Infinite Healthcare: What is It Worth?
What is Infinite Healthcare Worth? As AI becomes a new site of care and automates administrative orchestration, it rapidly eats into $5T+ worth of traditional health care services spend, and potentially represents the biggest market opportunity in all of healthtech.
AI has the promise of bringing the cost structure of care delivery down such that we see much higher ROI per dollar spent. Utilization will likely increase as access becomes more abundant (per Jevons Paradox), and we’ll expect to see entirely new forms of care delivery emerge that we can’t even imagine today. This could be the unlock that finally propels our healthcare system towards a more prevention-centric paradigm, in which we are able to engage consumers regularly and therefore reduce unnecessary, high-cost, and high-risk medical escalations by keeping people healthier to begin with.
In this context, dozens of pricing experiments are already playing out amongst AI care companies, even being facilitated by the federal government (e.g. CMMI's ACCESS program). We lay out a framework for these:
Per Task
Per Workflow
Per Episode
Per Patient
with Per Outcome as a possible overly on all 4 of those. Companies are blending multiple payment models under roof - sometimes mashing up traditional reimbursement with cash pay, or set fees with outcomes-based carrots/sticks.
One thing that is clear is that we’re in only the very early innings of seeing how AI will transform the topology of the care delivery landscape - how it’s delivered, what kinds of services it will comprise, and how it will be paid for. Core elements of this evolution expressly goes against the grain of the cultural status quo in which increased utilization is viewed as failure, prevention is not incentivized, and cost structure is only expected to inflate, not deflate. But the math of the current system no longer maths - so we must price healthcare accordingly.