Our healthcare system is failing Americans with chronic disease – and according to the CDC, that’s over 60% of the population. 

It’s extremely challenging for the chronically ill to access medication, thanks to high medication costs, insurance complexities, worker shortages, system fragmentation, and more. 

But even once a patient gains access to medication, the challenges continue: Patients in the US don’t stay on the medications they need. In fact, adherence rates fall to 50-60% for most chronic disease, contributing $500 billion in avoidable healthcare costs in the US. Even worse, in the US, poor adherence leads to around 125,000 potentially preventable deaths each year and a quarter of all hospitalizations. 

It doesn’t have to be this way. 

Our vision for the future

At Infinitus, we believe in a future where the US healthcare system meets and anticipates the needs of patients. With the help of AI, humans and technology can now work together to respond to unique patient needs, enabling payors, providers, and patient support programs to do more with less while delivering on a more personalized experience. And in the future of healthcare, personalization will not be a luxury; it will become a necessity.

Whether it is a voice AI agent or human engaging a patient, they must have the necessary knowledge and context to recommend the next best action. Depending on the unique needs of a patient, their insurance, plan requirements, prescribed therapy, and the provider who is supporting them, and ultimately the patients preferences, that next best step will vary.

A non-exhaustive list of the ways patient journeys can vary based on different attributes

The patient: Some patients have insurance, some don’t. For those that do have insurance, some have met some or all of their deductible, others have met none of it. Some patients qualify for Medicaid. Some patients qualify for copay assistance. These variables will impact the first steps of a patients’ care journey.

Their insurance: Depending on a patient’s group or plan type, their insurer may cover more – or less – of the total cost. If a prescribed therapy is included in the plan’s formulary, the patient may get access to a medication sooner. The plan might require a prior authorization, or trying step therapy, which could add a waiting period of two weeks or more. The wide-ranging differences in insurance coverage add further complexity to determining the next step of care. 

Their provider: The patient experience will differ whether the provider is or isn’t within the insurer’s network. But beyond that, does the provider’s practice have a sufficient amount of staff to manage the administrative work necessary to promptly get patients on insurance? Do they have the required knowledge to correctly administer the medication?

Patient support programs: Does the patient and/or provider know a patient support program exists? If so, can they enroll online or do they have to fax a form (yes, fax)? Are there free drug, subsidized copay, or financial support resources? Does the support program offer multiple ways to engage patients and meet them where they are, or are their offerings limited?

Patients need a healthcare system that meets them where they are

We know from the many conversations we’ve had, as well as scores of industry data, that adherence is a major problem in chronic disease. We also know that personalized outreach, for example from nurses, can be a major help – but that such personalized human phone calls do not scale.

And yet, a personalized healthcare experience means meeting patients where they are. Listening and adapting to their unique needs. That could be answering a pointed question at 11 p.m. on a Sunday, or guiding a patient when they or their provider is unsure what to do next. With a human workforce alone, we cannot achieve this vision. 

Infinitus voice AI agents enable a personalized healthcare future

At Infinitus, we are building safety-first AI agents and copilots that enable the personalized touch points in the patient experience. Our voice AI agents complete administrative and clinical tasks, and can augment human teams to ensure patients receive human connection when they need it most. 

Our AI agents are making real change today, creating new touchpoints to meet patients where they are, helping get them on therapy faster – and help them stay on therapy, too. We’d love to show you more about how we’re paving the way toward the personalized healthcare future America needs. Reach out to us today.