Consumer Cost Spike – Why AI is the Only Option for Consumers
For years, I’ve been following the nearly monthly reports from Altarum, which provide timely insights into the state of U.S. healthcare. These reports are far more frequent and relevant than the annual reports released by the Office of the Actuaries at the Center for Medicare and Medicaid Services (CMS). For example, last month we discussed the 7.5% increase in National Health Expenditures (NHE) for 2023, a significant figure.
As of October 2024, the most recent Altarum report revealed that NHE had surged from $4.9 trillion in 2023 to $5.32 trillion in 2024. This increase highlights the mounting burden on the healthcare system.
Currently, the vast majority of Americans—about 92%—do not bear the full cost of their healthcare, as they are covered by some form of health insurance. Around 202 million people are covered by private health insurance, 57 million by Medicare, and 74 million by Medicaid, leaving about 30 million uninsured. So, why are Americans so angry?
The answer lies in more than just the frustrations with insurance companies, which have been well-documented, especially following the distressing events of December 4th, 2024. The anger is also driven by the growing share that consumers themselves must pay for their healthcare.
Looking at the latest Altarum report, the data clearly shows that out-of-pocket costs for consumers are increasing. Focus on the green line in the report, which represents the consumer’s share of healthcare expenses—this has seen a noticeable uptick.
The Problem: Rising Utilization and Cost
The problem becomes even more pronounced when you consider the dual pressures of increased utilization and rising healthcare costs. This combination is devastating for consumers, especially the middle class, who are struggling to keep up. Those on Medicaid benefit from essentially free healthcare, and those on Medicare have some cost controls in place, as Medicare sets rates and co-pays, with additional options like Medicare Advantage. However, the burden for those in the top 20% of income earners is still relatively small compared to their total household income. For the vast majority of consumers, healthcare costs are becoming a growing problem.
Why Healthcare Needs Change
At this point, it’s clear that the current system is broken, and we need a change. More healthcare and higher costs are not the answer. Instead, we believe the only viable solution is to empower the consumer. Today, we have access to vast amounts of health data and the tools—specifically AI—that can help consumers take control of their healthcare decisions.
The Need for Consumers to Take Charge
For years, we’ve operated under the belief that whatever the doctor said was the final word. I recall personal experiences with my grandmother and father where the doctor’s opinion was considered irrefutable. However, the advent of the internet has changed that dynamic for many people. I’ll never forget a conversation I had with my mother’s cardiologist, during which I was also texting my son about a serious MRI result. While the doctor was explaining the situation to us—my elderly mother learning about a 5mm aneurysm in her brain—my son was quickly finding highly relevant, accurate information on the internet, which he shared with me in real-time.
This was nearly 10 years ago, and thanks to modern procedures, my mother is doing great today. The critical point is that the information my son found was 100% accurate and helped us make better-informed decisions. Fast-forward to today, and we now have access to exponentially more health data than we did back then—thanks to the widespread use of Electronic Health Records (EHRs). And now, with Generative AI, consumers can not only gather and analyze their health data but can also use AI to receive personalized insights and advice on what to discuss with their healthcare providers.
Why AI is the Only Option
Consumers today are paying more than ever for their healthcare, and the financial and physical burden is felt by all of us. With costs rising, it’s clear that AI is the only real option to help consumers navigate this complex and often frustrating system. By empowering consumers with the tools to analyze their own health data, AI can help bridge the gap between medical knowledge and everyday healthcare decisions. This is not about replacing doctors—AI can never take the place of human expertise—but it can help consumers make smarter choices, advocate for themselves, and engage in more meaningful conversations with their providers.
The status quo is no longer sustainable, and the time for consumer empowerment through AI is now.
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 exceeded $5.2 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 tech savvy 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.
Noel J. Guillama-Alvarez
+1-561-904-9477, Ext 355
https://altarum.org/sites/default/files/Altarum-December-2024-HSEI-Brief-Combined.pdf