The Most Critical Issues Facing Our Healthcare System—and How These Founders Are Solving for Them

The U.S. healthcare system as it stands is unsustainable. Patients pay exorbitant costs and face fragmented care and barriers to access in return. And yet the U.S. spends far more on healthcare than most other high-income nations. What’s the disconnect here? More importantly, how do we fix it?

While there’s no simple solution, we at Primary fundamentally believe that one of the answers lies in the growth of tech-enabled virtual care, an area where we are actively learning and investing. With this conviction in mind, we interviewed some of the brightest minds in next-gen consumer healthcare to understand what they see as the most pressing problems and how they hope to enact systemic change.

“We’re all familiar with ways that the healthcare system is failing us. It takes on average more than 29 days to get an appointment, costs over $100, and lasts about 13 minutes. This is only set to get worse, as by 2032 there will be a shortage of 132K physicians in the U.S. There is a structural imbalance. There are too many people who need care and too few people to provide it. As a society, the only way we have ever done more with less is with technology. From the printing press to the iPhone, technology is how we turn luxuries that only the rich have access to into commodities." —Zachariah Reitano from Ro

On misaligned incentives

“Every problem that you look into in healthcare, the root of it is misaligned incentives. If you can build a product and a business that aligns incentives between consumers, payers, providers, and employers, everybody wins. That's what I believe. There's exciting movement towards value-based care models and bundled payments that can allow providers like Tia to do more innovative things but we're still in just such the early innings of that. We need to move there more rapidly as a healthcare system. I also think we need more innovation on team-based care models that lower the cost of care, that can have patient panels be larger on a per provider basis.” —Carolyn Witte from Tia

“I think insurance is a terrible financial vehicle to cover the majority of healthcare. That doesn’t mean that it doesn’t have its place in healthcare but it’s currently being abused and, in my opinion, it’s misuse is one of, if not, the single largest thing holding every American back from accessing affordable, high-quality healthcare. Insurance is intended to pool risk. It is useful to pool risk when an event is rare, uncertain, and expensive. But it needs to be all three simultaneously. Insurance is great for a car accident, but we do not buy insurance for gas. Every time we place an insurance company between patients and their healthcare, we are incentivizing what’s best for the insurance company and not patients.” —Zachariah Reitano from Ro

On fragmented care

"I think one of the biggest issues that I'm really excited that we can solve, especially in telehealth, is care coordination. Care coordination right now is absolutely atrocious. Let's start with EMRs and data sharing. EMRs don't talk to each other, which means that when you go see one doctor, that doctor might have all this data about you, but then you go to the next doctor and they've lost all of that visibility. This is something that we've seen a lot in our patients. For example, a woman may go to a dermatologist who says, 'I see you have hormonal acne.' Then, they go to the gynecologist and say, 'I have irregular periods,' but if you're not putting that all together, then you might miss a diagnosis like PCOS, which is very multifaceted. Similarly, a lot of our patients need not just medical care, but also need lifestyle and nutrition modifications as well. But tell me, where you can find a gynecology practice that also has a nutritionist in it? That doesn't really exist.” —Rachel Blank from Allara

“We at Tia are decidedly anti-fragmentation, but I believe that's a problem not just in women's health but everywhere. And I think with the rise of actually so many new companies and products and services, they're increasing access but in other ways they're exacerbating fragmentation. I think it can, at times, make it harder for patients to get really good care when they’re trying to piece together a bunch of point solutions that don't connect to each other. I think these are solvable problems, but we need platforms that can connect the dots to really address that.” —Carolyn Witte from Tia

“There's no accountability for care coordination. I'll use my company as an example. I have technology, I have customer support, I have pharmaceutical operations, and I have medical care. And those four people, they coordinate care for an entire patient, right? The only reason that that care is coordinated for that one patient is because they have someone saying, ‘I need you to coordinate care for this patient because the life of this company is based upon the coordination for this particular patient.’ In the real world, you have your endocrinologist, your primary care physician, your urologist, and your cardiologist. Not one of them is accountable long-term for that patient. The patient is accountable for the patient.” —Saad Alam from Hone

On lack of prevention

“Healthcare is like education, right? It’s a core systemic part of society. It impacts the economy, people's happiness and livelihood. People ask me, ‘What's your revenue? Once you go to market, how do you make money?’ My response is that I can tell you about my CAC and LTV, but let me tell you what's really interesting. How much would you pay to significantly lower your risk of chronic conditions and death? I'm going to argue a lot in terms of value.” —Allon Bloch from K Health

“I'd say that a lot of these chronic diseases that we're starting to face right now wouldn’t happen if people were a lot more prevention focused. The reality is that if you do four things— learn how to manage your stress, sleep two more hours at night, walk around for 20 minutes a day, and exercise another 10 minutes a day on top of that— the majority of your problems could go away.” —Saad Alam from Hone

On managing chronic conditions

“To date, telehealth has focused primarily on diagnosis and (when appropriate) treatment with prescription medication. While this is effective for some conditions in the short-term, it’s longitudinal care that incorporates lifestyle intervention (often alongside medication) that really improves health over the long-term. In order to get the most out of telemedicine, longitudinal care programs like Calibrate must be created and integrated into treatment to better serve patients.

To ensure that our members were receiving the care they needed, we built a vertical pharmacy engine that can learn over time what medication and insurance combinations have the highest likelihood of success while also automating the application of copay cards and payment benefit integration. We also developed a system to provide members with these medications through their insurance with a copay of $25 or less a month. Compare this to paying a list price that falls between $800-$1,400 a month. Calibrate’s proprietary technology is how we’re able to get members affordable access to medications, and we believe this kind of technology can help patients across any category of chronic disease.” —Isabelle Kenyon from Calibrate

On care deserts

“Lack of access to high quality care is one of the most critical problems in the healthcare landscape in America today. This is where we focus our efforts, and where I’m the most excited to see technology play a role in the coming years. Telemedicine and remote patient monitoring are the tools on which a truly distributed, decentralized care system can be built. Currently, top quality specialist care is concentrated in a few high population density “nodes”, but virtual care models allow for the democratization and distribution of that care into care deserts and beyond. Technology not only removes these geographic barriers but also enables a handful of providers to treat large panels of patients, thereby reducing the cost of care.” —Pan Chaudhury from Perry Health

On the practitioner shortage

“Short term, remote care models should be leveraged to allow for a more efficient utilization of existing nursing capacity. Long term, health systems and digital health companies need to ensure that nursing continues to be an attractive career option by ensuring benefits and compensation on par with other career options. Broadening the opportunity set for nurses is crucial to justify going through the rigors of nursing school. On the provider side, the medical education system (medical school and residency) needs to adapt—for many people, the financial burden of a medical education puts it completely out of reach.” —Pan Chaudhury from Perry Health

“We fix this by increasing supply (this takes time), increasing the responsibilities of providers (e.g., nurses, PAs etc.), and leveraging technology to enable providers to practice at the top of their licenses (i.e., the right person performs the right task at the right time) and replace tasks all together (further decreasing costs and increasing access).” —Zachariah Reitano from Ro

“Virtual-first providers are increasingly leveraging alternative health professionals in an effort to reduce the total cost of care and combat shortages. Nurses, NPs, pharmacists, health coaches, navigators, and dietitians are not just filling gaps in the care, they are taking on key roles on the clinical teams of many digital health companies, limiting the need for potential doctor visits. By focusing on lifestyle interventions, they also prevent potential comorbidities that would put even more pressure on our healthcare ecosystem.” —Guillaume Cohen-Skalli from Paloma Health

Curious to learn more or swap ideas about digital health? Reach out to me at jason@primary.vc or @jasonrshuman on Twitter.