Equitable Healthcare: Can We Bypass Insurance Companies?

The Contentious Debate Surrounding Tech-Driven Healthcare Solutions

The U.S. healthcare landscape presents significant challenges, prompting a surge in startups aiming to improve standards of care through technological innovation. At TechCrunch Disrupt 2021, three companies – Cityblock Health, Forward, and Carbon Health – engaged in a lively discussion regarding these advancements.

Defining Customer-Centric Healthcare and the Role of Insurers

The core disagreement centered on the definition of truly customer-centric healthcare. Adrian Aoun, CEO of Forward, asserted that collaboration with insurance companies inherently compromises a company’s ability to prioritize consumer needs.

Aoun stated that companies partnering with insurers, such as Carbon Health and Cityblock Health, are incentivized to prioritize insurer interests rather than developing superior consumer products. He argued that their focus shifts from patient well-being to billing procedures.

Differing Perspectives on Collaboration and Patient Outcomes

Toyin Ajayi, president and co-founder of Cityblock Health, challenged Aoun’s rigid viewpoint, explaining that a collaborative approach doesn’t necessarily preclude a genuine focus on patient outcomes.

Ajayi proposed a different path: partnering with insurers while assuming financial risk for the total cost of care and patient results. This allows for investment in crucial services like community health workers who provide essential support, without being solely reliant on fee-for-service billing.

Reaching Marginalized Populations and the Limits of Direct-to-Consumer Models

Ajayi further emphasized that solutions solely focused on the consumer experience often fail to extend benefits to marginalized communities. She has not observed products designed for affluent individuals successfully reaching those most in need.

The Scale of Insurance Coverage and Accessibility

Eren Bali of Carbon Health highlighted the limitations of concierge healthcare models, noting that they are accessible to a relatively small segment of the population. Approximately 150 million people might be able to afford out-of-pocket healthcare expenses.

Bali pointed out that the majority of individuals rely on some form of insurance, even if inadequate, and lack the financial resources to cover substantial primary care costs. He estimated that another 20-40 million individuals fall into high-risk Medicaid or Medicare categories, unable to participate in risk-sharing arrangements.

A Call for Systemic Overhaul

Aoun advocated for a complete reconstruction of the healthcare system, drawing a parallel to Elon Musk’s approach with Tesla. He believes a fundamental redesign is necessary, encompassing everything from surgery to preventative care.

He envisions a future healthcare system built on infrastructure like body scanners and sensors, powered by AI and algorithms, and ultimately designed for the individual, not the insurance company.

Addressing Immediate Realities and Avoiding Exclusion

Ajayi countered that while an ideal future state is important, immediate realities must be addressed. Ignoring the existing system risks leaving vulnerable populations behind and jeopardizing their health.

She argued that current payment mechanisms, despite their flaws, represent a functioning market, and resources should be strategically deployed to maximize impact.

Rejecting Simplistic Analogies and Prioritizing Current Needs

Aoun likened the current moment in healthcare to the introduction of the iPhone and the subsequent flourishing of the App Store. However, Ajayi rejected this comparison, stating her focus is on improving the lives of people today.

She believes that existing tools and systems can be leveraged to achieve significant improvements, potentially converging with future technologies to benefit a wider population.

A Fundamental Question of Priorities

Ajayi challenged Aoun’s perspective, framing the debate as a difference in vision. While Aoun aspires to be the “Elon Musk of healthcare,” she identifies as someone dedicated to improving the lives of those currently suffering and lacking access to advanced technologies.

She emphasized that factors beyond medical technology – such as food security, transportation, trauma, and access to nutritious food – are often the primary determinants of health outcomes, particularly for low-income individuals.

Ultimately, the discussion underscored the complex interplay between innovation, accessibility, and the fundamental needs of a diverse population within the U.S. healthcare system.