Can AI-Powered Consumer Health Break Medicine’s Destructive Spiral?

This week’s Duke-Margolis Health Policy Conference (video here) left me feeling there’s a remarkable opportunity to leverage technology to dramatically improve healthcare — and there’s almost no chance of it happening within the current healthcare system.

A number of speakers (including UCSF’s Bob Wachter, my WSJ review of his recent book here) were genuinely enthusiastic about the transformative possibility of AI, a technology they said made them feel more optimistic about the opportunity to positively impact healthcare than they would have ever thought possible.

They described opportunities to organize disparate data, enhance chronic disease management, and provide patients with access to increasingly useful medical information and guidance.

Yet — the leading way hospitals are apparently actually leveraging AI? 

Upcoding and other approaches to maximize billing. 

As Jacob Shiff, Chief AI & Technology Officer, CMS Innovation Center, explained,

“Fundamentally, technology is a tool. People use tools based on their incentives. And the dominant incentives in our healthcare environment today are to maximize billable activity volume and intensity. And that is where we are seeing most technologies being deployed. A tool like an AI scribe can enable a clinician to shift non-reimbursable activities towards reimbursable activities and maximally capture every billable encounter, every billable event in an encounter. That’s a path we’re on. It’s going to increase health care costs. It may or may not have the value to show for it.”

And payors, of course, are leveraging AI in kind.  

The result is what appears to be a fatal mutual embrace, a death spiral for medicine, where most everyone involved in the current system of care appreciates how misaligned the incentives are, yet everyone continues to essentially do what they’re already doing, only more so — and the misery just gets worse. 

Costs remain high and the experience of both patients and providers seems to be degrading at an astonishing pace.

It’s not surprising to me that more physicians are opting out of the system, that more patients are turning to consumer health and wellness options, and that savvy entrepreneurs are trying to construct approaches to health that build from the consumer side, as Whoop and Oura (among others) seem intent on doing. 

Of course, it’s easy and appropriate to critique (as I and others such as Eric Topol have) aspects of consumer health, like the embrace of tests (such as biological age) that aren’t validated for individuals. 

But take a half step back and compare the trajectories of consumer health companies with the traditional health system.

Consumer health companies tend to offer elegant patient-centered design, often an emphasis on patient-ownership and management of their data (eg Superpower), and a proactive mindset.

In contrast, traditional healthcare has effectively locked down patient data (as several conference speakers commented), is entirely oriented around reimbursement (or denying reimbursement), and remains fixated on documenting adherence to defined process metrics vs actual patient need.

While it’s clear the guilds of healthcare will fight fiercely to prevent these tech-enabled interlopers from intruding on their turf, popular dissatisfaction with the status quo seems likely to encourage politicians to at least offer disruptive tech-enabled startups meaningfully more room to operate, which will likely only increase as the benefits become more obvious and are experienced by more people. 

Moreover, efforts by the health system to appeal to a gauzy, idealized view of medical care and insist we must defend it will carry less weight as such images feel ever more remote from our lived experiences and interactions with today’s health system.

It’s not only about AI, to be sure, but AI is a powerful driving force. Today’s AI models, University of Pennsylvania’s Ethan Mollick reminds us, are “the worst they will ever be,” and the technology is only getting better.

No one would say that about the trajectory of our current healthcare system.