In our previous blog, we discussed the latest report from The Commonwealth Fund (CWF), “Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System.” This report compares healthcare across ten developed nations and reveals sobering findings: the U.S. healthcare system lags behind, despite its enormous costs. The evaluation covers systems in Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States across five key domains: access to care, care process, administrative efficiency, equity, and health outcomes.
The results? The U.S. ranks 9th or 10th in all but one category—care process. This isn’t just bad news; it’s a crisis, with a significant gap between the U.S. and the next lowest-ranking country, Germany.
Lets break this down:
The Only Bright Spot—and Its Dark Cloud
The U.S. ranks 2nd in care delivery processes, which measures how well healthcare systems perform in areas like mammograms, flu vaccinations, and patient safety. While this may seem promising, deeper analysis reveals that this success is driven by the pay-for-performance model, particularly incentives from Medicare and other payers to ensure the delivery of specific services. Thus, the system excels here primarily because it is profitable—not necessarily because it serves patients’ best interests.
Additionally, the U.S. continues to excel in specific hospital care areas, such as for heart attacks, heart failure, pneumonia, and major surgeries. Many individuals from other countries seek treatment in the U.S. for significant health issues, often purchasing U.S. healthcare insurance for access. However, this reflects a system that excels in acute, high-cost care rather than one that effectively serves its entire population.
Poor Outcomes: A Dismal Record
While there are strengths in certain areas, the overall picture is bleak. Americans live shorter lives and experience more avoidable deaths than citizens of most other developed nations. Despite our vast resources and technological advancements, we are failing to help people live healthier, longer lives.
The CWF report shows that U.S. health outcomes lag behind those of other nations, exacerbated by a shortage of primary care physicians. While other countries have improved access to primary care and preventive health services, the U.S. remains behind, resulting in detrimental public health effects.
Technology: Is It Really Helping?
The U.S. is a leader in medical technology, with a much higher number of MRI machines per capita compared to countries like Canada. A few years ago, Greater Miami alone had more MRI machines than the entire country of Canada, with minimal wait times for patients. However, this efficiency comes at a cost, as access to advanced diagnostic technologies is not equitably distributed or affordable for everyone.
The U.S. also leads in health information systems, with companies like Epic and Cerner dominating the global market for electronic health records (EHRs). Yet, this technology has not necessarily translated into better outcomes or lower costs. While EHRs have streamlined some processes, they have not resolved the fundamental inefficiencies in our system.
The Core Issue: Misaligned Incentives
At the heart of the problem is a system built on financial incentives rather than patient outcomes. Other countries in the CWF study employ different healthcare payment models, which focus more on improving health. The U.S. system rewards procedures and diagnostics that generate revenue, rather than those that enhance health.
Technology could be part of the solution, but only if we stop using it to perpetuate the existing system. Much like the outdated practice of bloodletting, we must rethink our technological approach. Currently, the focus is on maximizing profitability rather than empowering consumers to take control of their health.
AI in Healthcare: A Glimmer of Hope?
The buzz around artificial intelligence (AI) in healthcare is palpable, with venture capital firms investing a record $19 billion in AI startups last quarter, according to Crunchbase News. Many of these investments target healthcare applications. However, many AI innovations aim to enhance existing healthcare infrastructure rather than transforming the system in ways that genuinely benefit consumers.
The Not-So-Good News
In our exploration of companies that help consumers aggregate, review, and monetize their de-identified medical information, we found that many are closely tied to the industry’s infrastructure. For instance, terms like TEFCA®—the Trusted Exchange Framework and Common Agreement—are prevalent in their literature. This government-sponsored initiative promotes interoperability among electronic health records but does little to change the consumer experience or improve access to valuable information. Instead, it often complicates navigation, increasing costs related to software creation, maintenance, and data transfer.
Where Are We Enabling the Consumer?
What’s missing from the conversation is AI’s role in empowering consumers. Where are the innovations that help patients take charge of their health? We need AI tools that assist individuals in gathering and interpreting their health data, predicting future health risks, and enhancing their quality of life.
The true potential of AI lies in shifting healthcare from a provider-driven model to a consumer-driven one. AI can aggregate and analyze a patient’s medical history, offering personalized recommendations based on a comprehensive view of their health. This could include preventive measures, wellness tips, and early warnings of potential health issues that can be discussed with personal physicians without necessitating a hospital visit.
However, this shift requires a fundamental rethinking of healthcare. Instead of using technology to prop up a broken system, we must empower individuals with the tools and knowledge to manage their health proactively, starting with unrestricted access to their complete healthcare records.
The Path Forward
Healthcare is primed for disruption, and AI holds the potential to be a game-changer—if we focus on the right priorities. The current model is unsustainable, both in terms of cost and outcomes. We cannot continue spending more while expecting better results. The U.S. system must shift from financial incentives that drive unnecessary procedures to one that rewards prevention, wellness, and personalized care.
AI can facilitate this transition, but it won’t happen automatically. We need to advocate for innovations that benefit consumers directly, rather than reinforcing the status quo. Fortunately, the technology exists, and there is increasing interest in making healthcare more consumer-friendly. Achieving this vision will require concerted efforts from innovators, entrepreneurs, investors, policymakers, and healthcare professionals.
The future of healthcare should prioritize empowering patients—not just improving hospital efficiency or making diagnostics more accessible. AI can help make that future a reality, but only if we put consumers at the center of the system. The sooner we make this shift, the better off we will all be.
-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.