AI, digital health and value-based care are among the biggest buzzwords in healthcare — and might be overhyped, according to these payer executives.
Becker’s connected with 11 leaders to learn what’s overhyped in healthcare.
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Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is overhyped in healthcare right now?
Nishant Anand, MD. President and CEO at Altais (sister company to Blue Shield of California): In today’s healthcare landscape, certain treatments — like IV vitamin therapy and stem cell injections for conditions ranging from arthritis to anti-aging — are being promoted ahead of solid scientific validation. While these interventions hold promise in specific, clinically validated scenarios, their widespread marketing often outpaces the evidence. Innovation is essential, but without rigorous data and regulatory oversight, such trends risk misleading patients and undermining trust. We must balance curiosity with caution, ensuring that new treatments truly enhance patient outcomes.
Abdou Bah, Chief Health Equity Officer, and Daniel Knecht, MD, Chief Medical Officer, at EmblemHealth: We hear a lot about digital tools in healthcare, and there is no doubt they have helped to advance the way we support the health of our members. However, platforms promising AI and digital personalized engagement still have a long way to go to fully support the most vulnerable populations. For example, addressing social determinants of health cannot be achieved through digital advancements alone because members who need to most help may be on the wrong side of the “digital divide.” When someone is in need of help with food, transportation or housing, nothing replaces the personal touch of a care navigator in a neighborhood care location, a nurse at an ACPNY medical office, or the community health provider giving health screenings at a community event. Human-driven, community-based solutions coupled with digital interventions provide an effective model that most effectively bridges healthcare gaps.
Howard Brill, PhD. Senior Vice President, Population Health and Quality at Monroe Plan for Medical Care: Value-based payment has been seen as a solution for the problems caused by fee-for-service reimbursement. Value-based payment links payment to population health quality measures and fosters cost-effectiveness through shared savings and downside risk. The concept is to encourage outreach, sustained patient follow-up, coordination of care, and careful management of utilization. However, it requires providers who have the ability and willingness to take risk and insurers who are motivated to work with providers and share materially in risk. These have to occur at enough scale and intensity to be impactful and with consistency so that efforts are not diluted. Over a decade of effort, it doesn’t appear that scale has reached a level to achieve the promised impacts.
Hillary Galyean. Chief Growth Officer at St. Luke’s Health Plan: Value-based care and population health management are often seen as overhyped — not because the ideas are flawed, but because the results to date have been underwhelming. The disappointment has less to do with the concepts and more with the execution, incentives and infrastructure.
The foundational belief behind VBC and PHM is sound: Keeping people healthy leads to better financial outcomes and higher quality of life.
Yet despite this, large-scale transformation has stalled or underdelivered. That’s not because the destination is wrong, it’s because the vehicle is misaligned.
Rob Hitchcock, President and CEO at Select Health (Intermountain Health): AI is a hot topic that everyone is talking about among healthcare executives and governing board members. While AI offers tremendous opportunities for healthcare organizations to maximize data, analytics and to simplify operations, I fear that it is being seen as a cure-all for nearly all problems facing healthcare leaders and organizations. In my opinion, artificial intelligence will not be able to replace human expertise and the trust that is developed with our customers and patients through direct interaction.
Matt Mitchell, PharmD. Associate Vice President of Pharmacy Services at Select Health and Scripius: Personalized medicine is overhyped. The majority of healthcare delivery (including medications) is not personalized. I am hopeful we will get to a time when one’s genetic profile drives decision making. Unfortunately, it won’t be soon, especially outside of cancer treatment.
Harlon Pickett. President of Eagle Care Health Solutions: AI in healthcare is one of the most overhyped developments. Not because it lacks potential but because of the disconnect between promise and practical impact. There’s an endless stream of headlines touting AI’s ability to revolutionize everything from diagnosis to administrative efficiency. Yet on the ground, most healthcare organizations are still struggling with basic interoperability, siloed data and outdated tech infrastructure.
We’re skipping steps. Instead of focusing on foundational improvements, like streamlining care navigation, price transparency, and administrative simplification, we’re rushing to install shiny, expensive tools that are often poorly implemented or misaligned with clinicians’ and patients’ needs.
The hype often ignores who benefits, and it’s rarely the patient. In many cases, AI tools are being leveraged to optimize revenue cycles, not outcomes. If we’re serious about improving healthcare, the transformation will come from fixing what’s fundamentally broken: cost structures, incentives and access, not just layering AI on top of a system that’s already too complex and costly.
Patrick Quigley. CEO at Sidecar Health: The idea that we can solve healthcare’s fundamental problems by layering on more and more point solutions is really overhyped right now. Every time I meet with employers, they’re dealing with 10, 15, 20 different vendors — one for diabetes management, another for mental health, another for prescription savings. It’s creating this massive administrative burden, and employees are completely overwhelmed trying to navigate all these different platforms, not to mention the massive financial waste they ultimately create.
The real issue is that we’re trying to patch a broken system instead of fixing the underlying problem. It’s like trying to fix a dam with duct tape when what you really need is to rebuild it from the ground up. These point solutions might help 3% of your population with a specific condition, but they’re not addressing the fact that 100% of your employees are struggling with a healthcare system that lacks transparency, creates confusion and makes it harder for people to get the care they need.
Jennifer St. Thomas. Senior Vice President of Commercial and Medicare Markets at Mass General Brigham Health Plan: For over a decade, we have heard about the sparkling potential of “big data” in a variety of industries from technology to healthcare. In reality, the value and quality of data matters most when it comes to our ability to support our members — no matter where they are in their healthcare journeys. In addition, protecting privacy and sensitive information is paramount in today’s world. Our goal is to better aggregate information across key touchpoints to help simplify our members’ experiences throughout the healthcare system.
Ty Wang. Co-Founder and CEO at Angle Health: Speaking as the leader of an AI-native company and someone that strongly believes in the opportunity to transform industries, the most overhyped trend we’re seeing in healthcare right now is the rush to apply generative AI without a clear path to operational integration or measurable outcomes. While there are some innovators driving true progress, we see a lot of noise in the field — companies deploying AI tools as surface-level experiments or PR plays rather than solving core workflow, access or clinical challenges. We’ve seen primitive GPT wrappers raising huge amounts of capital, flashy pilots without substance, and many tools that don’t scale because they aren’t embedded into clinical or administrative systems in a meaningful way. We believe that the real impact and value comes when AI is quietly powering human-in-the-loop workflows and decisions behind the scenes, which is a core focus of AI development at Angle Health.
