In recent months, the Centers for Medicare & Medicaid Services (CMS) has begun to reimagine the digital health landscape, with early efforts primarily focused on improving access to care and empowering beneficiaries through technology. As part of this mission, CMS has assembled a dedicated team to rethink the way the federal government delivers healthcare digitally and issued a public request for information (RFI) to explore new ways the agency can use technology to support Medicare beneficiaries.
These promising first steps signal that CMS, along with the broader healthcare landscape, recognizes the need for a smarter, more patient-centered infrastructure. But they also raise tough questions: What would it take to truly transform healthcare into a patient-centered system? Is it even possible? Can federal health programs evolve to deliver meaningful value for patients while ensuring operational sustainability for providers and the government?
At the heart of this transformation lies a necessary shift in how we define success in healthcare. Historically, access to care has been treated as the end goal, built on the assumption that providing patients with plan options, online portals and digital health records would automatically lead to improved outcomes. However, one of the most persistent challenges within the U.S. healthcare system, especially for those on federally funded healthcare plans, is poor patient engagement. Access alone doesn’t translate to action. Just because a patient has insurance coverage and access to digital tools to visit the doctor and maintain their health doesn’t mean they will.
Even with increased connectivity, engagement remains low. Patients still slip through the cracks, placing strain on an already burdened system. One study estimates that as many as 50 percent of patients fail to adhere to their medication, resulting in at least 100,000 preventable deaths and $100 billion in avoidable medical costs every year. But poor patient engagement isn’t just a financial burden we must overcome; it’s a looming threat to our healthcare system’s ability to deliver quality care.
There is no shortage of data and tools on the market, so the root cause of this problem is not a lack of digital infrastructure. It’s a misalignment between the tools that have already been built and what patients actually need to feel incentivized and motivated to utilize them. The solution lies in investing in personalization technology that integrates seamlessly with these tools to help optimize their use.
As someone who has spent years developing and building adaptive systems, I know firsthand that one-size-fits-all approaches don’t work. Patient engagement and outreach today are far too generic. We continue to treat large demographics of patients the same way, failing to account for each person’s unique health journey, beliefs and evolving needs. What motivates me to schedule an appointment with my doctor is likely very different from what motivates my wife, friend or a stranger at the grocery store. However, by leveraging behavioral science and A.I. to power one-to-one personalization, we can better recognize these differences and tailor communication and outreach accordingly.
By customizing and tailoring each patient interaction, we can help individuals take meaningful actions that significantly improve their overall health and well-being. This could involve sending a text to an unengaged diabetic patient, encouraging them to schedule an appointment with their primary care provider, using language and imagery that resonates with them. Or it could mean sending regular reminders to a patient who often misses appointments. These small, targeted interactions are the kind that drive long-term value, demonstrating that earlier, continuous personalized communications lead to better health outcomes, lower the cost of care and create a more efficient healthcare system.
Transforming and realigning our healthcare system to prioritize patients cannot and will not be achieved by simply increasing the number of platforms or data sources available to them. We must build systems that motivate and encourage patients to utilize what is already available to them.
We need a federally driven initiative to leverage A.I. in conjunction with behavioral science to support patients. If CMS’s modernization efforts stop at expanding access to care, we will fail to reach our system’s full potential. The future of Medicare and public health broadly depends on our ability to sustainably bridge the gap between availability and action. Now is the time to do so.
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