Vice President at Bessemer Venture Partners | bio, healthcare, AI | MD Candidate
One key reason why healthcare technologies like AI, telemedicine, and software haven't structurally lowered costs or broadened access for the entire system after decades of experimentation (excluding pure financial engineering of payer contracts) is the limited reimagining of care delivery itself, with asynchronous telemedicine as a notable exception. In the same way that digitizing physical paper failed to exploit the capabilities of a new computing medium for word processing, hosting physician-patient conversations over video does not transform the actual delivery of care. In telemedicine, many of the inputs (e.g., clinician time) and therefore cost structures of in-person care persist, which is why we often see fee-for-service telemedicine companies struggle to achieve economies of scale (i.e., growing revenues non-linearly while growing costs linearly). Until we deconstruct the components of a medical appointment – from intake and triage, to chart review, history gathering, physical examination, diagnosis, treatment, and follow-up – we will continue to be underwhelmed by the disconnect between the transformative potential of these technologies and real-world patient/system impact. I’m optimistic that the emergence of reliable and performant medical AI agents will urge us to perform this deconstruction and redesign the fundamental building blocks of a “medical appointment.”
Jeff L.
2mo
Many of the remote fee for service CPT codes (eg CCM, RPM) also require a fixed amount of time per month and synchronous interaction. You can’t really use AI to save time/money in that case without breaking the rules laid out by CMS and the AMA. And many of the “value-based” or private plans know that their patients will churn between plans every few years, so they aren’t really incentivized to invest in prevention unless maybe it immediately and directly impacts a HEDIS metric. What is exciting to me is the potential of AI to automate a lot of the administrative work around accounting for value-based care (quality metrics), which is a massive source of overhead in itself. That will enable higher resolution metrics/analytics at a fraction of the cost, and it should also make it faster and easier to see where investments in prevention and quality are more likely pay off.
Shantanu Nundy
2mo
Couldn’t agree more. All about reinventing the fundamental care/interaction model
Ozzie E Paez
2mo
The numbers for services like primary care can make fee-for-service models financially unsustainable. On the other hand, subscription-based primary care models can and do work well. The differences can be reduced to the latter producing reliable and predictable revenue streams independent of episodic patient needs and, in cases like direct primary care, free of constraints imposed by government (CMS) and private insurance machinations. These models can benefit from innovative technologies, including advanced physiological monitors, remote patient monitoring, and artificial intelligence.
Michael Doherty
2mo
There's a more fundamental problem. Whether it is flying a plane, driving a car, or making a diagnosis, most people will not accept a non human in those roles until they are convinced it is better than a human. It's not enough to be almost as good or even as good they want any substitute to be better. This is slowing down adoption of many AI possibilities. And even though humans are not error free, they expect any machine substitution to be error free.
Wendy Nguyen
2mo
I mostly believe that it’s not the lack of transformative technology and the reimagining of healthcare delivery that are the cost drivers to the system. It’s mostly an issue of pricing of the technology, related drug treatments and the inelasticity / willingness of consumers, health plans and the government to pay whatever the cost of treatment that’s driving healthcare costs up. Does anyone have a chart 📊 of the key drivers of healthcare costs?
Agree. This and the EHR debacle. The industry is still deadlocked in a debate over which EHR system is superior; why a dozen different EHRs are still in use, why achieving true interoperability remains a decade-long exercise with no end in sight. It's hard to talk about "stickiness" of modern technologies at the point of care if the basics haven't been sorted out.
Nikhil Krishnan
2mo
Feel like the reason it hasn’t lowered cost is because right now you can only bill for additive things but you can’t bill for replacing a process
Megan Hall
2mo
In the deconstruction of medical care, we should also include deconstruction of prescriber gatekeeping. Patients are more educated than ever, and enforcing a medical appointment to ask for low-risk, high-patient-knowledge treatments (UTI treatment, Paxlovid, birth control pills) drives up costs unnecessarily. Pharmacists have the knowledge to dispense many of these products safely and with fewer access hurdles and should be empowered to do so.
Great points, Morgan. This same thinking applies to clinical trials. To realize increased patient access to new therapies, we need to deconstruct the different components that make up a trial. In my view it's partially about emerging technology, but also about changing the operational approach. Significant acceleration of trials, and acceleration of patient access, will require entirely new workflows, beyond "decentralizing" patient visits, which is analogous to telehealth but limited because of the complexity of trials.
AI/Tech Innovation @ TPMG | Medical AI & Informatics Strategy | MDCalc Creator
2moFully agree, I also think you could probably argue there aren’t financial incentives to support the development of a new model. UHG and Medicare advantage create massive profits from such a system, so they have no incentive to change it, either. I also think VBC is extremely challenging when the healthcare system is supposed to keep all of society healthy via a 15 minute appointment a few times a year whilst fighting against the industrial food complex and growing wealth distribution inequality