IWe didn't need a tragedy to start a national conversation about a broken 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 Americans are underserved by our nation's health care system? And what can be done to fix it? Technology can be part of the solution, or it can exacerbate existing problems.
The ramifications of the murder of United Healthcare CEO Brian Thompson are significant. UnitedHealth Group stock fell nearly 15% in the days following the shooting. Shares of other insurance companies, including Cigna and Humana, also fell. The day after the shooting, Anthem Blue Cross Blue Shield announced it was discontinuing a controversial plan to limit anesthesia reimbursement for surgeries beyond a certain time limit.
The attack also sparked fresh anger over a broken health system. It's not hard to see why people are outraged. In a 2023 American Medical Association (AMA) survey, 94% of physicians said prior authorization requirements delay treatment, and 78% said it sometimes causes patients to abandon treatment altogether. Nearly one in four said prior authorization requirements resulted in significant adverse outcomes for patients. According to a study by Experian, disclaimers of health-related claims increased by 31% between 2022 and 2024. And appealing such denials is rarely successful. The Patient Advocate Foundation estimates that in 2018, case managers needed to initiate an average of 16 phone calls or emails to resolve a claim. The number now stands at 27.
It's no wonder, then, that the number of Americans who rate the quality of their health care positively is at its lowest point since Gallup began tracking such sentiments in 2001. And people in poorer health, perhaps those who have more interaction with the health care system, tend to evaluate the quality of their health care more positively. Health insurance ratings are low.
Symptoms of a sick healthcare system
The healthcare industry needs transformational change, not just incremental fixes. Rising costs, for example, clearly demonstrate how unsustainable the current system is. Health care costs increased from $353 per person in 1970 ($2,400 in today's dollars) to $14,423 in 2023. Healthcare spending is projected to reach $4.9 trillion in 2023, an increase of 7.5% from 2022, and approach $6 trillion by 2027. Family coverage is expected to reach $23,968 in 2023, a number that is expected to increase by about 8% over the next year. According to Willis Towers Watson, employees spend 25% of their take-home pay on health insurance premiums. And a 2022 study found that one in three adult Americans has medical debt, totaling $220 billion, and medical debt is the leading cause of bankruptcies in the United States. .
Much of this is due to the expansion of the management department. According to research from Athena Health, since 1970, insurance company administrative headcount has increased by 3,200%, but productivity has declined. And administrative demands on physicians have a significant impact on the time they can spend caring for patients. On average, doctors spend only one-third of their time in practice. The rest is spent on administrative tasks. This is another form of denial of care. And it's not just scary for the patient. According to the AMA, nearly half (48.2%) of physicians report experiencing at least one symptom of burnout.
Can AI help repair health systems?
These high costs and significant administrative bloat have made the healthcare sector a prime area for disruption and transformation. AI is already transforming nearly every business field. What this means for healthcare can be seen in the upcoming paper “GenAI Behemoth: U.S. Healthcare Isn’t Ready,” by Eric Larsen, a healthcare veteran and member of the Thrive Board of Directors. is the subject of.
“The potential for AI in healthcare is enormous,” Larsen writes, suggesting that healthcare “exposes the greatest surface area to GenAI disruption.”
Many experts agree that AI has the potential to significantly reduce administrative costs, including physician burdens. “Initially, generative AI will be a boon and savior for physicians, streamlining administrative tasks, reducing bureaucratic burden, and providing a kind of ‘joy restoration’ to the medical field,” says Larsen. he writes.
But just as important is what AI means for patients. The goal is not only to increase care by allowing doctors to spend more time with patients, but also to provide better care through personalization. As Larsen writes, true AI “killer apps” will use personal data, behavioral health data, biometric data, pharmacological data, and social determinants of health to create “hyper-personalized It will be possible to “distill guidance to a new level of specificity.”
Currently, our downstream balkanized system of “sick care” individualizes every aspect of our health: our physical health, our mental health, the medications we take, and our daily lifestyle choices. We are dealing with But of course, all these aspects of our health are deeply interconnected. I believe AI has the potential to integrate and unify them to improve overall health.
People aren't just angry at health insurance companies and pharmacy benefit managers. They also want more control over their own health. More Americans (65%) are turning to Google for health advice. This equates to 70,000 searches per minute and over 1 billion searches per day. And now, more Americans are using AI chatbots like ChatGPT, Gemini, and Claude to answer their health questions. The problem is that only 40% of people consider online health content to be trustworthy, and even when people find reliable information, they are unable to actually use it and incorporate it into their lives. Hyper-personalized AI can bridge this gap.
Hyper-personalization in AI reduces friction, empowers people to adopt healthier behaviors, and dramatically improves health outcomes, as seen in the AI coach Thrive AI Health is building I will. Andreessen Horowitz's Daisy Wolfe and Vijay Pande write: By simplifying health monitoring, ensuring medication compliance, and promoting healthier lifestyles, we can significantly improve our health. These are all areas that traditional healthcare companies have struggled with. ” That's why companies like Microsoft are building teams specifically focused on consumer health.
Will AI be used to help patients or to harm them?
Patients are eager to use tools that give them more control over their health. Whether the healthcare industry is ready to leverage AI for the benefit of patients is another question. After the shooting, reports emerged detailing that both UnitedHealthcare and Humana were filing lawsuits over their use of algorithms that systematically denied patients' claims. The lawsuit against UnitedHealth alleges that 90% of the algorithm's decisions are reversed on appeal.
This is an important reminder that AI is just a tool. This could be used to further deepen the flaws in the system that fuel so much anger, or it could be used to increase the amount of time doctors have to treat patients, and to increase the time between doctor visits through individualized behavior change. It can also be used to increase support for patients to improve their health status.
Michelle Gershberg and Michael Ehrman reported for Reuters that in the wake of the Thompson shooting, “health care companies are taking a step back to better understand the patient experience.”
I hope they also take a step forward and improve health outcomes by enabling better health care and better health habits, rather than using AI to maximize profits by more effectively denying care. We argue that AI should be used to maximize
UnitedHealth Group CEO Andrew Whitty told the New York Times: “We know our health care system is not working as well as we should, and we understand people's frustrations about it.'' ” he said. “Our mission is to help it work better.”
Now is the time to act on that mission. The U.S. health care system is currently an oligopoly, concentrated in the hands of a few CEOs who wield tremendous influence over the lives of millions of people. With great power comes great responsibility. The health 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 to make big changes.
