By Owen Tripp
Creating an experience in health care that builds up trust and delivers value to people and buyers is not a quick solution, but it is the only way to reverse the downward spiral of high costs and poor results
Entrepreneurs like to say that the American health care system is ‘broken’, usually just before they explain how they intend to repair it. I have a slightly different diagnosis.
The American health care system is the gold standard. Our institutions and companies, ranging from 200 -year -old academic centers to digital health startups, are the clear world leaders in clinical expertise, research, innovation and technology. With regard to the possibilities, the system is far from broken.
What is broken to trust In the system, because of the striking gap between what the system is capable of and what it actually delivers. Every day throughout the country people drive past hospitals of World Class, but then have to wait months for an appointment with first -line care. They pull hundreds for healthcare from every salary, but to hear in the pharmacy that their recipe is not covered. In anticipation of a state-of-the-art scan, they have handed over a clipboard and asked them to summarize their medical history.
This whipsa registration is not due to incompetence or poor infrastructure. It is the product of the dysfunction between the two largest health care players: providers and insurers, two entities that have optimized hell of their respective companies, in contrast to each other, and unintentionally at the expense of people.
Historically, hospitals and health systems-include that 200-year-old AMCs-Zich have fully devoted to improving and saving lives. I am not saying that they have lost sight of this, but until recently Margin took a backseat to mission. However, with the consolidation of the industry and the persistence of the Fee-For-Service model, the hands of providers are forced to maximize the volume of care against the highest possible unit costs, which in turn have become one Chief driver of the cost of the cost in general.
This push of providers has led to an equal and attitude of insurers. Although the industry (rightly, in some cases) has been drawn for a harsh approach to user management and prior authorization, insurers only do what their primary customer-particular employers have she hired To do: manage costs. Insurers have become very good at it, not only by limiting care, but also by Product innovation This has created more levels and options for sharing costs for planning sponsors.
In the meantime, consumers in health care (people!) Have been put aside in the midst of this tug of war. Doctors and hospitals say they are centered on the patientand insurers say they are member-centric – But the jargon is a dead giveaway. Each side is focused on their half of the cake, and neither is responsible for the whole Person: the person who receives care And Paying for care, not to mention navigating everything in between.
It should not be a surprise that trust falls. Only 56% From Americans relies on their health insurer to act in their best interest. Even faith in doctors – the good – have cellar. In a surprising reversal from just four years ago, no less than 76% of people to believe Hospitals care more about income than patient care.
| Loss of trust in care providers | |
| Hospitals in the US are usually aimed at … |  |
| ⏺ Care for patients ⏺ Make money Source: Jarrard / Sheets (2025) | |
This trust deficit is the main cause of so many health care problems. It is the reason that people loosen, delay and skip care and end up in the problems to be found in the there or or or for problems. When a good part of the population falls into this cycle, as they have, you end with the status quo: relentless costs And deteriorating the results that households, companies and the industry themselves drag down.
There is no quick solution. Despite what my fellow entrepreneurs could say, no point solution or technology (no, not even Ai) can rebuild trust. The only way to reverse the downward spiral is to serve a modern experience that was really designed around the needs of people.
Brace yourself: building that experience does not have to rebuild the entire system. But it requires step change. It is time for leaders and innovators in the ecosystem to redesign partnerships, people-first care and payment models and to define it again to create a new center of gravity in health care, one that lies outside the traditional job of providers and insurers, but also connected to all the possibilities and expertise the system has to offer. That is the solution, and this is what I think it looks like:
People and buyers, together
The market for commercial insurance policies of the group is perhaps the new Healthcare gravity center. Think about it: jointly represent private employers and public organizations that form the market the largest buyers of the country’s health care and offer health insurance to nearly 160 million Americans. Thanks to their scale and influence, these organizations are uniquely positioned to actually rise above the status quo and to create an alternative to the Dynamic Dynamic.
| Health insurance of the American populationSource: Kff (2023) | |
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Apart from scale, the interests and incentives of these planning sponsors are naturally tailored to those they cover. People (employees) and buyers (employers) both want the same thing. Employees and their families want more Healthy daysWith lower premiums and out-of-pocket editions. Employers want a healthy, happy and productive workforce, while reducing their astronomical health care expenses – projected To be with 9% for private employers this year. In contrast to the Zero-Sum game between providers and insurers, better health results at lower costs are a win-win for people and buyers.
Self-financed employers represent-Die two -thirds of the group market, and skew bigger – are especially important players, because of their purchasing power and their ability to put together benefits and services for their workforce that use the best options that the system has to offer. Instead of trusting a single carrier, many self -financed employers directly conclude a contract Centers of Excellence Model), as well as best-in-class service providers in the entire health care ecosystem.
End-to-end integration (for real)
The historic gap between providers and insurers has broken the experience in healthcare, but that is not the only culprit. In fact, the proliferation of point solutions, digital health apps and third-party service providers have worsened many of the cracks and pain points in the system. “Front doors” that claim to streamline the experience in health care for employees who open too often on the same fragmented and confusing landscape as they lead all over.
Repairing the experience must start with integration and not just clinical integration. Yes, integrated care issues. Connecting primary care with behavioral health and special care, combining virtual and personal experiences, giving care teams access to the same data-this are all essential steps. But integration must go much further. Clinical quality and results are inseparable from the administrative, financial and logistical aspects of health care that have long been stranded between providers and insurers.
People intuitively understand the relationship between their mental, physical and financial health, and they need a reliable support system that will treat all these dimensions together, through navigation, financial support, social support and other historical SILED services
A modern view of value -based care
Value -based care has long been seen as a solution for the incorrectly aligned incentives that the Fee-For-Service model has created among providers and insurers. However, two decades of experiments led by Medicare have mixed (Some would say disappointing) results. But those Call to end According to the value-based project, the unused potential for alternative payment and care delivery models overlooks the always important commercial market.
Healthcare value, as a concept and practice, is relatively new To the commercial space. Value-based schemes between sponsors of health plan and their care partners are largely limited to pay-for-performance models and bundled payments for specific clinical services (such as with centers or excellence). Although some of these targeted solutions do offer savings, measuring ROI is more an art than a science. In particular, the lack of integration has described in integration that includes multiple service providers, as well as clinical and non-clinical services for planning sponsors to attribute improved results or cost savings to specific solutions.
New value -based partnership models change that. Although value -based contracts can take many forms, the lead on the commercial market is a Shared savings Model that encourages care providers and insurers to join forces and generate results that are important for people And Buyers, including experience, clinical quality and – most important – the total healthcare costs. It is not enough to have the right partners and possibilities. The model must ensure coordination and accountability.
Conclusion: From downward spiral to flywheel
When these pieces come together in an experience in health care that provides people’s confidence, the spiral of high costs and poor results begins to reverse itself. An easier and more integrated people-first experience stimulates involvement, which improves the results. Better experiences and results build trust, which drives further involvement, and so on. Eventually a flywheel effect starts: as people become healthier, they need less expensive care, and they are more resilient and productive and that is passed on to the buyer.
Healthcare is not broken. We don’t have to dismantle or overhaul the system. We just have to get a better formation, so that the very best of the system actually works for people, not against them.
Owen Tripp is the co-founder and CEO of Including healthA personalized all-in-one healthcare company that cooperates with employers and organizations in the public sector about on value-based care.
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