Chethan Sarabu, MD
Jan 10, 2025
As we transition from the end of 2024 to 2025, America is in a moment with a great deal of conversation about the current state of health insurance. The assassination of a healthcare insurance company executive, a terrible act of violence, has brought out a strong public reaction to the many ways in which opaque insurance policies directly harm patients’ health. As trusted social media Ophthalmologist Dr. Glaucomflecken highlights: this can be the result of sudden changes of what medications are covered to multiple roadblocks such as prior authorizations that can delay time-sensitive surgeries. Ultimately, these are all financially motivated decisions made in opaque ways, increasingly with biased algorithms. Large healthcare systems and insurance companies are increasingly in an arms race of using AI to go back and forth around the costs of care and the amount reimbursed. At the end of this process patients are being left out of the process of being able to have visibility into the myriad decisions that are ultimately driving their high out of pocket bills.
It’s easy to feel powerless in the face of such a vast and entrenched system, especially when these opaque practices are so deeply woven into the fabric of healthcare. Patients often find themselves in a precarious position—paying significant amounts for health insurance, either directly or through their employers, only to be met with confusing and restrictive policies when they seek care. This disconnect between the promise of coverage and the reality of accessing care has fostered a deep frustration among patients, many of whom feel abandoned in their time of need. Yet, as complex as the system may be, change is beginning to take shape.
There is reason for optimism that a change in the system is possible. We are seeing increasing legislation around data and price transparency that is starting to have some impact, although not lower costs yet, according to price transparency company, Turquoise health’s recent report. We also are seeing how AI tools when put directly in the hands of patients are able to be used to fight back against unfair insurance practices such as denials, highlighted here in the Patients Use AI blog. These are the movements that OpenHand is building on top of, combining the latest advancements in AI with new direct patient access of health data to help patients advocate back to help save on medical bills and bring back more fairness in the system.