Recommendations for a Modern, Integrated U.S. Health Technology Ecosystem

Mike Serbinis, Founder & CEO, League

Co-Authored by Andrew Dubowec, Chief Growth Officer, League, and Sarah Donnelly, Chief Product Officer, League

The White House announced a new pledge from major tech companies to foster a more interoperable and patient-centric healthcare ecosystem. This initiative, spearheaded by the Centers for Medicare & Medicaid Services (CMS), marks a pivotal moment in the industry's evolution—one that League has been anticipating since our inception. We've always believed that building a better healthcare experience starts with putting the individual at the center, and this commitment is a powerful validation of that vision. As leaders in this space, we're proud to share our recommendations and a five-step framework designed to help achieve CMS's goals. Join us as we explore how this historic collaboration can transform healthcare for everyone.

At League, we believe in a future where healthcare is truly personalized, proactive, and accessible for every individual. The U.S. healthcare system, with its complexity and diverse needs, stands at a pivotal moment. By embracing a digital-first approach, we can overcome long-standing challenges in access, coordination, and efficiency, ultimately empowering individuals to take control of their health journeys.

The U.S. has consistently been at the forefront of innovative consumer experiences, driven by companies like Uber and Netflix, and has successfully adopted imported innovation from all over the world, including platforms like Shopify. We now have an unparalleled opportunity to apply this same level of consumer-centric design and technological advancement to the entire healthcare ecosystem, creating a more engaging and user-focused health journey. This transformation hinges on the synergy between multiple players – payers, provider networks, pharmacies, and digital health innovators – all working together to deliver a seamless and intuitive experience. AI is at the center of this innovation because it empowers users with personalized recommendations at a scale and level of complexity that was never possible with traditional engineering and data science approaches.

Drawing from our experience in building engaging digital health platforms, we propose a five-step framework for transforming the U.S. health technology ecosystem into one that is truly connected and patient-centric.

I. Unlock the Power of Health Data A foundational step in modernizing the U.S. healthcare experience is to fully unlock the power of health data. The current fragmented landscape of electronic health records and disparate point solutions creates silos that impede comprehensive care and makes it difficult to gain a holistic view of an individual's health journey. We must prioritize secure, seamless, and patient-controlled data exchange across all stakeholders – providers, payers, and individuals themselves.

• Universal Interoperability: We advocate for robust, mandatory interoperability standards that go beyond basic data exchange, enabling a truly comprehensive and bidirectional flow of information across all certified health IT systems and non-certified entities like labs and imaging centers. This includes expanding standards-based exchange to cover all clinically relevant patient data to eliminate manual processes and physical media.
• Patient-Controlled Data Access: Individuals must have effortless access to their complete medical records, with the ability to grant and revoke consent for data sharing with third-party applications. This empowers patients as active participants in managing their health.
• Unified Healthcare Directory: A national, reliable directory of providers and healthcare organizations is critical to accurate referrals, billing, and efficient data routing. This directory should be built with federated inputs from authoritative sources, robust governance for data quality, and automated, machine-to-machine updates to ensure real-time accuracy.

II. Widen the Definition of Care The definition of "care" in the U.S. must expand beyond traditional clinical encounters to encompass a broader ecosystem of health and wellness. This means fully integrating allied health professionals, pharmacists, therapists, and digital health tools into the care continuum.

• Empower Allied Health Professionals: Policies should support and incentivize the seamless integration of services from pharmacists, nurses, therapists, and other allied health professionals into digital care pathways. Their contributions are vital for holistic health management and preventative care.
• Integrate Digital Health Programs: Solutions like digital therapeutics, remote monitoring, and wellness programs should be seamlessly integrated into patient care plans, with data flowing back to the central health record to inform providers and patients.
• Proactive and Preventative Focus: The system should shift towards proactive and preventative care models, moving beyond episodic treatment to continuous health engagement facilitated by technology.

III. Make Virtual Access the Norm Virtual care has proven its value, but it needs to evolve beyond basic telehealth appointments to become a truly integrated and convenient part of everyday healthcare.

• Seamless Digital Front Door: Every individual should have a unified, personalized digital entry point to the healthcare system. This "digital front door" should provide intuitive access to appointments, health information, prescription refills, and communication with care teams.
• Personalized Digital Experiences: Leveraging data and user preferences, digital platforms should offer personalized care navigation, content, and proactive nudges that engage individuals in managing their health.
• Flexible Digital Identity Solutions: To facilitate convenient and secure access, the U.S. needs a flexible digital identity infrastructure. While supporting strong identity verification through Credential Service Providers (CSPs), it is crucial not to mandate a single approach. Instead, support for various digital identity methods should be prioritized, ensuring accessibility for all individuals. Importantly, patients must retain control over their digital identity, with the ability to revoke access and view audit trails.

IV. Embrace AI to Deliver Personalized Care at Scale Artificial intelligence (AI), particularly Large Language Models (LLMs), holds immense potential to revolutionize healthcare by enabling personalized care at scale and driving proactive wellness. AI's ability to process and interpret vast amounts of data is critical for delivering the individualized experiences that consumers have come to expect in other sectors.

• AI for Proactive Insights: AI can analyze vast datasets to identify health risks, predict potential issues, and offer personalized recommendations for preventative care and lifestyle adjustments. This includes leveraging LLMs to extract insights from unstructured data like clinical notes, as demonstrated in early cancer detection initiatives.
• Augmenting Care Teams: AI tools can support care teams across the care continuum by summarizing patient data, highlighting critical information, and automating routine tasks, freeing up healthcare professionals to focus on patient interactions that matter. This translates to opportunities to drive member and patient action through AI-powered recommendations, prioritize complex patients and high-value activities, and delegate routine outreach and personalized guidance to AI agents.
• Ethical and Responsible AI Deployment: As AI adoption grows, clear guidelines for ethical use, governance, data privacy, and algorithmic transparency are essential to build trust and ensure equitable outcomes. LLMs should complement existing standards-based data exchange, not replace the need for reliable structured data via FHIR APIs.

V. Enable Self-Service through a Unified Digital Front Door Empowering individuals with self-service capabilities through a unified digital front door is key to improving engagement and reducing administrative burden. This approach, mirroring successful consumer experiences in other industries, allows for a more efficient and user-friendly interaction with the healthcare system.

• Centralized Access to Information and Services: Individuals should be able to easily access their health records, manage appointments, request prescription refills, and understand their benefits and costs through a single, intuitive platform.
• Care Navigation and Support: The digital front door should provide intelligent guidance for navigating the complex healthcare system, helping individuals find appropriate care, understand their options, and connect with resources.
• Reduced Administrative Friction: By shifting many administrative tasks to self-service digital channels, healthcare organizations can reduce operational costs and allow staff to focus on direct patient care.

We believe that by focusing on these five interconnected steps, and fostering true synergy among payers, providers, and pharmacies, the U.S. can build a health technology ecosystem that is truly integrated, intelligent, and designed around the individual. League is committed to collaborating with CMS, ONC, and all stakeholders to realize this vision for a healthier future.