The U.S healthcare system is at a crossroads

November 4, 2019

Double threat of chronic disease and provider shortage looms over U.S population 

The U.S. healthcare system is at a crossroads. In one direction, we have the Mack truck of chronic disease barreling toward us. By 2020, about

- nearly half of the U.S. population - will be managing a chronic disease, with 81 million people managing more than one. These conditions are incredibly costly, representing 75 percent of the nation’s $3.3 trillion annual healthcare costs. And new research published in September shows that death rates have either stopped decreasing or are increasing for some of these conditions, including hypertension, diabetes, and cardiovascular disease.

In the other direction, we have a looming healthcare provider shortage. According to the Bureau of Labor Statistics’ Employment Projections, there is a need for an additional 203,700 new RNs each year through 2026 to fill newly created positions and to replace retiring nurses.

To make matters worse, by 2032, the United States could see a shortage between 46,900 and 121,900 physicians.

Both problems are only gaining momentum, and will accelerate more rapidly in the coming decade as our population ages. In order to avoid a massive collision, we need to move now.

The challenge is that the healthcare system was designed in an earlier era when acute and infectious diseases were the nation’s biggest health problems. We needed highly trained doctors to help the sickest people deal with urgent medical conditions. Then came industrialization, the end of polio, and the flu shot. People are living longer, our lifestyles and our diets have changed, and the new silent killer is chronic disease.

In the meantime, we have neglected to build a system that can help people stay healthy or manage a long-term, ongoing condition effectively and in a way that prevents more serious problems from developing. That burden is on the patient and their family members, caretakers, friends, and even social media contacts, who all supplement overworked nurses and doctors.

To build a new healthcare system that meets the needs of all patients - not just those requiring end of life, emergency, and acute care - we must do two things.

First, we need to make staying healthy or managing a chronic condition less difficult and less burdensome. People who have a chronic disease or are at-risk of developing one need highly personalized care that gives them ongoing support when they need it. In truth, that kind of care is not always very complex, but it is very time consuming and life long. Seemingly small things like helping people adhere to their medication regimen (and making sure it’s appropriate), keeping track of their blood sugar or blood pressure, helping patients make healthy food choices, and encouraging activity when possible have a huge impact on disease management and health outcomes.

Second, we need a healthcare system that can deliver care to half of the nation’s population every day. That’s not just doubling the clinical resources, that’s requiring a monumental increase at an incredible pace. The solution we tried first as an industry was telephonic care management, making it easier for patients to speak with a trained health coach or nurse. Even if everyone who could benefit from them used them, this would not improve provider efficiency enough to meet national care needs.

To achieve both of these things, we need to be considering conversational AI. While it is not yet developed enough to navigate most tasks that highly trained humans can do, artificial intelligence does works very well in tightly constrained, large scale, and data-rich situations. While it cannot replace doctors, nurses, and health coaches, it can provide the type of care needed to help people manage chronic conditions every day. The interventions are largely  similar across many of the most prevalent chronic conditions - the modality should be ongoing small touch points of support that feels empathetic, compassionate, and friendly. In addition, AI can base these touch points on daily health data.

While doctors and nurses should be monitoring and coordinating care for people with chronic conditions, it does not take a health professional with 15 years of training to provide the day-by-day, hour-by-hour support needed to help people stay healthy. Instead, we should be thinking about care that can meet people where they are - right on their smartphones that they carry with them all the time.  

This may not be the most exciting or provocative use of AI in healthcare, but it’s the one that will make the healthcare system more efficient and effective, and, ultimately, will result in better health outcomes while potentially saving billions of dollars.

Julia Hu is the CEO of Lark, a chronic disease prevention and management platform that’s powered by artificial intelligence.