Do you or someone in your family struggle to manage a chronic disease? Have you ever had a health question at night or on the weekend, only to find that no medical help was available? Are out-of-pocket costs keeping you from seeking the care you need? If so, your experience mirrors that of most Americans.
At the root of these problems is an outdated care model, one designed for a time when medicine was episodic rather than continuous and when doctors were the sole source of medical expertise. That model no longer works for today’s healthcare challenges.
- Chronic diseases like diabetes, heart failure, and hypertension affect millions of Americans daily. Yet, patients often go months between doctor visits, with no way to monitor or adjust treatments in real time. The result? Poorly controlled chronic diseases that lead to life-threatening complications like heart attacks, strokes, kidney failure, and cancer—which account for at least 70% of U.S. healthcare costs.
- Anywhere from 40-70% of U.S. counties lack a single specialist in fields like endocrinology, cardiology, and nephrology. Long waits and geographic barriers make it nearly impossible for many patients to receive timely, expert care.
- More than 100 million Americans struggle to afford healthcare, delaying or avoiding necessary medical care because of the financial burden. Even for those with insurance, out-of-pocket costs can be devastating.
The best way to improve quality and reduce healthcare costs is by keeping Americans healthier. Preventing chronic disease complications and making access to medical care easier would reduce the need for ER visits, expensive medications and hospitalizations, saving billions of dollars annually while improving lives.
The overlooked synergy of GenAI, telemedicine
The good news? We already have the tools to fix these problems. The challenge? We have failed to recognize the power of combining them.
Importantly, neither technology is sufficient on its own. If every patient turned to telemedicine whenever they had a new symptom or question, demands on already overburdened clinicians would soar alongside costs. And while AI can analyze symptoms, monitor chronic conditions, and even detect early warning signs of serious illness—all from a patient’s home—it cannot prescribe medications or adjust treatments in real-time without a doctor’s intervention. Fortunately, the limitations of one technology are the strengths of the other.
Together, AI and telemedicine are synergistic. AI ensures smarter, more efficient care by addressing routine concerns and identifying urgent problems. Telemedicine provides immediate clinician access when needs arise. Together, they create a seamless system that enhances access, improves efficiency, and delivers higher-quality care.
Yet, both these game-changing technologies remain woefully underused. While telemedicine use surged to 60% of all visits in the early days of COVID-19, it has since dropped to just 10% for all medical services except mental health. Meanwhile, GenAI is already outperforming doctors in key areas like diagnosing patient problems and analyzing large data sets, but hospitals and health systems still rely on outdated, manual workflows.
Combining AI, and telemedicine is the breakthrough medicine needs
The synergy between AI and telemedicine unlocks countless opportunities to transform healthcare. Among the most significant are two critical advancements: achieving better chronic disease control and granting 24/7 access to medical expertise.
1. Revolutionizing chronic disease management
Chronic diseases require constant monitoring and timely interventions, but today’s healthcare system is set up to provide neither. Nearly 40% of Americans with hypertension—the leading risk factor for stroke—do not have their condition under control. Diabetes and prediabetes, affecting 1 in 3 Americans, are managed even less effectively. The CDC estimates that with proper chronic disease management, our nation could see a 30-50% reduction in heart attacks, strokes, cancers, and kidney failures.
The biggest barrier? Patients with chronic diseases typically only see their doctors every few months, with little insight into their health between visits. The lack of real-time monitoring means it can take years to optimize treatment, leading to unnecessary complications, huge medical costs, and avoidable death.
A combined AI and telemedicine system solves this problem:
- Patients use wearable and/or home monitoring devices to continuously track their chronic diseases.
- GenAI assesses whether readings (think: blood pressure or blood glucose) are improving or worsening.
- If the patient’s condition is not improving, AI schedules a short telemedicine visit with the individual’s doctor for medication adjustments or additional testing.
- For urgent issues, patients are immediately connected to a telemedicine team in a centralized call center for rapid evaluation and management until they reach an ER.
With fully effective chronic disease control, the United States could save $1.5 trillion annually, more than a quarter of the nation’s total healthcare expenditures.
2. Ensuring timely specialist access
Specialist shortages plague American medicine, particularly in rural and underserved urban communities. AI and telemedicine can eliminate these barriers. Imagine this stepwise process:
- GenAI analyzes symptoms and medical history to determine whether a patient needs a specialist.
- Instead of waiting weeks for a referral, patients are scheduled for a telemedicine consultation with an expert who could be hundreds of miles away.
- In The Permanente Medical Group, virtual specialty consults like these resolved 40% of cases immediately without the need for additional visits. Another 30% were handled in a second telemedicine visit with the specialist after additional laboratory and radiological testing.
For patients with rare diseases or complex conditions, a virtual, AI-powered approach ensures they see the right specialist the first time, reducing misdiagnoses, unnecessary referrals and delays.
Overcoming the biggest barriers to adoption
Doctors today understand that better chronic disease management could prevent up to half of all heart attacks, strokes, kidney disease and cancer. But they also recognize that seeing fewer patients per day would reduce their income. To unlock the full potential of AI and telemedicine, the nation’s healthcare reimbursement model must evolve.
Today’s fee-for-service system pays clinicians for volume, not value. Every office visit and procedure generates revenue while preventing medical problems does not. The issue isn’t that doctors want patients to suffer from chronic illnesses. It’s that the system offers no incentive to prioritize proactive, holistic care. Instead of investing time in continuous monitoring, early intervention and treatment optimization, physicians are financially rewarded for treating the complications of chronic disease after they arise. Without fundamental payment reform, even the most powerful medical technologies will remain underutilized.
Furthermore, doctors worry about whether telemedicine will be reimbursed at sustainable rates. During the COVID-19 pandemic, Medicare temporarily expanded telemedicine payments, allowing more patients to access care remotely. However, unless Congress acts by the policy’s April 1 expiration date, expanded funding will disappear, leaving both patients and providers in limbo.
Meanwhile, care provided through generative AI isn’t reimbursed at all, making it financially unfeasible for doctors to integrate these tools into their practice. Consequently, without a fundamental shift in how healthcare is paid, these game-changing technologies will remain underutilized, and patients will continue to suffer needlessly.
Complex, bureaucratic payment models could be devised to encourage the use of AI and telemedicine, but they would be difficult to implement and easy to game. A more effective and sustainable solution is to shift from fee-for-service to a value-based care model that rewards prevention and efficiency. Here’s how that would work:
- Instead of paying clinicians per visit or procedure, health systems would provide groups of providers with a set annual fee to deliver all preventive and acute care for a defined patient population.
- In this “capitated” model, doctors would take home more income when they prevent chronic disease, provide timely access, and avoid costly complications like heart attacks, strokes, cancers and kidney failure.
- With financial incentives aligned toward keeping people healthy, widespread adoption of GenAI and telemedicine would follow, ensuring these tools are used to their fullest potential.
The technologies needed to fix American healthcare already exist. Used effectively, they can save lives, reduce costs, and ease the burden on overworked doctors. The only question is: How long will we wait before abandoning a system that no longer serves patients or physicians?
Dr. Robert Pearl is the former CEO of The Permanente Medical Group, the nation’s largest physician group. He’s a LinkedIn "Top Voice," bestselling author, Stanford University professor, and host of two healthcare podcasts. Check out Pearl’s newest book, ChatGPT, MD: How AI-Empowered Patients & Doctors Can Take Back Control of American Medicine with all profits going to Doctors Without Borders.
