IIt wouldn’t have taken a tragedy to spark a national debate about our failing health care system and the pain it causes. But the question now is, how can we use this moment of collective focus to fully recognize how poorly the American public is served by our healthcare system? And what can be done to fix it? Technology has the potential to be part of the solution or exacerbate existing problems.
The fallout from the murder of UnitedHealthcare CEO Brian Thompson has been far-reaching. UnitedHealth Group Stocks abandoned by nearly 15% in the days following the shooting. And shares of other insurers, like Cigna and Humana, also fell. The day after the shooting, Anthem Blue Cross Blue Shield announcement this would put an end to his controversy plan to limit the reimbursement of anesthesia for surgical procedures beyond certain deadlines.
The attack also sparked renewed anger at our failing healthcare system. It’s not hard to understand why people are furious. A 2023 American Medical Association (AMA) Survey find that 94% of doctors said prior authorization requirements delayed care, and 78% said it sometimes caused patients to forgo seeking care altogether. Nearly one in four said prior authorization requirements had led to serious adverse consequences for patients. According to an Experian investigationdenials of health claims increased by 31% between 2022 and 2024. And appealing such a denial is rarely successful. THE Patient Advocate Foundation estimates that in 2018, case managers should initiate on average 16 phone calls or emails to resolve a complaint. This number now stands at 27.
So it’s no surprise that the number of Americans rating the quality of their health care positively is at an all-time high. lowest point since Gallup began tracking these sentiments in 2001. And those in less health, likely those who interact with them, more with the health system – tend to give their health insurance has lower ratings.
Symptoms of our sick health system
The healthcare sector not only needs incremental solutions, but also transformative change. For example, soaring costs clearly demonstrate how our current system is unsustainable. Health care costs rose from $353 per capita in 1970 ($2,400 in today’s dollars) to $14,423 in 2023. Health spending has reached 4.9 trillion dollars in 2023, an increase of 7.5% from 2022, with projections close to $6 trillion by 2027. The average annual premium for family coverage reached $23,968 in 2023 and this number is expected to increase by approximately 8% over the next year. According to Willis Towers Watsonemployees spend up to 25% of their take-home pay on healthcare premiums. And a 2022 study found that one in three adult Americans has medical debt – $220 billion in total – and that medical debt is the leading cause of bankruptcy in the United States.
This is largely due to administrative overload. AthénasantéResearch suggests that since 1970, administrative staff at insurance companies has increased by 3,200%, but productivity has declined. And the administrative demands placed on physicians have a significant impact on the time they can devote to patient care. On average, doctors only spend a third of their time devoted to clinical care. The rest is devoted to administrative tasks. This is yet another form of refusal of care. And it’s not just terrible for patients. According to the AMA, almost half (48.2%) of doctors report experiencing at least one symptom of burnout.
Can AI help heal our healthcare system?
These high costs and administrative burden make the healthcare sector primed for disruption and transformation. AI is already transforming almost every industry. What this will mean for healthcare is the subject of an upcoming article, “The GenAI Juggernaut: US Healthcare Is Not Prepared,” authored by Eric Larsen, healthcare industry veteran and board member of Thrive.
“The promise of AI in healthcare is immense,” writes Larsen, who suggests that the healthcare sector “is the one most exposed to disruption from GenAI.”
Many experts agree that AI has the potential to significantly reduce administrative costs, including burdens on physicians. “At first, we will view generative AI as a boon and deliverance for doctors: streamlining administrative tasks and reducing bureaucratic burdens, bringing a kind of ‘restoration of joy’ to the practice of medicine,” writes Larsen.
But just as important is what AI can mean for patients. The goal should not just be to provide more care, by increasing the time doctors can spend with patients, but also better care, through personalization. As Larsen writes, the real “killer application” of AI will be one that can use personal data, behavioral health data, biometric data, pharmacological data and social determinants of health to “distill insights advice at a hyper-personalized level of specificity.”
Currently, our balkanized downstream “sick care” system treats all aspects of our health – our physical health, our mental health, the medications we take, our daily lifestyle choices – in isolation. But of course, all of these aspects of our health are deeply interconnected. I believe that AI promises to integrate and unify them and thus improve holistic health.
People aren’t just angry at health insurers and pharmacy benefit managers. They also want to take more control of their own health. A growing number of Americans (65%) turn to Google for health advice. It is 70,000 searches per minute and more than a billion per day. And more and more Americans are now using AI chatbots like ChatGPT, Gemini, and Claude to answer their health questions. The problem is that only 40% find online health content reliable, and when people find credible information, they are unable to use it practically and integrate it into their lives. Hyper-personalized AI can fill this gap.
As we see with the AI coach developed by Thrive AI Health, AI hyper-personalization helps reduce friction and help people adopt healthier behaviors that can lead to dramatically improved health outcomes. best. Like Daisy Wolf and Vijay Pande by Andreessen Horowitz wrote“The most important changes in human health are not only about curing all diseases, but also about 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 have struggled. This is why companies like Microsoft building teams to focus specifically on consumer health.
Will AI be used to help or harm patients?
Patients are eager to use tools that will give them greater control over their health. Whether the healthcare industry is ready to use AI to benefit patients is another matter. After the shooting, reports came out detailing the lawsuits UnitedHealthcare and Humana are facing due to their use of algorithms to systematically deny patient claims. The lawsuit against UnitedHealth claims that 90% of the algorithms’ decisions were overturned on appeal.
It’s an important reminder that AI is just a tool. It can be used to worsen the system flaws that fuel so much outrage, or it can be used to give doctors more time to treat patients and more support for patients to improve their health between doctor visits through to personalized behavior change.
Like Michele Gershberg and Michael Erman report Reuters reported that in the wake of the Thompson shooting, “health care companies are stepping back to better understand patient experiences.”
I would argue that they also need to take a step forward and use AI not to maximize profits by more effectively withholding care, but to maximize health outcomes by enabling better healthcare and habits in matters of health.
“We know that the health care system is not working as well as it should and we understand people’s frustrations on this issue. » wrote Andrew Witty, CEO of UnitedHealth Group at New York Times. “Our mission is to contribute to its better functioning. »
The time has come to act to fulfill this mission. The U.S. healthcare system is currently an oligopoly, concentrated in the hands of a few CEOs who wield immense power over the lives of millions of people. With great power comes great responsibility. The health care system is at the center of our national and personal conversations. Healthcare leaders must take this opportunity to not only talk about the need for big changes, but also to make big changes happen.