Secret to solving healthcare found in AI concepts

In the race to shape our future, tech companies are often trailblazers. By sharing knowledge through open-source collaborations and embracing transparency, they are able to drive progress for the greater good. In other industries, we see systems controlled by a small number of powerful players — an oligarchy wherein a select few hold the reins. 

The American healthcare system is a prime example. Insurance companies, pharmaceutical giants, monopolistic hospital networks and the Big Three pharmacy benefit managers dominate the landscape, maintaining control of a system that's more concerned with profit than progress.

This closed-source system has led to an inefficient and fragmented approach to healthcare — unlike the open-source model embraced by tech companies. For example, lack of transparency in pricing can leave many patients unable to see the true cost of care until after they've received it.

This can lead to costly, surprise medical bills, and while the No Surprises Act helps prevent this under certain circumstances, it doesn't prevent them all. In some cases, patients may be treated for an emergency and receive follow-up care from an out-of-network provider, leading to unexpected bills.

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This is just one example of how information, which could help patients make more affordable decisions, is kept behind closed doors. Several other key features contribute to this closed system, including:

Direct contracting 
Large or self-funded employers often negotiate exclusive contracts directly with healthcare providers or hospitals, limiting options for employees and increasing the potential for providers to prioritize cost-cutting over patient needs.

Network agreements
Insurance companies form contracts with specific physicians or hospitals, controlling patient access which allows a few large insurance companies to dominate the market. This can prevent patients from seeking care from specialists outside of their network, which can lead to delayed treatment or suboptimal care. Lack of competition between establishments can also lower overall quality of care by reducing the incentive to value patient satisfaction and health outcomes. This also creates hidden agreements and opaqueness to the pricing and billing model so the entire healthcare system is in the dark about the supply chain and flow of money.

Pharmaceutical pricing
The pricing of medications is kept secret with closed-door deals and a lack of transparency. Despite laws aimed at providing clarity, the actual costs still remain hidden, making it difficult for everyone to make informed decisions.

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While these strategies can streamline access to healthcare, it is a closed sourced model that creates certainty for a few stakeholders in the system. For example, when a broker facilitates a direct contract between an employer and healthcare provider — attempting to cut out middlemen — the deal benefits a limited group and leaves a larger part of the population outside of the conversation.

A small win in a broken, closed system. An open-sourced view in healthcare, however, has the potential to be as groundbreaking as AI itself.

A recipe for global success

AI is widely recognized and often considered the next great technological leap. But what we can learn from AI goes beyond its technical breakthroughs. Many companies are using AI in many ways, from enhancing efficiency to automating tasks, but the true potential lies in how we can leverage it to encourage collective growth, support continuous learning and promote ethical responsibility. Two primary types of AI systems drive changes throughout industries: closed-source AI and open-source AI.

Closed-source AI drives change that is limited to a small, chosen group. This approach keeps knowledge and advancements within a private network, preventing others from benefiting. Open-source AI, on the other hand, is built on collaboration. Changes are available to everyone, allowing developers, researchers and businesses to learn, improve and build upon each other's work. This approach can create change faster than any one company or individual could on their own.

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Currently, many adults are facing barriers to receiving optimal healthcare. High out-of-pocket costs, geographical disparities or insufficient insurance coverage contribute to the challenge. The shift toward a more open-source healthcare system – one that's driven by the same collaborative approach that has fueled AI innovation – could help address these issues.

In the tech world, an open-source model has led to explosive innovation. Companies and developers can quickly share and enhance each other's work, creating new opportunities and solutions. This collaborative spirit has led to faster advancements and a more dynamic industry.

If everyone in healthcare adopted this collaborative approach and worked together, we could start making meaningful changes. We have a chance to start pushing this transformation today. By advocating for more transparency and encouraging employers to explore innovative healthcare solutions, we can help break down the walls that have kept healthcare so closed and profit-driven.

The future of healthcare could be just as revolutionary as AI itself, but only if we choose to embrace the power of collaboration and transparency as part of an open-sourced system.