Our Healthcare System Is Broken. Can Technology Help? 

IIt shouldn’t have taken a tragedy to spark a national conversation about our broken healthcare system and the suffering it causes. But the question now is: How can we use this moment of collective focus to fully acknowledge how poorly the American people are served by our healthcare system? So what can be done to fix this? Technology has the potential to be part of the solution or to make existing problems worse.

The ripple effects of the murder of UnitedHealthcare CEO Brian Thompson have been significant. Shares of UnitedHealth Group fell It rose by nearly 15% in the days following the conflict. Shares of other insurers such as Cigna and Humana also fell. Blue Cross Blue Shield Anthem the day after the conflict announced will end the controversy We plan to limit anesthesia reimbursement for surgeries that exceed certain time limits.

The attack also sparked renewed anger at our broken healthcare system. It’s not hard to understand why people are angry. 2023 American Medical Association (AMA) survey to create 94% of doctors said prior authorization delays care, and 78% said it sometimes causes patients to give up on seeking care altogether. Nearly one in four said prior authorization requirements lead to serious negative consequences for patients. According to an Experian questionnaireBetween 2022 and 2024, health claim denials increased by 31%. And appealing such a rejection is rarely successful. Patient Advocate Foundation In 2018, on average, case managers 16 phone calls or emails to resolve a claim. This number has now increased to 27.

So it’s no surprise that the number of Americans who rate the quality of their health care positively is so high. lowest point Since Gallup began tracking such sentiments in 2001. And those in poorer health are likely to interact tendency to become more involved with the healthcare system to give health insurance scores are lower.

Signs of our ailing healthcare system

The healthcare industry needs not just incremental fixes, but also transformative change. For example, rising costs clearly reveal how unsustainable our current system is. Healthcare costs rose from $353 ($2,400 in today’s dollars) per person to $2,400 in 1970. $14,423 In 2023. Health expenditures reached the following level: $4.9 trillion It is predicted that in 2023, it will reach 6 trillion dollars by 2027, with a 7.5% increase compared to 2022. The average annual premium for family insurance has reached: $23,968 in 2023 This number is expected to increase by approximately 8% next year. Accordingly Willis Towers WatsonEmployees spend 25% of their take-home pay on health premiums. And a 2022 to work It was revealed that 1 in 3 adult Americans have medical debt ($220 billion in total) and medical debt is the leading cause of bankruptcies in the US

Much of this is due to administrative bloat. athenahealth‘s research shows that the number of administrative staff in insurance companies has increased by 3,200% since 1970, but productivity has decreased. And administrative demands on doctors have a huge impact on how much time they can devote to caring for patients. On average doctors only one third The remainder of their time in clinical care is spent on administrative tasks. This is another form of denial of care. And it’s not just scary for patients. According to the AMA, nearly half (48.2%) of doctors report If you are experiencing at least one symptom of burnout.

Could artificial intelligence help improve our healthcare system?

These high costs and significant administrative bloat leave the healthcare industry vulnerable to disruption and transformation. Artificial intelligence is already transforming nearly every business sector. What this will mean for healthcare is the subject of an upcoming article, “GenAI Juggernaut: U.S. Healthcare Is Not Ready,” by healthcare veteran and Thrive board member Eric Larsen.

“The promise of AI in healthcare is enormous,” Larsen writes, arguing that healthcare “has the surface area most exposed to GenAI disruption.”

Many experts agree It is stated that artificial intelligence has the potential to greatly reduce administrative costs, including the burden on doctors. “Initially, we will see Generative AI as a blessing and a salvation for doctors, streamlining administrative tasks and reducing bureaucratic burdens, providing a sort of ‘restore of joy’ to the practice of medicine,” Larsen writes.

But equally important is what artificial intelligence can mean for patients. The goal should not be to provide more care by increasing the time doctors can spend with patients, but to provide better care through personalization. As Larsen writes, the true AI “perfect application” will be one that can use personal data, behavioral health data, biometric data, pharmacology data, and social determinants of health to “distill guidance to a hyper-personalized level of specificity.”

Currently, our Balkanized system of “patient care” treats all aspects of our health separately—our physical health, our mental health, the medications we take, our daily lifestyle choices. But of course all these aspects of our health are deeply interconnected. I believe AI holds the promise of integrating and unifying these and thus improving holistic health.

People aren’t just angry at health insurers and pharmacy benefit managers. They also want to have more control over their own health. An increasing number of Americans (65%) turns to Google for health advice. This 70,000 searches per minute and more than 1 billion per day. And more and more Americans now use AI chatbots like ChatGPT, Gemini, and Claude to answer their health-related questions. The problem is only 40% They find online health content reliable, and when people find reliable information, they fail to use it practically and incorporate it into their lives. Hyper-personalized AI can fill this gap.

As we see with the AI ​​coach developed by Thrive AI Health, the extreme personalization of AI makes it possible to reduce friction and help people adopt healthier behaviors that can lead to significantly better health outcomes. Andreessen Horowitz’s Daisy Wolf and Vijay Pande wrote“The biggest step forward for change in human health lies not only in curing every disease, but also in revolutionizing the consumer experience. “We can significantly improve our health by simplifying health monitoring, ensuring medication adherence, and promoting healthier lifestyles—all areas where traditional healthcare companies struggle.” That’s why companies like Microsoft building The teams will specifically focus on consumer health.

Will artificial intelligence be used to help or harm patients?

Patients are eager to use tools that will allow them to have more control over their health. Whether the healthcare industry is ready to use AI for the benefit of patients is another matter. After shooting, reports It detailed lawsuits that both UnitedHealthcare and Humana are facing for using algorithms to systematically deny patients’ claims. The lawsuit against UnitedHealth claims that 90% of the algorithms’ decisions are overturned on appeal.

This is an important reminder that AI is just a tool. It can be used to deepen the flaws in the system that fuels so much anger, or it can be used to create more time for doctors to treat patients and provide more support for patients to improve their health between doctor visits through personalized behavior change.

As Michele Gershberg and Michael Erman report Following Thompson’s shooting, “healthcare companies are stepping back to better understand patients’ experiences,” according to Reuters.

I also argue that they should take a step forward and use AI not to maximize profits by denying care more efficiently, but to maximize health outcomes by providing better healthcare and better health habits.

“We know the healthcare system is not working as it should, and we understand people’s frustrations about that.” wrote Andrew Witty, CEO of UnitedHealth Group New York Times. “Our mission is to help this work better.”

Now is the time to take action on this mission. The US healthcare system is currently an oligopoly concentrated in the hands of a few CEOs who exercise enormous power over the lives of millions of people. With great power comes great responsibility. The healthcare system is front and center in both our national and personal conversations. Healthcare leaders need to use this opportunity to not only talk about the need for big changes, but also to make big changes happen.