While fee-for-service models incentivize in-clinic treatments, value-based care shifts the focus to outcomes and overall cost. Under these new models, home dialysis—which offers better patient outcomes and lower societal costs—becomes more profitable for providers, creating a powerful financial incentive to drive adoption.
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The new Medicare 'Access' code for AI in chronic care is priced too low to be profitable if humans are kept in the loop. This clever incentive design forces providers to adopt genuine AI-driven leverage rather than simply relabeling human effort, a first for healthcare technology.
ProKidney's CEO observes that over a 10-year period, the only significant change he saw in dialysis clinics was the addition of flat-screen TVs. This starkly illustrates the profound lack of clinical and technological innovation in a massive, life-sustaining industry, highlighting a huge opportunity for disruption.
By allowing insurance companies to price plans based on biometric data (blood pressure, fitness), you create powerful financial incentives for people to improve their health. This moves beyond abstract advice and makes diet and exercise a direct factor in personal finance, driving real behavioral change.
General Catalyst's CEO highlights a core flaw in healthcare: insurance providers don't reimburse for longevity or preventative care because customers frequently switch plans, preventing insurers from capturing long-term ROI. The first company to solve this misalignment and make longevity "financeable" will unlock a massive market.
While positioned as a clinical decision support tool rather than a formal diagnostic, the technology is still reimbursable under existing CPT codes. This provides a direct financial incentive for providers, a critical advantage in a healthcare system where new, unreimbursed technologies face steep adoption hurdles.
Elliot Cohen posits that the healthcare system is broken because it optimizes for financial relationships, not the patient. He argues the key metric should be Net Promoter Score—how much consumers love the experience. A system that people enjoy engaging with would inherently solve many cost and quality issues.
Of the 30+ million Americans with chronic kidney disease (CKD), most are unaware they have it. The greatest societal impact would come not from a new therapy, but from widespread screening and education, as existing drugs and lifestyle changes can help patients in the early stages before they need advanced care.
Chronic disease patients face a cascade of interconnected problems: pre-authorizations, pharmacy stockouts, and incomprehensible insurance rules. AI's potential lies in acting as an intelligent agent to navigate this complex, fragmented system on behalf of the patient, reducing waste and improving outcomes.
By aggregating millions of users, ZocDoc acts as a collective bargaining unit for patients. It uses its marketplace power to reward providers for patient-friendly behavior (e.g., price transparency, better hours) with better visibility, proving more effective at driving change than punitive government regulations.
The core issue preventing a patient-centric system is not a lack of technological capability but a fundamental misalignment of incentives and a deep-seated lack of trust between payers and providers. Until the data exists to change incentives, technological solutions will have limited impact.
