Key insights:
- Less than a third of Americans follow their doctor’s care plans, primarily due to how complicated, fragmented, and frustrating the patient experience has become.
- Using technology to smooth these friction points can reduce US healthcare spending by $1 trillion per year.
- Innovators can use AI, smartphones, and other technologies to alter patient behavior through remote monitoring and electronic “nudges.”
- 80 million Americans, many of them older than 65, suffer from two or more chronic diseases and consume 92 percent of health spend.
The US healthcare system faces many intractable problems, from doctor burnout and soaring administrative costs to misaligned incentives and ineffective insurance. But there’s an even bigger problem that gets far less attention: Only 28 percent of Americans actually follow through on the directives of their doctors and other caregivers.
The reason is simple: friction. Whether it’s the hassle of securing a doctor’s appointment, remembering to order refills for your meds, or understanding the medical gobbledygook in hospital discharge instructions, the process is so time-consuming and frustrating that the most rational thing anyone can do — taking care of your own health — can seem totally irrational. If ordering a pizza were this hard, no one would eat pizza.
Fixing this problem is, in my opinion, the biggest opportunity we have to improve the industry. We can’t magically reverse the aging of the Baby Boomers or conjure up millions of new doctors and nurses to fill expected shortfalls. But if the other 72 percent of patients just followed doctor’s orders rather than waste all the amazing knowledge, treatments, and innovations at their disposal, I believe the US could save $1 trillion a year. That’s nearly a quarter of the $4.4 trillion Americans spent on healthcare in 2022.
“But if the other 72 percent of patients just followed doctor’s orders… I believe the US could save $1 trillion a year.”
A trillion dollars is a big number to get one’s head around. To break it down just a bit, consider this: Even when people fill their prescriptions, only half of those medicines are actually taken, according to the FDA. Given that Americans spent $633 billion on pharmaceuticals in 2022, that’s hundreds of billions wasted – and that doesn’t count the extra, acute care these people end up needing because they didn’t benefit from those meds. A related problem is poor coordination between care providers, which not only hurts the quality of care but further reduces people’s faith in the healthcare system. According to the Peter G. Peterson Foundation, this lack of coordination costs between $27 billion and $78 billion.
The resulting lack of confidence leads far too many people to simply go to the emergency room, which costs $2,032 on average, rather than wait to see their doctor, which costs $167 per visit. According to United Healthcare, an astounding 78% of ER visits are for such non-emergencies, for a total cost of $32 billion system-wise. This group includes a woman I once met who had called 911 18 times within a year, each time requesting an ambulance. When I asked her why, she said “Well, I don’t drive so this way they come and get me.”
With the technologies available today, following doctor’s orders should not be nearly this difficult. I recently purchased a car during a lunch break, and it was delivered by dinner. Yet it takes 24 days on average just to get a doctor’s appointment. Ankit Jain, CEO of Infinitus Systems, explained how companies are using AI to whittle down such wait times in his essay “Thanks to A.I., the Doctor Will See You Now.” Indeed, my wife Renee Dua, an accomplished doctor, and I also helped attack this problem when we started Heal in 2014. Patients, mostly seniors, have used the Heal app to arrange nearly 300,000 at-home appointments with licensed physicians, almost all of them within two to four hours!
We’re proud of that achievement, but the experience highlighted that reducing wait times is not enough to convince people to get the most out of the healthcare system. The proof: Many of the doctors in Heal’s network reported that even patients who’d had those convenient, at-home visits were not following through on their recommendations.
A litany of friction points
The most obvious challenge, and opportunity, is to change the behavior of the more than 80 million Americans who have two or more chronic diseases. Remarkably, these Americans consume 92 percent of the overall US health budget, despite making up only 25% of the US population. And that doesn’t count the indirect costs of lost productivity. In 2016, the Milken Institute estimated that the total cost of chronic diseases in the US was $3.7 trillion, or one-fifth of the total economy at the time.
To get a sense of why Americans struggle to stick to their care plans, consider a hypothetical patient named Jill Smith. She’s 63 years old and has always struggled with her weight. In part due to fatty, processed foods and a lack of exercise, she went from pre-diabetic to a dangerous stew of Type 2 diabetes, high cholesterol, and hypertension. She also has chronic back pain related to her obesity.
The industry makes it maddeningly difficult for her to do much to improve her situation. Just keeping track of her battery of caregivers — a primary care physician, a kidney doctor, an endocrinologist, and a physical therapist — is difficult. A fifth-grade-level reader, she’s never attempted to read the 20-plus-page documents that come with her meds, so she doesn’t really understand what they do. When she does make it to an office appointment, she hates the repetitive, intrusive intake forms she’s continually asked to fill out, and the maddening “mistakes” that happen with irritating regularity, like schlepping to the pharmacy only to find out that the prescription hasn’t been filled.
In terms of her daily regimen, Jill gets precious little help holding up her end of the healthcare system. She gets no reminders when she forgets to take her medicines, which is an epidemic in and of itself. Less than half of polychronics take all their medications as prescribed. In fact, only 66 percent of people who manage to get their hands on “miracle drugs” like Ozempic take it long enough to be effective. Experts say one reason is how difficult it is to get information if someone feels faint or nauseous after taking a new medicine. The only way to find out about common side effects is to wait on hold for an advice nurse or call 911.
Making the most of AI
After almost a decade at Heal, Renee and I decided in 2022 that the time was right to start a company to smooth out many of these friction points. AI, particularly generative AI, is making it possible to hide the complexity of many healthcare issues behind interfaces that use simple, conversational language. Patients can speak plainly (with no typing required, if they choose), and get back instructions and information that are equally easy to understand. The fast-rising power of AI makes it possible to accomplish far more with data harvested via smartphones and wearable devices such as the Apple Watch. The ability for healthcare providers to monitor someone’s condition in the 99.99 percent of the time that they’re not in their office for an exam means they can provide timely, on-the-spot guidance, whether it’s to take a nitroglycerin pill or to take a warm shower.
“In fact, only 66 percent of people who manage to get their hands on “miracle drugs” like Ozempic take it long enough to be effective.”
AI also speeds up how quickly technology can be developed. We created Together, a universal app designed to meet the needs of seniors and polychronics, in just 14 months. The app provides a central hub that gives people like Jill access to all of her providers in one place, puts all of her appointments on her calendar (and her daughter’s or another caregiver’s, if she chooses), and sets up lab tests and medicine refills at the appropriate times. The app uses AI-based summarization technology to condense complex medical documents into jargon-free explanations of how medicines work with simple instructions like “Take Advil when your back hurts.”
Together is just one example of new health-tech products that use a “nudge-inspired” approach to change a patient’s behavior. Once users scan a photo of their medicine bottle labels into Together, the app gives repeated reminders each day until the patient confirms they’ve taken their meds. It adds information on potential side effects, so people don’t immediately give up on the medicine because it makes them nauseous. The early results are impressive. Since Together went on the market at the start of July 2023, adherence to prescriptions has risen from 54 percent to 71 percent for app users.
The app lets healthcare providers monitor patients’ health and look for signs that they’ve fallen off their care plans. For example, Together is the first iPhone app that can capture a person’s vitals with nothing more than a face scan. Patients can get their heart rate, blood oxygen level, breath frequency, and heart rate variability just by looking into their iPhone’s camera for 60 seconds.
Helping the most vulnerable help themselves
Studies show that all types of people struggle to follow their care plans. I myself am far from a perfect patient. My wife and I have three children along with a business to run, which means finding time for at least 22 visits per year for various checkups and other appointments, barring any major illnesses or injuries. And did you know that new research has found that many of the vaccinations you got as a kid lose their efficacy over time? Neither did I, and I wouldn’t have found out if my doctor (a friend of my wife) hadn’t told me. It turns out I needed a booster for hepatitis B.
Taking full advantage of our healthcare system is much more difficult for other demographics, particularly our most vulnerable populations. Obviously, people who don’t speak English are at a disadvantage in navigating the friction points, as are seniors. People with low levels of education and those with low incomes often have jobs that don’t provide the extra time or resources to attend to their health.
We are excited to see other companies embrace new technologies to empower patients to help themselves. Companies like Teladoc and Doctors on Demand, aided by the need for options beyond in-office visits during the COVID lockdowns, have made telemedicine a broadly accepted way to get treatment more conveniently. A number of other startups have followed in Heal’s footsteps to enable home doctor’s visits, while Infinitus and others are tackling the back-office inefficiencies that make getting healthcare so frustrating.
But we’re just at the start of this revolution in patient experience. Getting to the next level will simply require following doctor’s orders.
