Could AI be the Antidote to ‘Sick Care’ in America?

Patients want to be healthy – and they want fast, convenient services without friction. That’s not what many are getting today from their nearby health systems, and direct-to-consumer (DTC) services are eager to fill the gap.

By giving people the next best step in their healthcare and quick access to it, AI can completely transform the patient experience from reactive and frustrating to empowering, easy and helpful. 

The prevention paradox

Preventive healthcare is a growing priority for millions of Americans: 65% say they want care built around prevention rather than treatment. 

Yet despite fully covered annual wellness services, fewer than 10% get a yearly physical, and routine screenings are among the most frequently skipped or cancelled healthcare appointments. Why?

For most people, it isn’t a lack of available care that keeps them away. The biggest barriers are a lack of healthcare literacy and friction in the process. Take a career mom in her mid-30s. Between school drop-off, caring for aging parents and catching up on emails after the kids are in bed, she might put off scheduling a preventive dermatology appointment for months. Meanwhile, her health system’s access team members are too bogged down in manual tasks to reach out and encourage her to schedule.

This scenario is all too common. On the patient side, many don’t know which screening services they need, what’s available or what’s covered. Life is often too busy for people to self-manage their own preventive care. And making an appointment is often complex and inconvenient, even with the most sophisticated digital front-door platforms.

On the health system side, limited staff simply don’t have the time to call or message every patient manually, guiding them through their options for preventive care and ensuring they schedule. 

Enter: the growing number of direct-to-consumer (DTC) services eager to fill the gap, offering proactive insights and convenient preventive services right at your fingertips. 

As a result, traditional health systems are losing market share, revenue and relevance when it comes to prevention. 

AI-powered patient outreach can help health systems stay relevant and deliver the wellness services patients need — even when they don’t know it. Take the busy career mom, whose patient record shows that she had a skin check five years ago and recently started a prescription cream. AI has the power to reach out to her after business hours, suggest a dermatology checkup, find an open appointment at a convenient location and book the appointment – no fuss, no additional mental load for the patient and no manual work for staff. 

By suggesting preventive care and making it easier to access, health systems can move beyond reactive medicine, offering timely, personalized guidance that engages patients earlier. This is how preventive care should work with the technology we have today.

Consumers want proactive service, health systems are stuck in sick care mode

The gap between patient expectations and traditional fee-for-service healthcare has never been wider. Health systems have invested heavily in digital front-door platforms, but most are hampered by an “If you build it, they will come” mentality. They’re waiting for consumers to come to them, but consumers are more likely than ever to find what they need via LLMs without relying on a health system’s website.

No other industry waits for consumers to make the first move. Savvy marketers know that recommendations, upsells and add-ons are what drive revenue, top-of-mind awareness and repeat business. And consumers have been trained to expect it:

• Financial apps automatically flag unusual account activity. 
• Retailers anticipate needs and offer product recommendations based on context cues. 
• Travel sites suggest add-ons to round out your trip — a rental car or an excursion to go with the hotel and flight package.

Despite having a mountain of rich personalization data (age, risk factors, existing conditions, lab results, current medications and insurance coverage details), traditional healthcare still relies on patients to schedule appointments, even for proactive care. 

If that visit leads to a referral for diagnostics or specialty care, it often gets lost in a fax queue, a never-ending game of phone tag or voicemails. Weeks may go by with no follow-up. By the time someone actually reaches the patient to take the next step, they’ve either given up, forgotten or found another option. Meanwhile, their social media feeds are flooded with ads for comprehensive screening lab work, metabolic optimization and mental health support, all available at the touch of a button. More than just offering convenience, DTC companies are catering to consumers’ hunger for guidance, capturing their curiosity in the moment and satisfying both with on-demand access.

As consumer expectations change, health systems can no longer afford to wait passively for patients to make the first move. Instead, they must start meeting patients where they are, offering guidance and recommended services earlier in the process.

AI can move care upstream

With one in five consumers willing to pay more for personalized treatment and continuous monitoring, and 73% already using or interested in AI-powered care navigation tools, the demand is undeniable. 

But most health systems don’t have the staff or bandwidth to manage proactive outreach. They’re already overwhelmed with chronic and acute care. 

Using AI to provide personalized recommendations can shift in-person care from reactive to proactive medicine, while automating the burden of care orchestration and patient engagement. With automated AI patient outreach, health systems can operate like sophisticated marketers, offering the right service to the right patient at the right time. For example, AI can:

• Suggest services based on known patient data. For the busy 35-year-old mom of two who’s overdue for her annual skin cancer screening, AI can send her a text offering two open appointment slots with an in-network clinician next week. All she has to do is click to book. 
• Anticipate needs with contextual data. Just like online retailers can recommend baby products for a new mom, AI-powered patient engagement can prompt her to book a postpartum depression screening ahead of her six-week checkup. 
• Offer guidance to reduce cost and convenience barriers. When a patient’s LDL cholesterol creeps up based on their latest lab results, AI can automatically send them a link to book a virtual visit with a nutrition coach that’s covered under their insurance plan. 
• Cultivate continuous care instead of episodic. AI can help keep the practice top of mind and drive loyalty. Ongoing engagement and proactive service offerings help providers build long-term relationships and a deeper level of trust with patients, positioning them ahead of faceless DTC services. 
• Optimize limited capacity. AI can help manage capacity constraints by coordinating alternative options. For example, colonoscopies are among the most frequently cancelled procedures, and unfilled slots create significant revenue loss. AI can prompt patients who cancel to reschedule or proactively mail them at-home screening kits. 

Proactive guidance at scale

In many ways, traditional “sick care” has turned health systems into gatekeepers. Even the best prevention programs create barriers when the onus is on patients to take the initiative, and complex workflows require 14 steps just to get routine lab work.

As competition from on-demand DTC services grows, traditional health systems can’t afford to remain passive. In doing so, they risk becoming downstream providers stuck in perpetual sick-care mode, resulting in brand erosion, patient loss and revenue leakage. 

With AI-powered outreach, health systems can offer the timely, personalized guidance patients expect at scale and prioritize prevention.

Photo: J Studios, Getty Images

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