Q&A: BCG on the American healthcare system and the use of AI

Boston Consulting Group’s Ashkan Afkhami, managing director and senior partner and global leader of healthcare at BCG X, sat down with MobiHealthNews outside of the JPM Healthcare Conference to discuss the strengths and weaknesses of America’s health system – and his take on the importance of trust, governance and iterative development with the rise of AI adoption.
MobiHealthNews: Where does the U.S. lag in healthcare technology compared to other countries?
Ashkan Afkhami: What’s really nice in the U.S., interesting enough, is we have integrated delivery networks. So, the IDNs of the world, and in the IDNs of the world, what’s really unique and nice to see is we have health systems that are providing care, and also that are covering that care.
Whereas, in other countries, at the end of the day, they are the ones that are either government-backed or secondary, and so on. So, their care and their payment models are a little bit divergent. And we can get into some healthy discussions about the trade-offs of that, because, in some places, it’s covered, and they claim that it is in some ways better. I think the IDN, the integrated delivery network model, is something unique and different about the U.S.
Medicare and Medicaid is also another big area that has been interesting to see, something that’s been backed on the government side, and then, obviously, there’s supplemental insurance as well. But again, I think that the unique aspect of it is we kind of have a best of all worlds in that kind of model where you can get coverage in a variety of different ways, access, et cetera.
Then 65% of the population is actually covered by self-insured. So, a lot of those are employers, and, again, there are multinationals as well, that cover people outside in other areas as well.
The part that I would say we were facing headwinds or have some relative challenges with, quite honestly, of the seven-plus trillion dollars of global healthcare spend, three and some change of that, $3.7 trillion, I believe, is the latest, and might even be north of that, is in the U.S.
So we are essentially the R&D department for the rest of the world. That is fueling a lot of what’s happening in healthcare as an ecosystem. One of our challenges, or places that we could do better, is there’s a lot of spending, and there are a lot of dollars that are coming out of taxpayers, that are coming out of these larger corporations, and so on. So, for us to bend the cost curve, I think, is really important.
Maybe the other thing is that, again, depending on how you look at this, there are countries that it is very much government-sponsored, government-backed, etc., and people say, “Well, they have higher taxes,” which, depending on your tax bracket, you could also be in that as well. But in other countries, healthcare is covered, and covered for everybody, no matter who you are. And so, there’s a standard of coverage and also a standard of care that is universal.
I think, while that is great in some aspects of it, in other aspects it might take you multiple months to see somebody, and you’re waiting in line, and there are all these things, and that is really tricky and challenging. All that to say, there are trade-offs and pros and cons around it, but that’s kind of how we’re seeing some of those things. And we have not even talked about APAC and the Middle East, because that, I mean, that is a whole different arena as well in terms of how they cover care.
MHN: One could argue that, at times, it takes months for people to see a doctor in the U.S. as well. What do you think about healthcare technology improving access to care?
Afkhami: You are right, and I also think that you almost have to de-average it, because seeing your primary care doctor versus seeing a specialist, versus if you have comorbidities, and you have to triangulate amongst those.
Now, to your second point, which is, how does healthcare IT and digital help that? I think there are a couple of things. One is, I think COVID was a catalyst for the adoption of telehealth as a whole, which I think is great, because it allows you to be able to collapse that, you know, the comment you were making about how long it takes to see somebody or have a conversation, or so on, and in some cases, you know even that quick reassurance is really, really helpful.
The second one is, I also think more folks are okay with the fact that there are other things you can do in the home, whether it is around testing, delivery, etc. So, we saw a surge of in-home diagnostics. We saw a surge of potential tools and things that you could use as a consumer in your own home that would allow you to essentially help the physician or whoever you’re talking to.
My last one would be this notion of being able to receive, whether it’s prescriptions or devices or if you’re on dialysis. If you’re on Coumadin or if you’re taking … whatever you’re taking, I think that notion of being able to, whether you get it from Amazon, CVS, Walgreens, Duane Reade or whoever, to be able to again, and this is even something that has happened to me, where I’ve been able to see a physician. I’ve been able to get diagnosed. I’ve then been able to get prescribed, and I never had to leave my home to be able to get my medication. That’s pretty amazing. That’s pretty powerful, and I think a lot of that has really taken shape in the past couple of years.
And I’ll mention consumerism and the adoption on the consumer side to be able to use these things. We’re at the beginning of a whole new evolution of how care is going to be delivered.
MHN: How does a change in government administration affect the evolution of technology?
Afkhami: One of the things that we, and I’ve heard a lot of CEOs say as well, there’s an excitement of corporations working more closely with the administration. There’s a willingness and there’s an openness behind being able to bring that even more, because I think this new administration understands that, in order to be able to truly make an impact, you need scale.
In order to get scale, you really need some of the largest companies in the world to be thinking about the right things and working with government agencies to figure out those challenges. Have they all figured it out? Absolutely not, but even just being able to have a seat at the table and having that dialog, I think, is really, really important, because if you can’t talk about it, you can’t change it.
So that’s one thing that, personally, and I think we as an organization are starting to see is that there’s definitely a willingness. Again … you have to then break that down into subgroups of, you know, what could happen in certain areas, whether you’re a payer or whether you’re a provider, or whether you’re a pharma manufacturer or medical device company, and so on.
But again, each of them have been in conversation with the previous administration and are in conversation with the current administration. And again, what we’re hearing and we’re seeing from them is that they think it could be a big opportunity for us to be able to get some of the things that we’ve been trying to get done for a long time through. But again, we’ll see what happens.
I think all that to say is 2025 will be the year where we can start to see as things start to settle – markets settle, opportunities settle, and so on. We will have a lot more insight to be able to say, “Is it going to be successful, not successful?” etc.
MHN: What are your thoughts on AI use in healthcare?
Afkhami: So, I think there are three things from my vantage point: One, in all the conversations we’re having is, as folks are creating these basically strategies, and governance, and policies, and SOPs [standard operating procedures] that are very specific to their organization, and then are collaborating with agencies on the outside to make sure that it’s done effectively. So one is, I think, having a strategy.
Two is then having the right governance and operating model to make sure that that strategy actually happens the right way. And I think what is really critical, and we’re seeing a lot of organizations make sure of, that they hold at least a group or an individual accountable for the execution of that strategy.
And then the last thing is the notion of “set it and forget it” on this topic. It doesn’t work. There’s this constant iteration of “We know what we know up until this point.” We’re going to submit it, we’re going to try it out, and then it might take us another couple months or six months or so on to see what happens, and then we’re going to have to do it again.
So, again, having seen the web model, the mobile era, and now we’re in the AI era as another wave, that frequency of refreshment on policy, ethics, governance, etc. I think it is just going to be the norm for us on how we operate as things go.
MHN: What are you most nervous about when it comes to healthcare technology?
Afkhami: I do think there is a higher rigor around accountability, and I think taking that very seriously across the board is going to be critical for organizations to be successful.
I think, as part of that, one of the things I and [BCG] thinks a lot about is, how do you make sure you create trust? And I think that’s going to be one of the things that is going to be somewhat of a challenge for some organizations, is truly being able to create solutions, avenues, transparency, having the right mindset of making sure that that trust is there. Because at the end of the day, if you don’t have trust with your end customers, users, etc., they’re probably going to stop using it, or not be willing to share as much data, or whatever the context may be.
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