By MIKE MAGEE

In a 1996  JAMA editorial Nobel Laureate Joshua Lederberg MD wrote “Our fight with microbes is far from over …odds are tipped in their favor…they outnumber us a billion fold, and mutate a billion times more quickly…pitted against microbial genes, we humans mainly have our wits.”

Now three decades later, our scientists remain in a “battle of wits” with this amazing viral foe, but even without a vaccine, have maintained a slide edge for humanity. Experts recently confirmed that we are unlikely to have a vaccine bullet by 2030. And it’s not because we haven’t tried. There have been more than 250 official HIV vaccine trials, with fewer than 10 making it past the safety threshold to test efficacy – and the best performer only had a moderate success rate in triggering some immunity in 31%.

HIV is just a bad actor according to Professor Anna Durbin at the Bloomberg School of Public Health at Johns Hopkins. To start with, it embeds its chemistry in the host’s DNA genome, blurring the boundaries between “self” and “non-self.” Most of our successful vaccines focus in on a protein portion of the virus envelop or capsule. But the HIV virus has a “glycan shield” – a protein envelope that incorporates around 95 different sugar molecules which shield or disguise the viral protein from detection by our immune system. As one expert described it, “The immune system’s antibodies approach the virus and effectively see a blurry cloud of sugars rather than the vulnerable protein underneath.”

The second problem is the virus’s “sloppy gene duplication” is riddles with mutations. This yields dozens of different versions each with endless subtype variations. This is not typical disciplined viral behavior. Today’s measles viral genome for example is nearly identical to its late 20th century version.

And finally, HIV’s favorite target for invasion is the CD4 lymphocyte, otherwise known as the “Helper T-cell.” That happens to be the cellular key that unlocks our entire immune apparatus. This virus effectively decapitates the lead generals of our defensive force. And yet, we’re gaining on the virus. How have we done it?

First, by focusing on two “work-arounds” that trigger “passive immunity” without the help of our own immune machinery. Three decades ago, breakthrough discoveries first offered a glimmer of hope in the form of antiretroviral medications. With a variety of different combined therapy approaches, HIV/AIDS emerged as “no longer a death sentence,” but a chronic disease, like diabetes, that could be managed. In the modern era, this effective approach has spawned PrEP, or “Pre-exposure Prophylaxis,” – a preventive regimen for HIV negative individuals who are at risk of contracting HIV.

This regimen, generally combining the two anti-HIV meds, tenofovir and emtricitabine, prevents HIV replication if an individual is exposed to the virus. This cut transmission through sexual contact by 99%, and from illicit dug injection by 74%. The challenge has been access – especially in under-developed countries. But las month, Gilead Pharmaceuticals, teaming up with The Global Fund and PEPFAR (President’s Emergency Plan for AIDS Relief) agreed to provide their new antiretroviral drug, lenacapavir (LEN) at cost. In trials, the drug was 99% effective in keeping individuals HIV negative. As important, it is a twice a year injectable that could make a world of difference in developing nations, especially when it comes to transmission of the virus from HIV+ mothers to newborns through pregnancy and breastfeeding.

Scientists have known for some time that this population is key to combating HIV/AIDS. The chances of a newborn contracting HIV from an infected mother are 1 in 2. Contrast that with unprotected sex (1 in 72) and IV drug use (1 in 158), and it was clear to policy makers where to focus. Three decades ago, 1 in 4 infants born in Uganda were HIV+. That translated into 32,000 HIV infected children per year. Today it is less than 5000. How? 1) All expectant parents are HIV tested. 2) If positive, they receive anti-retroviral meds.

The latest WHO stats show progress is indeed possible:

“At the end of 2024, 77% of people living with HIV were accessing antiretroviral therapy, up from 24% in 2010. Globally, there were 1.1 million pregnant women with HIV in 2024, of which an estimated 84% received antiretroviral drugs to prevent mother-to-child transmission. At the end of 2024, there were 1.4 million children aged 0–14 years living with HIV globally, down from 2.7 million in 2010.” Clearly there is still work to be done. One in six pregnant women with HIV is still not under treatment.

The second “work-around” is equally promising. It is what the NIH has labeled a “passive immunization strategy” – monoclonal antibodies. Research in animals, dating back to 2014, found that animals with long-standing HIV sometimes develop “broadly neutralizing antibodies” that effectively stop a whole range of different genetic subtypes of HIV. A decade later, synthetically engineered copies of these natural antibodies are being tested. Challenges remain, including the need for continued infusions, perhaps every six months, to keep formally HIV+ individuals in “permanent remission.” 

A summary report in Smithsonian magazine six months ago stated, “This year, researchers reported a breakthrough that suggests a ‘functional’ cure for HIV—a way to keep the virus under control long-term, without constant treatment—may indeed be possible. In two independent trials using infusions of engineered antibodies, some participants remained healthy without taking antiretrovirals, long after the interventions ended.”

The final word goes to Johns Hopkins Bloomberg School of Public Health’s Morgan Coulson, who recently wrote, “The history of HIV vaccine research is a long record of promising ideas that didn’t translate into protection in large trials. What makes the current moment different is that researchers have, for the first time, demonstrated they can deliberately guide the human immune system toward producing the kind of antibodies known to neutralize HIV broadly. Whether that initial success can be built into full protection is the central question for the next decade of research.”

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex. (Grove/2020)

By MATTHEW ZACHARY

The American healthcare system behaves exactly as its incentives tell it to behave. That sentence sounds almost boring until you follow it to its logical conclusion.

Insurance companies now influence clinical decisions more aggressively than many physicians. They shape hospital consolidation. They determine startup viability. They influence venture capital allocation. They dictate which drugs succeed commercially. They pressure physician behavior through reimbursement design. They decide who accesses diagnostics, rehabilitation, home care, specialty drugs, imaging, mental health services, and sometimes whether a patient gets enough time left on Earth to watch their kid graduate college.

And somehow we still spend an astonishing amount of time talking about apps.

I have spent almost 30 years inside this machine as a brain cancer survivor, nonprofit founder, media mogul, healthcare conference producer, policy advocate, and accidental anthropologist of American institutional failure. I have watched every corner of healthcare promise transformation. Precision medicine. Digital therapeutics. Patient engagement. AI. Consumerism. Value based care. Coordinated care. Interoperability. Navigation. Ambient listening. Population health. Personalized medicine. Blah blah blah,.

Meanwhile millions of Americans spend their afternoons arguing with an insurance company employee named Chad who has never met them but somehow possesses the authority to overrule their oncologist.

At some point we need to admit the obvious. Innovation stopped driving healthcare years ago. Insurance drives healthcare now.

That realization sits underneath every chapter of my new book, We the Patients: Understanding, Navigating, and Surviving America’s Healthcare Nightmare. I wrote it because after decades inside the system I finally understood something uncomfortable. Americans think they are angry about healthcare costs, wait times, medical debt, or inaccessible care. They are. But underneath all of that sits a deeper fury most people struggle to articulate.

People understand, instinctively, that somebody they never elected now controls enormous portions of their lives during moments of maximum vulnerability.

That changes a country.

Healthcare executives still talk about “patient experience” like it is 2004 and somebody just discovered FourSquare recommendations. Venture backed startups still pitch friction reduction while prior authorization delays chemotherapy. Health systems launch innovation centers with reclaimed wood conference tables and espresso bars while patients crowdsource GoFundMe campaigns to afford deductibles larger than a used Volkswagen Scirocco.

Everybody inside healthcare knows this tension exists. Few people say it plainly because too many livelihoods depend on pretending the current arrangement remains sustainable.

The business incentives tell a clearer story than the public relations campaigns ever will.

UnitedHealthcare generated more than $400 billion in revenue last year. CVS Health topped $350 billion. Cigna approaches the GDP of mid sized nations.

Meanwhile independent physician practices collapse, rural hospitals disappear, oncology practices consolidate under private equity pressure, and patients navigate a reimbursement structure designed by people who appear to view Kafka novels as operational blueprints.

The market consolidated exactly as incentives encouraged it to consolidate.

Insurance companies figured out something the rest of healthcare still struggles to admit. Whoever controls reimbursement controls the system itself.

That means every healthcare innovation eventually slams into the same wall. Reimbursement policy determines survival.

Founders know it. Hospital executives know it. Pharma knows it. Investors definitely know it.

You can build the greatest diagnostic AI platform in human history. If insurers refuse coverage or bury reimbursement under administrative complexity, congratulations on your beautiful science project.

You can build extraordinary survivorship programs. If insurance declines long term rehabilitation, fertility preservation, cognitive support, nutrition counseling, or mental health services, patients still absorb the damage alone.

You can launch patient navigation companies until every healthcare conference ballroom from San Diego to Orlando glows with backlit logos and optimism. If the underlying insurance architecture rewards denial, delay, and opacity, navigation simply becomes another coping mechanism layered on top of institutional dysfunction.

The healthcare industry increasingly resembles a city building flood mitigation kiosks while refusing to discuss the hurricane.

That hurricane carries a giant insurance company logo.

The irony here deserves attention. American healthcare still publicly frames itself around medicine. The system actually operates around financial risk management.

Insurance companies do not fundamentally exist to maximize health outcomes. They exist to manage financial exposure. Sometimes those goals align. Sometimes they violently diverge.

Every physician reading this knows exactly what I mean.

Every hospital CFO knows it too.

Every founder who quietly pivoted their startup because reimbursement codes changed knows it.

Every exhausted caregiver sitting on hold for 97 minutes while hearing a pan flute version of “Don’t Stop Believin’” knows it too.

The healthcare industry often defends itself by pointing to complexity. Healthcare involves regulation, compliance, clinical nuance, labor shortages, fragmented infrastructure, aging populations, and rising chronic disease burdens. All true.

But complexity became profitable.

That distinction changes everything.

Administrative complexity now functions as both operational reality and economic moat. Entire sectors profit from helping employers, providers, and patients navigate complexity created by other sectors profiting from complexity. We built trillion dollar ecosystems whose business models depend on translation services between fragmented bureaucracies.

At some point that stops looking accidental.

None of this means markets fail automatically or private sector participation inherently creates harm. The opposite argument deserves attention. Properly aligned incentives could produce extraordinary outcomes. Efficient reimbursement models, transparent pricing, aligned preventive care incentives, and rational risk pooling could dramatically improve patient protection while lowering long term system costs.

But current incentives reward scale, opacity, leverage, and administrative endurance.

Patients experience those incentives as exhaustion.

The healthcare industry still underestimates the political consequences of that exhaustion.

For years Americans compartmentalized healthcare suffering as individual misfortune. Cancer happened to somebody else. Bankruptcy happened somewhere else. Insurance denials belonged to another family. Then the system expanded its dysfunction into nearly every household in America.

Now everybody has a story.

• The delayed scan.
• The denied medication.
• The impossible bill.
• The out of network anesthesiologist.
• The prior authorization nightmare.
• The “we regret to inform you” letter.
• The 3 hour phone call transferred 6 times before disconnection.
• The family forced into amateur actuarial science while somebody they love sits in an ICU bed.
• Healthcare stopped feeling like civic infrastructure. It started feeling adversarial.

That erosion of trust carries enormous consequences for every institution attached to healthcare. Pharma wonders why public trust collapsed. Hospitals wonder why patient hostility increased. Insurers wonder why public rage escalates. Policymakers wonder why healthcare suddenly carries populist volatility across the political spectrum.

People eventually recognize when a system treats them like revenue extraction units wrapped in diagnostic codes.

The most dangerous mistake healthcare insiders still make involves assuming patients lack systemic awareness. Patients understand incentives far better than the industry gives them credit for. They may not speak in reimbursement terminology or regulatory language, but they understand outcomes.

They understand when nobody takes responsibility.

They understand when every institution redirects blame toward another institution.

They understand when “care coordination” means their exhausted spouse now functions as unpaid case manager, billing specialist, transportation coordinator, pharmacist, medical records clerk, and amateur attorney.

That awareness creates political energy.

Healthcare leaders should pay closer attention to what happens when millions of Americans across ideological lines begin reaching the same conclusion at the same time. The insurance architecture underpinning modern American healthcare increasingly shapes labor markets, household economics, disability, entrepreneurship, retirement timing, caregiving burdens, and social trust itself.

That reaches far beyond medicine.

The healthcare industry still behaves like patients remain fragmented consumers navigating isolated problems. Reality changed. Americans increasingly recognize shared structural exposure.

That realization explains why I wrote We the Patients.

I wanted to document the mechanics underneath the madness. I wanted readers to understand how incentives compound harm over time. I wanted healthcare insiders to confront the gap between what the system claims to deliver and what ordinary people actually experience after the MRI, after the diagnosis, after discharge papers land in their hands.

Most importantly, I wanted people to recognize their anger has a rational source.

Nothing destabilizes public trust faster than realizing your survival may depend less on medical science than on whether an insurance company decides your care fits an approved financial framework.

Once people see that clearly, they cannot unsee it.

That realization changes how people vote, organize, spend, work, retire, build companies, evaluate institutions, and understand power itself.

And frankly, after 30 years watching this system from every possible angle, I think healthcare insiders should spend a lot less time celebrating innovation theater and a lot more time asking a brutally simple question.

Who actually controls reality when a patient hears the word no?

Matthew Zachary is a 30-year brain cancer survivor & the co-founder of We The Patients, and the author of We the Patients: Understanding, Navigating, and Surviving America’s Healthcare Nightmare (Wiley, May 2026).

By TOMMY BEVERIDGE

Just like the Holy Roman Empire was none of those things, America’s health care system is neither health care, nor a system. Both are in fact decentralized commercial arrangements clothed in things that sound good, like Holy-Romanness, or Consumer-driven Health Care. Rather than health care, we have a patchwork of consumer products and government subsidies designed to pay a vast cadre of individuals and interests to perhaps incidentally provide health care. To even call it a system would imply something centrally coordinated, which no one in their right mind would do.

It feels hopeless. Health insurance is expensive, arbitrary, and capricious. It profits off of slices of an ever-growing pie, regardless of margins. The providers we cannot live without often charge whatever the market will bear. On top of this, the government, directed by laws written by politicians unwilling to upset powerful interests, has spent the past two decades pushing complex payment ideas with little result except a growing ecosystem of consultants specializing in gaming such incentives. Then there are the consultants— arms dealers in both sides of a war, selling hospital systems software that helps them bill as much as they can for their work, and health insurance companies software that helps them deny claims wherever they can.

We all know this. It’s the learned helplessness about it all that gets me. Sometimes a sob story about chemotherapy denied enters the zeitgeist, or the tale of a lone vigilante taking out a health care executive, but mostly we just take the 7 percent annual premium increases and deductible hikes with a stiff upper lip. Meanwhile, few of the players: payer, provider, government, or software slinger, put American’s health at the top of their agendas. Customer satisfaction? Maybe. Public ire? Occasionally. Shareholder value? Certainly. But our actual health?  

Something that isn’t health care or a system can’t be a health care system. Not when this how we pay for care:

People with steady work usually get employer-sponsored coverage. This is about 54 percent of America. These plans negotiate with providers in thousands of separate and discrete settings, with the natural incentive to maximize their own percentage in the deal. A family facing a surgery or cancer diagnosis can easily shell out $10k or more, on top of their growing monthly premiums.

Old people, and certain sick and disabled people get Medicare. That’s about 19 percent of America. It’s federally run and it’s a good deal, except that it covers only 80 percent of costs, and you need to buy a separate Medicare plan to cover prescription drugs whose prices are largely dictated by the sellers, plus a commercial plan that fills in all the gaps of its antiquated insurance coverage. Or a fully commercial Medicare Advantage plan that may or may not cover all your costs, but will make its money through a mix of annoying-to-lethal administrative frictions.

Poor people, certain sick people, and some lower-middle-class people get Medicaid. That’s about 18 percent of America. Low rates, coupled with the administrative headaches common to all health plans lead to considerably fewer providers taking Medicaid.

Ten percent of people buy individual coverage. All the claims of impending socialist doom, or a coming golden age sixteen years ago were about this sliver of the population. The problem is that it’s expensive, negotiates like employer-sponsored coverage (i.e., badly) and the government just cut subsidies for a lot of people. And the politics still burn.

People who are ineligible for coverage, can’t afford it, or don’t want it remain uninsured. This is about 8 percent of America (and growing, again). They show up at the ER and cost us all.

Then there’s the VA and Military Health System. About 1.2 percent of America is enrolled for health care with the VA. Active-duty military, their families, and retirees get TRICARE and the Military Health System. That’s about 2.8 percent of America. They both own large portions of the care delivery as well. These programs barely communicate with one another, and are perennial policy basket cases.

Each of these plan types have various subtypes, their own state and federal legal structure, their own billing and administrative procedures, and their own constantly churning client base. Each provider must individually contend with each of these complications with every claim or patient interaction. This is not a system, nor is it really health care. Against all this, how will small-ball, often voluntary payment reforms fix these problems?

Market utopians imagine that the right economic incentives will create the just and rational distribution of health resources. Some people even believe that health care will be better if we expose the patient to more costs— give them high deductibles and they’ll shop for care. I can’t believe that I would be a better buyer of chemotherapy than an expert who works on my behalf. But hey, what do I know?

This market conceit has been convenient for academics and politicians to dance around tough choices, hoping that the utopian’s light touch will be enough. Well-meaning economists thought up complex incentive structures like Accountable Care Organizations; where providers willingly enter contracts with insurance plans to pay them less. If I hear about one more clever economist’s approach to changing consumer or provider behavior, I’ll invoke the spirit of Uwe Reinhardt upon them. 

In the end, the only non-theoretical ways to control health care costs are things like negotiated fee schedules and global payments, and we still act as if they’re entirely novel. The only way to improve health is to restructure care towards prevention, but that’s a hard sell for committees of cardiologists and CEOs. The fact remains that market logic on its own has never and probably never will guarantee anything close to a “system,” where health care is delivered on behalf of people.

But there’s a lot of good too. There’s no better place on Earth for someone with a weird cancer or in need of a transplant (plus the money/coverage). Payers do good work too, when their incentives are aligned to helping the patient above all else. Medicaid managed care is a good example. Then there’s the drug industry, who does amazing things, but should be paid according to the marginal value of their new products, just like everyone else across the world does. Old power structures must be challenged, but they also need a role in the new order.

That’s a lot. Let’s think big again. Big and different. Medicare for All is a good slogan for a lot of different ideas. Taken literally, what you really get is a mid-1960s health plan design, some administrative simplicity, lower rates, and tremendous political baggage. Matthew’s Concierge Care for All concept offers a robust rubric for reform, reorganizing how both payer and provider operate in a thoughtful way; sort of a laissez faire NHS that takes advantage of what already works here in America. Agree or not, it’s an idea whose scale matches the challenge. Any way we do it, the road to reform is through prices and reorienting incentives away from hospitals, specialists, and pharma. The world is full of options:

• We could impose various forms of fee schedules and global budgets, reorienting providers to serve populations with heavy emphasis on primary care. That’s how much of Europe works.
• We could abolish most private insurance, directing the government to set prices and process claims, leaving the care to provincial and regional authorities. That’s how Canada works.
• We could change payer incentives so they’re more interested in collectively bargaining on our behalf instead of taking a percentage of the ever-growing pie. That’s how Japan works.
• We could attempt a consultant’s dream where heart surgery is just another consumer product. That’s the consensus of what entrenched interests think would work. 

Options abound, but no system will provide every service to everyone for cheap. Someone, whether it be government, a private insurance company, or ourselves, will need to judge that a particular back surgery is not necessary or too expensive for its value. The politics are dark and full of demagogues. But we can’t say we have health care, a system, or a healthy civil society until we look at the whole thing and make some fundamental changes. Bring your own ideas, and let’s get to work.  

Tommy Beveridge is a longtime health care policy wonk who has worked in the .org, .com, .edu, and .gov worlds. Due to present employment constraints, Tommy is sticking to a nom de plume. His picture above is actually Asclepius, the Greek god of medicine. Because why not?

By EMMANUEL SARKEES

Arizona consistently ranks among the states with the highest uninsured rates in the nation. Over 800,000 residents lack health coverage, a number shaped not by failure, but by a consistency of structural, geographic, financial, and linguistic barriers that have been poorly addressed for decades. What makes Arizona’s situation this severe is that the demographic makeup, geographic issues, policy history, and high uninsured rate do not exist as separate problems, but as a link of issues where each difficulty increases the next.

In the United States, health insurance is not just a financial factor, but it is the primary mechanism through which people gain access to healthcare. Without insurance, an annual checkup becomes a pricey luxury, a chronic illness becomes undealt with, and a slight emergency can devastate someone’s life finances. This can be seen at its highest in Arizona, where Arizona ranks 43rd in the nation for its uninsured rate at 10.3%, carrying higher rates of disease mortality and late stage sickness as a result.

Who Arizona’s Uninsured Actually Are

One of the most common misconceptions about uninsured communities is that they are mostly unemployed. In Arizona, that is simply not accurate. A huge part of the state’s uninsured population works full time in agriculture, construction, and food service, where there is a shortage of health benefits. Although coverage is technically available through an employer, the costs to maintain these benefits are often too high in relation to their earnings. This leaves a large group of people in an unfortunate circumstance: they make too much to qualify for AHCCCS, Arizona’s Medicaid program, but too little to afford insurance plans. They fall into a coverage gap that lacks a current policy built to close it.

The data is also clear that the consequences do not distribute evenly. Hispanic and Latino residents are uninsured at higher rates than white Arizonans, while Native American and Indigenous people endure similar circumstances, surged through the federal government’s history of underfunding tribal healthcare and the fact that these communities often live in remote areas where there is a lack of healthcare infrastructure. Geography adds to this further, as uninsured rates are highest in rural and border areas like Yuma, Santa Cruz, Apache, and Navajo, communities that already greatly lack economic opportunities and healthcare infrastructure compared to urban areas like Phoenix and Tucson.

What Happens When People Can’t Get Care

All of these barriers have real consequences. Conditions that are quite easy and simple to treat become serious issues by the time they are finally caught. Social factors like insurance status stand as one of the greatest predictors of whether someone gets cancer and whether they survive it. Late stage cancer diagnoses are not just bad luck, but in some cases, are dependent on whether the patient was able to access the routine checks that would have easily caught it earlier.

Chronic conditions like diabetes and hypertension are another area where being uninsured causes serious, life-altering harm. These conditions need to be managed consistently with regular checkups and medication. Uninsured people often cannot afford visits or medication, so the conditions go unmanaged and worsen over time. A striking example: GLP-1 medications increased 442% in price between 2021 and 2023, creating a market three times larger than cancer spending, with list prices reaching $1,400. The fundamental issue is not just prices, but a system where everyone is focused on maximizing revenue rather than patient outcomes.

When uninsured patients consistently resort to the emergency room because of a lack of options, those costs do not disappear.

They get moved to different hospitals, insured patients through higher prices, and to taxpayers. The emergency room overreliance, the late diagnoses, and the unmanaged chronic conditions are not the result of poor patient choices, but are the outcomes of the financial burdens, physical distance, and cultural barriers that have been allowed to compound for decades.

How Policy Created This Problem

The uninsured crisis in Arizona did not just occur by coincidence. It was driven by specific political decisions that left certain groups without sufficient coverage that no one has been willing to fix.

Arizona was the last state in the nation to accept Medicaid, adopting it in 1982 after years of reluctance. In 2011, the state froze Medicaid enrollment for childless adults, locking the low-income population out of coverage for years. Arizona did eventually accept the ACA Medicaid expansion in 2014, which brought uninsured rates down. However, AHCCCS still has eligibility limits, coupled with complicated enrollment processes, that leave a large portion of low-income Arizonans out of coverage. As of June 2024, AHCCCS enrollment decreased by 153,173 in a single year, even after expansion.

Federal immigration laws make things even harder. Undocumented immigrants cannot enroll in Medicaid or buy plans through the ACA marketplace. In Arizona, where a large portion of the agricultural and construction workforce is undocumented, this means an entire segment of the working population has zero path to coverage. These policies do not just fail to help these communities, they almost guarantee that they stay uninsured. Making this worse, current federal Medicaid cuts signed into law in July 2025 are projected to push Arizona’s uninsured rate to 18-20%, undoing years of progress in a single policy stroke.

What Needs to Happen

Health inequities like these are not natural or random, but are directly caused by structural conditions that require structural responses to fix. This is important because it shifts the question away from individual decisions and toward the systems that are failing patients.

AHCCCS eligibility must expand and enrollment needs to be simpler. More Federally Qualified Health Centers need to be built in rural and underserved areas. Outreach needs to be done in the languages and through the cultural paths that actually reach the populations being excluded. The immigration exclusions from Medicaid need to be seriously reconsidered.

Arizona is already paying for the health of its uninsured population. It is just paying in the most expensive and least effective way possible. The next steps Arizona takes will say something not just about the state, but about what this country is willing to accept when it comes to who deserves quality healthcare.

Emanuel Sarkees is a high school student with a strong interest in medicine, healthcare, and innovations that improve patient care and access to treatment

By MATTHEW HOLT

More tales of the woes of dealing with health insurance. I live in Marin County, California and one of the things that comes with that is a diagnosis of ADHD for my children. (OK, I have made that joke before but it is true!). My kids now visit a psychiatrist for more sophisticated med management than they receive at their pediatrician. We were (until recently) on a Blue Shield HMO via the Covered California exchange. 

While I was at the doctor’s office, I talked to the staff. They told me I owed a $50 copay. I didn’t pay them (yet) and I went online and saw the claim

The reasonable, informed consumer might think that I owed nothing. The clue being that
“Patient Responsibility” was $0.

But if you click the “See More” in the top right it shows you this

You probably still think that I owe $0. But if you add the numbers on the right you might notice they don’t total $0.

Just to make sure I go to the benefits section of the website. When I click on “Mental Health & Substance Use Disorder”, the top section is “Behavioral Health Treatment”. There’s a choice of “in home” or “In office”. This particular session was by telehealth but as I assume that is in office and I have also had some in office visits that looked the same, so I picked that. And there is a $0 copay.

So now the reasonable consumer sees a Patient Responsibility that’s $0 and a $0 copay

But I am not reasonable.  So I click through to the EOB and see that there is a difference between what is allowed and what Blue Shield paid.

On the EOB it shows a $0 patient responsibility but a $50 co-pay/co-insurance charge. Which makes the $635 Blue Shield paid total the $685 they have (very badly) negotiated with UCSF. And yes they also let you see the PDF of the original EOB

This is the Schrodinger’s EOB because I owe $0 and $50 at the same time.

At this stage I call Blue Shield. No, they do not have a chatbot or a human chat function. It’s phone or nothing.  Yes, it’s nearly June 2026.

After talking to their voice recognition system which still can’t recognize my birthdate or much else about me I eventually hit 0 enough times to get through to their barely audible customer service rep in the Philippines. There are multiple echoes and we can’t hear each other. The rep calls me back. It still is echoing horribly. Eventually she gives up and decides I need to speak to mental health customer service as this is a behavioral health claim. Even though it’s an office visit that looks like any other claim to me.

She puts me through. The voice recognition system answers again. Of course I had to tell it all my information again.  It still can’t understand me and I hit 0 a few more times. Eventually I get an American-based rep working in the mental health claims team. None of the information I told the voice system transferred to the rep – even the bits I thought it did understand!

The rep told me that I owed $50. 

So why was it showing me that I had $0 patient responsibility? Because in their mind/system I had already paid the $50 at the time of service, therefore it wasn’t my responsibility to pay it as I already had paid it. Even though I hadn’t! (BTW it was a telehealth visit with no way to pay but whatever). 

But I did owe the $50 co-pay

So next I pointed out that the benefits on the website said there was a $0 co-pay. A-ha! 

In fact if you read down in the fine print it says this

The rep told me that the $0 co-pay was for office based “treatment”. Had I scrolled down further I would have found the outpatient visit category. That does have a $50 co-pay. So I scroll down and she is correct.

But what distinguishes office based treatment from an office visit? Where is that in the fine print? In fact the fine print for both “treatment” and “outpatient” are exactly the same and never mentions what the difference is.

I asked the rep. Treatment, she told me, is specifically treatment for pervasive developmental disorder or autism. “Outpatient office visit” includes a whole range of diagnosis and in office treatments that she read off to me. I suspect that means that CPT code 90792, which is the one billed on the EOB, triggers “outpatient office visit” not “treatment”. Even though part of this session clearly is treatment!

CPT Code 90792 is used by psychiatrists, psychiatric nurse practitioners, and other medical professionals to bill for a Psychiatric Diagnostic Evaluation with Medical Services. It includes a comprehensive diagnostic assessment, medical history, mental status exam, and potentially medical decision-making for medication management 

I suspect that the “treatment” category in the Blue Shield’s benefits list with the $0 co-pay is for CPT CPT codes (97151–97158) which are primarily used for Applied Behavior Analysis for behavior therapy for children with autism.

But who knows? They don’t tell you. They make it almost impossible to find out. And the EOB’s that Blue Shield issue have such shoddy UX it’s unlikely anyone understands what they should be paying.

It’s 2026 and while we have AI coming through the wazoo in our real lives, this major health plan just doesn’t seem to care about its customer’s experience.

And of course who but me would bother going through all this crap to find out! 

Matthew Holt is the founder & publisher of THCB. He’s just left Blue Shield for Cigna. We suspect Cigna isn’t too happy about that.

By KIM BELLARD

Until a couple of days ago I hadn’t heard of the phrase “meat computer.”  Apparently this has been around for some time, and, as Lora Kelley discusses in The New York Times, the tech elites are increasingly using it, either as a way to humanize AI or as a way to disparage what humans can do relative to AI (e.g., Elon Musk posted last summer, “We are all dumb meat computers compared to digital superintelligence.”).  

Raphaël Millière, an associate professor at the University of Oxford, told Ms. Kelley that the metaphor aims to“move the public perception on how humanlike and intelligent frontier models are.”

Well, Pope Leo isn’t buying it.

On Monday he issued his first encyclical, “Magnifica humanitas: On Safeguarding the Human Person in the Time of Artificial Intelligence.” It’s some 200 pages long, so forgive me if I’m having to rely on summaries, but he raises issues that I hope our politicians and business leaders will pay appropriate attention to.

Encyclicals are, it appears, one of the highest forms of teaching that a pope can give, and it is rare for a pope to deliver one himself, so this is something he takes very seriously. As he should.

AI, he asserts, is the new industrial revolution, and he calls for us to “disarm” it: “Disarming AI means freeing it from the mentality of ‘armed’ competition, which today is not limited simply to the military context, but is also an economic and cognitive phenomenon. Disarming does not mean renouncing technology, but preventing it from dominating humanity.”

“Artificial intelligence needs to be disarmed, freed from the logic that turned it into an instrument of domination, exclusion and death,” he said. “It must be at the service of all, and of the common good.”

The pope makes it clear that he is not against technology per se – “technology should not be considered, in itself, as a force antagonistic to humanity” – but the question is how it is used and what the impact on people will be. “For this reason, merely regulating it is insufficient; it must be disarmed, welcoming and accessible,” he said.

He is particularly concerned about control over AI, and the wealth that comes from it, should not be concentrated among an elite few:

AI tends to amplify the power of those who already possess economic resources, expertise and access to data. Small but highly influential groups can shape information and consumption patterns, influence democratic processes and steer economic dynamics to their own advantage, undermining social justice and solidarity among peoples.

And, he notes: “A society that guarantees employment to only a small fraction of the population, despite having a high level of technical development, risks exposing many to forced inactivity. This creates a paradox of material progress and anthropological regression that undermines the foundations of a just and stable social peace,”

Marx and Engels would recognize this, although perhaps not the “meat computer” metaphor.

The pope indirectly but firmly disavows the meat computer metaphor:

Building for the common good means accepting the limits and weakness of humanity without considering them an error to be corrected…We must avoid the misconception of equating this type of ‘intelligence’ with that of human beings. These systems merely imitate certain functions of human intelligence. In doing so, they often surpass human intelligence in speed and computational capacity, offering tangible benefits across many fields. Yet this power remains entirely tied to data processing.

The pope posits our choice with a biblical reference to Babel or Jerusalem: “The primary choice is not between a ‘yes’ or ‘no’ to technology, but rather between constructing Babel or rebuilding Jerusalem; between a power that claims to dominate the heavens and a people who work together in the presence of God to rebuild the walls of fraternal coexistence.”

His choice is clear:

We must, then, avoid the “Babel syndrome,” namely the idolatry of profit that sacrifices the weak, a uniformity that neutralizes differences, and the pretense that a single language — even a digital one — can translate everything, including the mystery of the person, into data and performance.

The Pope was joined at the presentation by Christopher Olah, a co-founder of Anthropic. Mr. Olah said: “Today is just the beginning — the start of a long collaboration between those of us who are building this and those who can see what we, from the inside, cannot.” He added: “We need informed critics who will tell the labs when we are failing. We need moral voices that the incentives cannot bend.”

“Leo sees the challenge of AI as a choice about its design, and about who gets to make those choices,” Vincent Miller, a professor of theology at the University of Dayton, Ohio, told The Wall Street Journal.

Not surprisingly, the pope directly addresses the use of AI in warfare. “Moral judgment cannot be reduced to calculation, for it involves conscience, personal responsibility and the recognition of the other as a person,” he writes. “Therefore, it is not permissible to entrust lethal or otherwise irreversible decisions to artificial systems.”

He is also concerned about its use in politics, and its potential impacts on children. And he calls our data “the new rare earths of power,” warning:

Here lies one of the most urgent moral challenges of our time: to ensure that shared knowledge becomes a true common good rather than an instrument of dominance. This requires restoring to individuals not only the data that describes them, but also the ability to decide how it is used, by whom and for whose benefit.

The Pope warns: “Robust legal frameworks, independent oversight, informed users and a political system that does not abdicate its responsibility are required,” We’re going to need more than “hopes and prayers” to make those happen.

In light of recent verbal exchanges, I can hardly wait to see how President Trump responds. Indeed, Anna Rowlands, a British theologian who was among the encyclical’s presenters, said: “I think the danger for an American audience is funneling everything solely down to some kind of drama between Trump and Leo.” She went on to add, though: “Certainly, there would be questions that can be asked for the U.S. when you read that section on power, but there are questions for other global leaders, as well, and also for the tech industry itself.”

It’s bigger than Trump, bigger than the U.S., bigger than tech.

The Pope doesn’t have all the answers and probably doesn’t even raise all the right questions. But he’s thrown down the gauntlet with some very specific concerns, and it’s up to all of us meat computers to pick it up and take action.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By JAKE SEGAL and KAREN LARSEN

Call 988 in California and someone picks up. In parts of the state, a mobile crisis team might arrive at your door instead of police. Through Proposition 1, the state is putting billions into treatment beds, supportive housing, and youth services. On paper, California is in the middle of the most ambitious behavioral health expansion in the country.

And yet, about two-thirds of adults and adolescents in need of care don’t get treatment. A behavioral health system that you can’t staff is just a blueprint, not a strategy.

Even as demand for mental health and substance use treatment surges, the supply of trained professionals is not keeping pace. California needs 375,000 behavioral workers by 2030, doubling positions  statewide. State officials estimate a 38% shortfall in psychiatrists and a gap of roughly one-third among the 100,000 licensed therapists needed. Rural and underserved communities are especially hard hit; many have no child and adolescent psychiatrists at all. And shortages extend beyond doctors and therapists. Clinical social workers, addiction counselors, peer support specialists, and community health workers are also in short supply. 

Building on State Leadership

California is not starting from scratch. The Department of Health Care Access and Information (HCAI) already administers several scholarship and loan repayment programs that encourage clinicians to practice in high-need settings, including loan repayment for nurses, licensed mental health providers, substance use disorder counselors, and psychiatric nurse practitioners. Through the BH-CONNECT federal waiver, HCAI is rolling out five workforce programs over 2025–2030, including a Medi-Cal Behavioral Health Student Loan Repayment Program. 

These are important efforts, but they aren’t scaled to the size of the crisis. Loan repayment awards are often a fraction of a graduate’s full debt, and have limited availability. Even the largest programs will only target a few hundred providers; California needs thousands more.

Repayment alone doesn’t solve the immediate affordability problem: people can’t enter training if they can’t pay rent while they are doing it.

A $1 Billion Statewide Workforce Fund for California

California should create a statewide Behavioral Health Workforce “Pay It Forward” Fund: a $1 billion pool that lends money to trainees at zero interest, gets paid back as they get good jobs, and lends those same dollars out again.

Unlike a one-time grant program that disappears at the end of the budget cycle, a revolving fund is designed to recycle repayments to support future cohorts. It stretches public and philanthropic dollars further, while not increasing debt burden if there’s no payoff for trainees.

These funds provide zero-interest loans to cover tuition as well as critical living expenses while completing training and/or licensure. Repayments are recycled to support future cohorts. And graduates who work in high-need public systems can be eligible for retention-based loan forgiveness.

In the wake of federal changes that severely curtail access to affordable loans for graduate degrees—through Grad PLUS caps under HR1—the need is ever greater.

Beyond financing tuition, these models help close affordability gaps for peers, substance use counselors, and navigators–workers who may not carry large student loans but face meaningful financial barriers during training itself. They can also be adapted to support incumbent workers seeking additional credentials, further strengthening retention.

This model is not theoretical—it’s being piloted today in San Diego, where a county-led program (supported by one of our organizations, Social Finance) launched in 2025 to address an 8,000-worker shortfall in the region. Similar revolving workforce funds are operating in states such as New Jersey, Indiana, and Massachusetts, demonstrating how finite public investments can support long-term workforce pipelines and worker retention while building accountability into the system. 

The Stakes Are High

Behavioral health policy changes don’t work without the workforce to deliver. A Pay It Forward Fund won’t close the gap alone. But without something like it, the rest of the investment can’t do what it was designed to do.

Karen Larsen, LMFT, is the CEO of the Steinberg Institute and formerly served as the Director of Yolo County’s Health and Human Services Agency. Jake Segal is managing director for the public sector practice of Social Finance

By KIM BELLARD

MIT is, most people would admit, a pretty good school.  Even those who don’t know a lot about universities probably associate MIT with science, engineering, and math, and in fact, it is one of the leading universities in the world for those (and other) areas. E.g., the QS World University Rankings have named it the top university in the world the last 14 years, USN&WR Global Universities Ranking has it #2, as does The Times Higher Education World University Rankings. There have been over 100 Nobel Laureate recipients associated with MIT. If you meet a Harvard grad you might think, oh, they may not actually be all that smart – they could be just a legacy admission, but if you meet an MIT grad you probably do expect that they must be smart, especially since MIT does not have legacy admissions. Even President Trump, who rails against “elite universities” and who has slashed science funding in his second administration (more on that later), can’t help but rave about his smart uncle who taught at MIT.

So when the President of MIT warns about reductions in research funding and in graduate school admissions, we’re not talking about the proverbial canaries in the coal mine dying. We’re talking about miners going down.  

In a video message last week, MIT President Sally Kornbluth warned of some startling losses: over 20% drops in federally funded research, in new federal research awards, and in graduate student enrollment. Overall, the school’s research enterprise has shrunk 10% in the last year.

Gulp.

“That is a striking loss for one of the most influential and productive research communities in the world,“ Dr. Kornbluth said. She added:

The fact is that we’re looking at a real drop in research being done by the people of MIT. It’s a loss of momentum for faculty and students and frankly, it’s a loss for the nation. When you shrink the pipeline of basic discovery research, you choke off the flow of future solutions, innovations, and cures, and you shrink the supply of future scientists.

Make no mistake: although MIT itself may be an outlier, what is happening to it is not. Ted Mitchell, president of the American Council on Education, told The Washington Post: “This is the first of many of these kinds of alarms that will be ringing,” Brendan Cantwell, a professor of higher education at Michigan State University, also told WaPo that if MIT is scaling back how it does research, that means universities across the country should be thinking about scaling back and adjusting. The ripple effects will go far and wide, and will have bigger impacts than we realize.

I’ve written before about the Trump war on U.S. science, and while some of his attempted funding cuts have been halted by courts, no one should have their hopes up. The American Physical Society reports:

The National Science Foundation has awarded just 613 grants this fiscal year, at about 20% the level at this time in the year in each of fiscal years 2021 through 2024, according to the group Grant Witness. The amount of funding awarded is at similarly low levels, about one-third that of previous years. The trend is visible across each of NSF’s directorates. New and competitive award renewals, which undergo full peer review, are particularly low compared to previous years. The National Institutes of Health has seen a similar trend regarding its number of awards, having given out about 10,000 awards this year compared to around 18,000 at this time in previous years; total award funding is also down by a similar amount. NSF and NIH are even lagging behind fiscal year 2025, during which thousands of grants were canceled and fewer grants were awarded than in previous years.

Meanwhile, of course, there was last month’s firing of the entire board that is supposed to oversee the National Science Foundation (NSF), which itself has been without a director for the last year. More than 2,500 scientists joined in a letter to Congress decrying the move, warning that the move “ramps up an alarming attack on the ability of the US to engage in basic and applied research, and to be competitive globally, particularly given that China is now investing more in R&D than the US.”

Dr. Kornbluth cited one threat to MIT’s financial well-being that most of us may not have realized: the excise tax on endowments. Harvard takes some grief for its $56b endowment fund, but Yale ($41b), Stanford ($38b), Princeton ($33b), MIT ($25b), and U Penn ($22b) also have large endowments. Congress during the first Trump Administration put a 1.4% excise tax on university endowments, but the so-called Big, Beautiful Bill introduced a sliding scale that gets up to 8% for the universities with the largest endowments – including MIT. It expects to pay $240 million annually for that tax, and that’s money not being spent on supporting research or educating exceptional students. Yale expects to pay $280 million annually.

Maurice McInnis, the President of Yale, warned: “The impact of this tax will also be felt far beyond our campus and our hometown. Taxing universities undermines the education and research that fuel life-saving medical breakthroughs, life-changing innovations, and economic growth in communities across the country and around the globe.” 

It feels less focused on raising revenues and more focused on punishing elite universities, and damn the consequences.

Dr. Kornbluth also pointed out the Administration apparently antipathy towards international students. The U.S.-based international education nonprofit NAFSA recently issued a report estimated that foreign student enrollment fell 20% for this spring semester. Not all of them are brilliant, not all of them would have gone to MIT or another elite research university, and not all of them would have stayed in the U.S., but our track record of attracting and retaining the best & the brightest from all around the world is in danger.

This. Is. Not. Good.

I didn’t go to an elite college, and I know that not all scientific or technological breakthroughs come from people who do (or even who graduate from college at all). But I do know that America did not become what it is without those elite research institutes, and if we continue to try to kill the golden geese (to move away from the canary metaphor), we’re going to miss out on the gold they produce.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor

By OWEN TRIPP

For decades, quality in healthcare has been defined on industry terms — not people’s terms. New technology and innovative health plan designs are finally changing that.

People know quality when they see it, and they are definitely not seeing it in healthcare. Fifty-six percent of Americans rate the quality of care as “poor” or “fair,” and 90% believe we’re overpaying for it. Likewise, 80% of employers — collectively the largest purchasers of healthcare in the country — say that higher-quality care is a top priority for their workforce.

And yet, the U.S. healthcare system remains a global leader; a lack of know-how or quality control isn’t the problem. The problem is the wide gap between how the healthcare industry has historically defined quality and how quality is experienced by the people actually receiving and paying for care.

For the past 75 years, healthcare quality has been shaped by a grab bag of federal agencies, accrediting bodies, medical organizations, health insurers, and — more recently — consumer-focused ratings outfits ranging from U.S. News & World Report to Zocdoc. Though many pay lip service to patient experience, none has clearly defined quality — or explained it intuitively enough — to help individuals make smarter healthcare decisions based on their clinical and financial context.

Healthcare needs to move beyond narrow metrics and top doc lists to create a dynamic, value-driven view of quality that consistently connects people to the best care for them, where and when they need it — and ideally, even before they know they need it. Too often, “quality” equates to some numbers on a dashboard, when it needs to be more like a combination of GPS and driver-assist technology: guiding people to their health goals, keeping them in the highest-quality lane, and nudging them if they start to drift.

This was always the vision (for some of us). But we simply haven’t had the right mix of technology and system-wide connectivity to bring it to life. Now we do.

AI and dynamic alternative health plan designs — to name just two innovation hot spots — are finally putting people and purchasers in the driver’s seat by making healthcare quality multidimensional, personalized, and actionable.

1. Multidimensional

In virtually every other purchasing decision, consumers optimize for quality based on need, preference, priorities, and budget. Healthcare is the outlier. Providers and insurers (among others) have made this decision-making impossible by carving up key dimensions of quality — outcomes, experience, and cost — that people rightly view as a whole. (This was the basic idea behind the Triple Aim, which still holds up two decades later.)

No one in healthcare has successfully optimized for all dimensions. Hospitals and health systems have optimized for outcomes by focusing on specialty care and cutting-edge treatments that boost their U.S. News ranking — while also driving up unit costs. Insurers have optimized for cost through utilization management and tactics like prior authorization — while also degrading the healthcare experience for patients and providers.

This fragmentation has led us astray. Without a clear roadmap for getting to quality, people fall back on word of mouth, iffy ratings, and unreliable health plan directories. As a result, many people unwittingly see lower-quality doctors, undergo unnecessary procedures, and bypass cost-effective primary care for high-priced specialists at highly rated hospitals. Yet every day, even at world-class academic medical centers, physicians of varying expertise make questionable decisions — such as recommending surgery — that fail to consider the whole person, significantly impacting outcomes and healthcare spending for individuals and populations alike.

In 2014, I co-founded Grand Rounds (since rebranded as Included Health) to fill the gaps in existing quality metrics and guide people to the best possible care by building a fuller picture of individual clinical judgment and individual patient needs. With the aid of machine learning, we analyzed billions of data points to untangle the associations between physician characteristics and credentials, health claims, patient experience ratings, and the many contextual factors — including the quality of the institution where a physician works, and the patient’s specific medical history — that influence downstream clinical and financial outcomes.

Considering quality across all dimensions makes all the difference. With more than a decade of data under our belt, we’ve consistently found that people who connect with higher-quality providers and settings via our platform experience better outcomes and are more likely to stay engaged in care, which in turn generates short- and long-term cost savings by (for example) reducing avoidable surgeries, ER visits, and hospitalizations.

2. Personalized

But we also knew from the start that quality is more complex than labeling “good” and “bad” doctors. The reality is, some doctors are excellent for certain needs and certain patients, but not for others. Even for two people with the same underlying medical condition, quality can look very different, depending on their clinical, financial, and social context. That’s where personalization comes in.

Incorporating each person’s unique context into how we define quality is a profound and long-overdue shift in mindset. Instead of stopping at conventional provider metrics and retrospective claims data — which are important but incomplete — a truly personalized, person-first approach requires tapping into a much broader range of data sources to proactively adjust for patient-provider fit and surface the highest-quality care for that person, at that moment in time.

This level of personalization is challenging to scale, but AI has changed the game. Now, the machine learning underlying next-generation quality platforms can dynamically leverage data from hundreds of sources across the healthcare ecosystem, including the EHR, prior clinical interactions, and patient-stated needs and preferences. Additionally, personalized AI healthcare assistants are proactively collecting insights 24/7 that help (human) care teams create individual care plans to keep people “in quality” throughout their healthcare journey.

Even before people express a specific need, chat-based interactions provide a longitudinal record of personal health goals, what’s working (or isn’t), and relevant barriers or constraints. If a person needs a Spanish-speaking provider close to public transportation, for example, or prefers virtual primary care to in-person care, those signals can now seamlessly inform real-time recommendations and guidance.

3. Actionable

Personalization behind the scenes isn’t enough, however. A critical third step is feeding quality-related insights back to people in easy-to-understand terms that make them feel confident in their next best action. At Included Health, we’ve found that explaining the rationale behind recommended providers in our digital app, at the right level of detail, increases the likelihood that the person will follow through on that recommendation and actually schedule an appointment.

A simple, user-friendly view of quality is especially important when it comes to provider networks and cost-sharing. The tiered networks that underpin most HMOs, PPOs, and high-deductible health plans — and the corresponding differences in cost — are notoriously confusing to consumers. The lack of clarity into why certain doctors or facilities are in- vs. out-of-network, how quality is defined, and how that translates into coinsurance and deductibles leads people to make suboptimal decisions, resulting in fragmented and drawn-out care, higher out-of-pocket costs, and increased waste and inefficiency in the system overall.

This long-standing pattern is driving a surge of interest in alternative health plans that combine quality-based networks and simple, transparent pricing — often copays only — to incentivize and guide people toward quality. The most sophisticated of these plans incorporate dynamic networks, AI-first digital experiences, and clear financial signals to guide people to high-quality, high-value care.

Musculoskeletal conditions are a prime example. For a routine knee X-ray, variance in quality across facilities is quite low; we should guide people toward a nearby low-cost facility, rather than the expensive academic medical center downtown. But if the X-ray suggests a knee replacement, provider and facility quality suddenly become highly variable and important — and the academic medical center may then offer the best outcome at the lowest possible cost.

We can’t expect the typical consumer (or any of us, for that matter) to make this type of calculation on their own. They need guidance, and to be truly actionable at the point of care, that guidance has to be built into the front-end experience. With the help of AI, healthcare quality platforms — just like the navigation and safety systems in our cars — need to instantaneously translate the mass of available data into simple visual cues, personalized nudges, and clear direction. Any definition of “quality” that doesn’t keep people moving toward their goal isn’t doing its job.

A generational opportunity

The confluence of new technology and new thinking outlined here has created a pivotal moment in healthcare. For the first time, healthcare innovators are empowered to simultaneously optimize for outcomes, experience, and cost with the necessary nuance and speed. That’s a generational opportunity — a mandate, even — but it comes with a responsibility.

Quality has to be at the center of the healthcare experience. Provider recommendation tools and other quality platforms have proliferated in recent years, and many have failed to deliver lasting value to people and purchasers. If the definition of quality at the core of these platforms is narrow, flawed, or (worst of all) biased in favor of stakeholders with an interest in the status quo, they run the risk of exacerbating the subpar outcomes and unsustainable costs dragging down U.S. healthcare.

No matter how sophisticated the technology, if we don’t redefine quality in a way that puts people first, we’ll still be heading in the wrong direction. The good news is, for the first time, we have everything we need to get it right.

Owen Tripp is the co-founder and CEO of Included Health, a personalized all-in-one healthcare company.