Owen Tripp
Creating a medical experience that builds trust and brings value to people and buyers is not a quick fix, but it is the only way to reverse the downward trend of high costs and bad outcomes
Entrepreneurs like to say that the health care system in the United States is “breaking”, usually before explaining how to fix it. My diagnosis was slightly different.
The U.S. health care system is the gold standard. From 200-year-old academic health centers to digital health startups, our institutions and businesses are world leaders in clear areas of clinical expertise, research, innovation and technology. Functionally, the system is far from damaged.
Broken is believe In the system, there is a clear gap between the capabilities of the system and the content actually provided. Every day around the country, people drive past world-class hospitals, but then have to wait a few months before making an appointment. They deduct hundreds of health care from each salary, but were told at the pharmacy that their prescription was not covered. While waiting for the state-of-the-art scan, they handed the clipboard and asked to review their medical history.
The experience of this whip is not due to incompetence or poor infrastructure. This is the product of the dysfunction between the two largest players in healthcare: providers and insurers, which are two entities that optimize their respective businesses, oppose each other, and at the expense of humans.
Historically, hospitals and health systems, including the 200-year-old AMC, have been fully committed to improving and saving lives. I'm not saying they've lost sight of this, but until recently, Margin retreated it to Mission. However, with the continuation of industry consolidation and expense as service models, the provider’s hands are forced to maximize the amount of care at the highest unit cost, which in turn becomes the main driver of the overall out-of-control cost trend.
The provider’s push prompted insurance companies to respond equally and tolerantly. Although the industry has been (in some cases right) used by villains to achieve serious exploitation and prior authorization, insurance companies are simply doing their primary clients – private employers – hiring their jobs: managing costs. Insurers not only limit care, but also create more hierarchical and cost distribution options for plan sponsors through product innovation, which is very good at.
Meanwhile, in this tug of war, healthcare consumers (people!) were eliminated. The doctor and the hospital said they were Patient-centeredthe insurance company said they are Member-centered – But the term is a dead giveaway. Each side is concentrated on half of them, not right All People: Those who receive care and Pay for care, not to mention everything in between.
It is no surprise that trust is declining. Only 56% of Americans trust their health insurance companies to act in their best interests. Even trusting doctors (good people) plummeted. From four years ago, in a shocking reversal, 76% believed that hospitals were more concerned about income than patient care.
| Losing trust in health care providers | |
| Hospitals in the United States Focus mainly on… |
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| ⏺Care for patients⏺Make money
Source: Jarrard/Chartis (2025) |
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This trust deficit is the root cause of many health care problems. That's why people get out of the way, delay and skip care, and end up getting stuck due to preventable issues. When most of the population enters this cycle, you end up with the status quo: indomitable costs and deteriorating results that delay families, businesses and industries themselves.
No quick fix. Despite what my peer entrepreneur might say, there is no problem solution or technology (no, even AI) that can rebuild trust. The only way to twist the downward spiral is to provide a modern experience that is truly designed around people’s needs.
Support yourself: Building this experience does not require rebuilding the entire system. But this does require gradual change. It is time for leaders and innovators across the ecosystem to reimagine and redefine partnerships to create a new center of gravity in healthcare with a human-first model of care and payments, which is located outside the traditional track of providers and insurers but also associated with all capabilities and expertise that the system needs to provide. This is the solution, and this is what I think it looks like:
People and buyers, together
The group's commercial insurance market is likely to be the new focus of healthcare. Consider it: The private employers and public sector organizations that make up the market represent the largest health care buyers in the United States, providing health insurance to nearly 160 million Americans. Due to their size and influence, these organizations are uniquely positioned to actually rise to the status quo and create alternatives dynamically for provider-insurers.
| Health insurance coverage for the U.S. populationSource: KFF (2023) | |
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In addition to scale, the interests and incentives of these program sponsors are naturally aligned with the interests they cover. People (employees) and buyers (employers) need the same thing. Employees and their families need healthier days with lower premiums and out-of-pocket expenses. Employers want a healthy, happy and productive workforce while reducing their astronomical healthcare spending – private employers are expected to grow by 9% this year. Contrary to zero-sum game between providers and insurers, healthy outcomes at lower costs are a win-win for both people and buyers.
Self-funded employers (representing two-thirds of the group market, biased bias), this is especially important because of their purchasing power and their ability to provide benefits and services to the workforce, which leverages the best features the system must provide. Many self-funded employers do not rely on a single carrier, but contract directly with leading physical health systems such as the center in the model of excellence, as well as the best-in-class service providers across the healthcare ecosystem.
End-to-end integration (actual)
The historic divide between providers and insurers has shattered the health care experience, but that is not the only culprit. In fact, the spread of point solutions, digital health applications and third-party service providers has exacerbated many cracks and pain points in the system. The “front door” that claims to simplify employees’ healthcare experience is often on the same fragmented and confusing landscape if they aren’t at all.
The repair experience must begin with integration, not just clinical integration. Yes, comprehensive care is important. Linking primary care with behavioral health and professional care, converging virtual and in-person experiences, allows care teams to share access to the same data, is an essential step. But integration must develop further. Clinical quality and outcomes are inseparable from the administrative, financial and logistical aspects of healthcare, which have long been stranded between providers and insurers.
People intuitively understand the relationship between their mental, physical and financial health, and they need a trusted support system that will work together to address all of these aspects through navigation, financial advocacy, social support and other historically isolated services.
Modern value-based care
Value-based care has long been seen as a solution to the unaligned incentives for expense models between suppliers and insurers. However, two decades of experiments led by Medicare have mixed results (some can be disappointing). However, those calling for an end to value-based projects overlook the untapped potential of alternative payment and care delivery models in the ever-pivotal commercial market.
As a concept and practice, healthcare values are relatively new in the business world. Value-based arrangements between health plan sponsors and their healthcare partners are largely limited to bundled payments for performance models and specific clinical services (as with the Centers of Excellence). While some of these targeted solutions do offer savings, measuring ROI is more like an art than a science. Specifically, the lack of integration described above – integration across multiple service providers and clinical and non-clinical services makes it difficult for program sponsors to attribute improved results or cost savings to specific solutions.
New value-based partner models are changing that. Although value-based contracts can take many forms, the forefront of the commercial market is a common savings model that inspires healthcare providers and insurers to join forces and drive outcomes that are important to people. and Buyers, including experience, clinical quality and (most important) total care costs. Having the right partners and capabilities is not enough. The model needs to ensure alignment and accountability.
Conclusion: From spiral to flywheel
When these works are integrated into a medical experience that earns people’s trust, the spiral of high costs and adverse outcomes begins to twist itself. An easier, more integrated person-first experience can drive engagement and thus improve outcomes. Better experiences and results build trust, which drives further engagement, etc. Eventually, the flywheel effect begins to emerge: As people are in health, they need less costly care, and they are more resilient and productive – and that value will be passed on to the buyer.
Healthcare is not ruined. We do not need to remove or overhaul the system. We just need to do better formations so that the best choices in the system are actually for people rather than against them.
Owen Tripp is co-founder and CEO Including healthThis is a personalized all-in-one healthcare company that works with employers and public sector organizations to engage in value-based care.
