spoke with Marketplace Tech host Molly Wood about what Theranos' downfall means to the industry overall. The following is an edited transcript of their conversation.

A staggering $453 billion will be spent on pharmaceutical products in 2018 in the United States per Statista analyst estimates. Ten years ago, that amount was $291 billion. With 326 million Americans, that is nearly $1,400 per capita. Into this marketplace enters Aspen Health, our most recent “semi-stealth” investment which is focused on enabling pharmacists to practice to their fullest potential.

Monday mornings are one of the busiest times of the week in the emergency room at the Mayo Clinic in Rochester, Minnesota. On one Monday in May, a middle-aged man tells Dr. Daniel Grossman he's been feeling weak and having heart palpitations.

"They keep telling me my heart's fine but yet I have no energy, I want to pass out all the time," the man says, "you know, things are just telling me there's something wrong with my heart."

After a few more questions, the doctor recommends some blood work, and pulls open the curtain to head back to the ER.

It's a typical doctor-patient interaction, but one thing is unusual: Both the patient and the doctor are in wheelchairs — the patient because he's visiting the emergency room, and the doctor because of a spinal cord injury. Grossman, 37, lost the use of his legs less than a year ago, and he's already back at work.

Buoy Health, an online platform that uses an AI chatbot as a gateway into healthcare treatment, has teamed up with Circulation, a technology startup that helps connect patients in need of medical transport with rides from Lyft, Uber, and other specialized options like wheelchair vans and non-emergency ambulances.