Our Healthcare System Is Broken. Can Technology Help Heal It?
It shouldn’t have taken a tragedy to launch a national conversation about our broken healthcare system and the pain it causes. But the question now is how can we use this moment of collective focus to fully acknowledge 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 to exacerbate existing issues.
[time-brightcove not-tgx=”true”]The ripple effects of the killing of UnitedHealthcare CEO Brian Thompson have been significant. Shares of UnitedHealth Group dropped by nearly 15% in the days following the shooting. And shares of other insurers, like Cigna and Humana, also dipped. The day after the shooting, Anthem Blue Cross Blue Shield announced it would halt its controversial plan to limit reimbursement for anesthesia for surgeries that went over certain time limits.
The attack also sparked renewed anger at our broken healthcare system. It’s not hard to see why people are furious. A 2023 American Medical Association (AMA) survey found that 94% of doctors said prior authorization requirements delayed care, and 78% said this sometimes caused patients to give up seeking treatment altogether. Nearly one in four said prior authorization requirements had led to serious adverse outcomes for patients. According to an Experian survey, denials of health claims increased 31% between 2022 and 2024. And appealing such a denial is seldom successful. The Patient Advocate Foundation estimates that in 2018, case managers would have to initiate an average of 16 phone calls or emails to resolve a claim. That number is now up to 27.
So it is no surprise that the number of Americans who positively rate their quality of healthcare is at its lowest point since Gallup began tracking such sentiments in 2001. And those in poorer health—presumably those interacting more with the healthcare system—tend to give their health insurance lower ratings.
The symptoms of our sick healthcare system
The healthcare industry needs not just incremental fixes, but transformative change. For instance, soaring costs demonstrate plainly how our current system is unsustainable. Healthcare costs have risen from $353 per capita in 1970 ($2,400 in today’s dollars) to $14,423 in 2023. Spending on healthcare reached $4.9 trillion in 2023, a 7.5% increase from 2022, with projections nearing $6 trillion by 2027. The average annual premium for family coverage reached $23,968 in 2023 and this number is expected to increase by roughly 8% over next year. According to Willis Towers Watson, employees spend as much as 25% of their take home pay on healthcare premiums. And a 2022 study found that 1 in 3 adult Americans has medical debt—$220 billion in total—and medical debt is the leading cause of bankruptcy in the U.S.
Much of this is due to administrative bloat. Athenahealth’s research suggests that since 1970, the administrative headcount at insurance companies has increased by 3,200% but productivity has declined. And the administrative demands on doctors have a huge impact on how much time they can spend caring for patients. On average, doctors spend only one-third of their time on clinical care. The rest is spent on administrative tasks. This is yet another form of denial of care. And it’s not just terrible for patients. According to the AMA, nearly half (48.2%) of physicians report experiencing at least one symptom of burnout.
Can AI help heal our health care system?
These high costs and significant administrative bloat make the healthcare sector prime for disruption and transformation. AI is already transforming nearly every business sector. What this will mean for healthcare is the subject of an upcoming paper, “The GenAI Juggernaut: US Healthcare Is Not Prepared,” by Eric Larsen, a healthcare veteran and member of Thrive’s board.
“The promise of AI in healthcare is immense,” writes Larsen, who suggests that healthcare “has the greatest surface area exposure to GenAI disruption.”
Many experts agree that AI has the potential to vastly reduce administrative costs, including burdens on doctors. “Initially, we’ll see Generative AI as a boon and a deliverance for physicians—streamlining administrative tasks and reducing bureaucratic burdens, providing something of a ‘restoration of joy’ to the practice of medicine,” writes Larsen.
But equally important is what AI can mean for patients. The goal should be not just more care, by increasing the amount of time doctors can spend with patients, but better care, through personalization. As Larsen writes, the true AI “killer app” 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.”
Right now, our Balkanized system of downstream “sick care” 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 AI holds the promise of integrating and unifying them and so improving 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. An increasing number of Americans (65%) are turning to Google for health advice. That’s 70,000 searches per minute and more than 1 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 do find credible information, they’re unable to make practical use of it and incorporate it into their lives. Hyper-personalized AI can bridge this gap.
As we’re seeing with the AI coach that Thrive AI Health is building, the hyper-personalization of AI makes it possible to lower friction and help people adopt healthier behaviors that can lead to dramatically better health outcomes. As Daisy Wolf and Vijay Pande from Andreessen Horowitz wrote, “The biggest step changes in human health lie not just in curing every disease, but in revolutionizing the consumer experience. We can markedly 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 are building teams to focus specifically on consumer health.
Will AI be used to help, or hurt, patients?
Patients are eager to use tools that will empower 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 the shooting, reports came out detailing lawsuits both UnitedHealthcare and Humana are facing over their use of algorithms to systematically deny patients’ claims. The lawsuit against UnitedHealth claims that 90% of the algorithms’ decisions were reversed 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’s fueling so much outrage, or it can be used to create more time for doctors to treat patients and more support for patients to improve their health between doctor visits through personalized behavior change.
As Michele Gershberg and Michael Erman report for Reuters, in the wake of Thompson’s shooting, “healthcare companies are taking a step back to better understand patients’ experiences.”
I would argue that they also need to take a step forward, and use AI not to maximize profit by more efficiently denying care, but to maximize health outcomes by enabling better health care and better health habits.
“We know the health system does not work as well as it should, and we understand people’s frustrations with it,” wrote Andrew Witty, the CEO of UnitedHealth Group in the New York Times. “Our mission is to help make it work better.”
The time to act on that mission is now. The U.S. healthcare system is currently an oligopoly, concentrated in the hands of a few CEOs who exert tremendous power on the lives of millions. 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 not just to talk about the need for big changes—but to make big changes happen.