The U.S. healthcare system is plagued by inefficiencies, soaring costs, and deteriorating outcomes per dollar invested. With healthcare expenditures surpassing $4.7 trillion and projected to exceed $7 trillion in the next decade, one pressing question remains: why are we spending more yet receiving less? Despite advancements in diagnostics, the widespread adoption of electronic health records (EHRs), and ongoing technological breakthroughs, our system remains fragmented, costly, and ineffective for many Americans.
The Broken Model: More Spending, Worse Outcomes
Over my 30 years in healthcare, I’ve witnessed annual costs balloon from under $1 trillion to more than $4.7 trillion. Yet, the grim reality is that outcomes have not improved. A recent report from Trilliant Health, a Tennessee-based firm tracking healthcare trends, starkly contrasts healthcare spending with actual care utilization.
For instance, between 2012 and 2022, national healthcare expenditures rose from $2.8 trillion to $4.5 trillion, even as hospital admissions and surgical volumes declined. Inpatient surgical volume alone fell from 9.7 million in 2012 to 7.6 million in 2022. This raises an important question: where is all this money going if not towards patient care?
A major takeaway from the report is that, despite spending nearly twice as much on healthcare as peer countries, U.S. healthcare utilization has remained largely stagnant. Even more concerning, health outcomes in the U.S. are worsening in comparison to these nations.
A stark example is the persistent shortage of primary care physicians, a problem that has escalated over decades. This shortage leaves us with fewer primary care providers per capita compared to other developed countries, inevitably leading to poorer health outcomes and an increasing number of “years of life lost.”
Technology Hasn’t Lived Up to the Promise—Yet!
If technology was meant to be the great equalizer, U.S. healthcare has missed the mark. The rapid adoption of EHRs in outpatient settings, soaring from single-digit percentages in 2000 to over 90% today, was anticipated to revolutionize healthcare. The goal was clear: digitize records, improve communication between providers, and enhance patient care.
However, the outcome has been disappointing. Costs have continued to rise without a corresponding improvement in outcomes. Unlike other industries that have successfully harnessed technology to enhance quality and customer satisfaction, healthcare remains mired in inefficiencies. While EHRs have their benefits, they have not proven to be the solution many anticipated. Trilliant Health’s report emphasizes that despite substantial investments in EHR systems, healthcare costs have not diminished; instead, the system is overwhelmed with data yet struggles to deliver coherent, patient-centered care.
The healthcare sector generates more data than any other part of the U.S. economy, yet this data is largely untapped, especially for consumers. The average individual, particularly those over 65, sees five or more providers, each likely using different EHR systems. With nearly 500 EHR systems in use across the country, piecing together a comprehensive view of one’s health becomes nearly impossible.
Let’s consider an experiment: look back at the graph depicting healthcare costs and projections through 2032. Can you identify the moment we transitioned from minimal EHR use to near-full adoption? I can’t. In a debate, one might argue that EHRs have contributed to rising costs. While I wouldn’t go that far, it’s evident that EHRs have created more challenges than solutions. The underlying issue appears to be that consumers are not sufficiently involved or in control of their own health information.
My Confession
For 25 years, I was an advocate for EHRs. We designed, invested tens of millions in, and built three platforms—two as an owner-operator of diversified medical centers and one as a dedicated technology company. Our last platform was certified three times by a U.S. government agency. We know this space from every angle. However, I’ve had a “road to Damascus” conversion: today, I believe EHRs are problematic, contributing to provider and nurse burnout without improving care or meeting consumer expectations. So, what now?
Consumer-Driven Healthcare: The Solution We Need
The U.S. healthcare model is undeniably broken, and it’s clear that traditional approaches are ineffective. The solution lies in empowering consumers. Technology can play a pivotal role, but it needs to shift from serving institutional players to focusing on consumers, equipping them with the tools and information to take charge of their wellness.
Artificial intelligence (AI) holds significant potential in this regard. While many view AI primarily as a diagnostic tool for physicians, the real opportunity lies in consumer applications. AI can provide personalized insights by analyzing a person’s entire medical history rather than just isolated episodes of care. By creating a holistic view of an individual’s health, AI can suggest lifestyle changes, provide early warnings, and allow consumers to securely store and access their medical data.
However, a significant hurdle remains: access to comprehensive health records. Although patients have the legal right to access their medical records, compiling these from various providers and disparate EHR systems can be daunting. This is where AI can intervene. By aggregating and analyzing medical records across multiple providers, AI can offer consumers a coherent view of their health, empowering them to make informed decisions about their care.
The Baby Boomer Factor: A Tech-Savvy Generation Demands More
One often-overlooked aspect of the healthcare discussion is the changing demographics of Medicare recipients. The Baby Boomer generation, now entering retirement, differs significantly from previous generations. These individuals were early adopters of personal computers, cell phones, and the internet. They’ve utilized “Dr. Google” for years and are more engaged with their healthcare than any generation before them.
This tech-savvy generation expects more from the healthcare system. They demand seamless access to their health information, personalized care recommendations, and the ability to manage their health using the same technologies that enhance other aspects of their lives. This is where AI can excel, delivering personalized insights, predictive analytics, and secure access to health records—all at their fingertips.
The Path Forward: AI, Consumer Empowerment, and Healthcare Innovation
To fix the U.S. healthcare system, we must stop waiting for institutional players to change and instead focus on empowering consumers. AI can bridge the gap between a fragmented healthcare system and the needs of today’s tech-savvy population.
By aggregating EHR data, providing personalized insights, and making healthcare information more accessible, AI can help consumers take control of their wellness. There’s enormous opportunity for investors, particularly in the application layer of AI, where consumer-focused innovations are just beginning to emerge.
As we move forward, the key to unlocking AI’s full potential in healthcare will be ensuring that it remains focused on consumers’ needs. By placing patients in the driver’s seat, we can create a healthcare system that is not only more efficient but also more responsive to the needs of those it serves.
While the U.S. healthcare system may be broken, the tools to fix it are already here. AI, combined with a consumer-driven approach, offers the best chance to create a system that works for everyone. The future of healthcare lies not in the hands of doctors or hospitals but in the hands of the people. The time to empower them is now.
-Noel J. Guillama, Chairman
About HealthScoreAI™
Healthcare is at a tipping point, and HealthScoreAI is positioning to revolutionize the industry by giving consumers control over their health data and unlocking its immense value. U.S. healthcare annual spending has reached $4.7 trillion with little improvement in outcomes. Despite advances, technology has failed to reduce costs or improve care. Meanwhile, 3,000 exabytes of consumer health data remain trapped in fragmented USA systems, leaving consumers and doctors without a complete picture of care.
HealthScoreAI seeks to provide a unique solution, acting as a data surrogate for consumers and offering an unbiased holistic view of their health. By monetizing de-identified data, HealthScoreAI seeks to share revenue with consumers, potentially creating a new $100 billion market opportunity. With near-universal EHR adoption in the USA, and advances in technology, now is the perfect time to capitalize on the data available, practical use of AI and the empowering of consumers, in particular the 13,000 baby boomers turning 65 every single day and entering the Medicare system for the first time. Our team, with deep healthcare and tech expertise, holds U.S. patents and a proven track record of scaling companies and leading them to IPO.