Healthcare in America stands at a crossroads: embrace transformation or protect the status quo. After decades of fragmentation, rising costs, and uneven outcomes, we're witnessing an unprecedented opportunity to fundamentally reshape the industry through market-drivens solutions — powered by applied AI. 

At General Catalyst, we've been at the forefront of healthcare innovation, investing in companies that are not merely incrementally improving the system but reimagining it entirely. This includes companies focused on automating healthcare interactions, companies building rural health systems, companies working on Medicaid solutions, companies delivering better health outcomes daily, and companies pioneering solutions dedicated to preventive care, workforce transformation, and technological innovation.

To further harness this technological potential, we're pleased to introduce Catalyzing Care: A Framework for a Healthier America — a comprehensive approach to transforming U.S. healthcare delivery. In the past, we’ve written a bold manifesto for health assurance, which guides some of our recommendations here. This exercise is about making it even more actionable and practical for our national policymakers, many of whom will be tasked with navigating the intersection of traditional models of healthcare and the rise of transformational technologies. Most importantly, we believe it's the start of a new rallying call — to deliver U.S. healthcare that works. 

If embraced, what do we think this framework can help to deliver? Healthier outcomes for all, technological innovation, patient-first care, fiscal responsibility, strengthened U.S. medical talent — and a more resilient America Let’s dive in. 

Catalyzing Care: A Framework for a Healthier America

Catalyzing Care: A Framework for a Healthier America addresses the most pressing challenges in healthcare through five interconnected pillars:

1. Foster Healthier Outcomes for All: Drive better value-based healthcare outcomes while reducing costs through evidence-based approaches and free-market competition.
2. Refine Needed Innovations Without Red Tape: Position the U.S. as the global leader in healthcare innovation through enhanced market freedom while maintaining rigorous patient safety standards.
3. Advance Patient-First Care, Data and Agency: Prioritize patient choice, provider accessibility, and removal of administrative barriers to care.
4. Maximize Fiscal Responsibility in U.S. Healthcare: Implement market-driven solutions that reduce wasteful spending and fraud while improving quality of care.
5. Enhance U.S. Medical Talent for Today and Tomorrow: Prepare the healthcare workforce to excel in an AI-driven environment while developing new career pathways.

From Vision to Reality: Action-Oriented Solutions

The true power of the framework lies in its actionable roadmap. We've identified ten high-impact initiatives — five short-term and five longer-term — that together create a clear pathway to healthcare transformation. Crucially, we believe these recommendations speak to broad bipartisan beliefs: about the need for a healthy, more resilient, and market-driven healthcare system. One that is responsive to the needs of our citizens, while leveraging the ingenuity and aspiration of our best technical builders. 

Short-Term Actions (Achievable within 9 months)

Launch Regional Healthcare Innovation Sandboxes
By establishing designated geographic regions where healthcare providers and technology companies can test new solutions under streamlined regulatory frameworks, we can rapidly evaluate what works. These innovation sandboxes would bridge toward true outcomes-based care by allowing companies to test technology, patient engagement tools and evidence-based care delivery models that drive measurable improvements — enhancing health outcomes and lowering costs.

Establish a Fast-Track AI Approval Process
By creating an expedited pathway for reviewing and approving AI-driven healthcare solutions that demonstrate clear potential for improving patient outcomes while maintaining rigorous safety standards. The process would include a two-tier AI reimbursement pathway: Phase 1 allowing AI tools to be deployed in real-world settings under clear Quality Management System standards, and Phase 2 making tools eligible for full reimbursement upon demonstrating positive patient outcomes and cost savings.

Create Patient-Controlled Health Data Infrastructure 

By establishing a secure, standardized "Innovation Data Commons" with patient-controlled data infrastructure that empowers individuals to manage their health information, while enabling efficient care coordination. This patient-centric approach enhances agency while improving coordination between providers would eliminate data silos that currently fragment and undermine effective healthcare delivery.

Implement Next-Gen AI-Powered Fraud Detection Systems
By focusing on next-generation AI-powered fraud detection. If embraced, we could save taxpayers billions and identify and prevent healthcare fraud in near real-time. In 2024 alone, Medicare Fee-for-Service saw $31.7 billion and Medicaid $31.1 billion in improper payments, much of which could be prevented with sophisticated pattern recognition capabilities. This technology analyzes claims data across multiple dimensions, including provider behavior, patient utilization patterns, and billing anomalies, while maintaining patient privacy and data security standards. T.

Advance U.S. Healthcare Provider Mobility
By improving credentialing infrastructure and enabling qualified providers to practice across state lines. This reform would be particularly valuable for telehealth services and specialized care delivery, enabling qualified providers to practice across state lines more easily, especially benefiting rural and underserved communities that face significant healthcare access challenges. 

Longer-Term Actions (Achievable within 2 years)

Advance AI-Augmented Rural Health Hubs for Greater Access
By modernizing existing Federally Qualified Health Centers (FQHCs) through AI-enabled care delivery models, creating a network of AI-powered rural health hubs. The initiative would include AI-enabled mobile integrated care to bring advanced medical capabilities directly to rural communities, reducing long-distance travel needs. The program would establish partnerships with local businesses and community organizations to create health promotion programs addressing social determinants of health in rural areas. A voluntary federal licensure framework — specifically for FQHCs — would enable practice across state lines, while serving federal health program beneficiaries with AI-powered credentialing and verification systems. This approach enables rapid provider onboarding while maintaining safety standards.

Implement AI-Driven Measurements To Eliminate Red Tape & Drive Cost Savings
AI can fundamentally shift the focus from administrative costs to direct clinical care which would improve patient outcomes. This data and processing power can help to tackle the challenge of attributing costs and outcomes across complex patient journeys–both clinical and non-clinical–thereby eliminating excessive administrative burden and significant cost-savings. Furthermore, natural language processing would extract meaningful insights from unstructured clinical notes and patient feedback, providing a more complete picture of care quality. 

Launch an Interoperable, State-Based Health Data Infrastructure
By developing scalable platforms necessary for this state-based infrastructure, bringing expertise in cloud computing, distributed systems, and advanced security protocols. The infrastructure would leverage HL7's established interoperability standards and frameworks to ensure consistent, vendor-neutral data exchange across state-based healthcare ecosystems while enabling AI-powered analytics capabilities. The system would include robust disaster recovery and business continuity features, with regular security assessments and comprehensive training programs for healthcare providers. The same data-driven approaches would help identify fraud and wasteful spending in healthcare.

Promote Comprehensive Cost-Saving Preventive Care Programs
By implementing models that emphasize prevention over treatment, while ensuring interventions are culturally appropriate and accessible to all populations. The cost-saving, quality measurement approaches would incorporate HL7's standardized data formats and exchange protocols to ensure consistent metrics collection and reporting. The program would include continuous monitoring and evaluation of intervention effectiveness, with AI systems automatically adjusting recommendations based on observed outcomes and new data. The initiative would establish clear metrics for measuring success, including both short-term health improvements and long-term cost savings.

Accelerate Training for AI-Empowered Healthcare Workers
By creating a groundbreaking program to fundamentally transform how medical professionals are trained and their role. This comprehensive initiative would include partnerships with medical schools, technology companies, and healthcare providers to develop innovative curriculum and practical training programs blending traditional medical knowledge with advanced AI capabilities. It could also unlock AI-enabled healthcare professionals while ensuring core medical skills remain central to healthcare delivery, with specialized tracks for different healthcare roles and clear career pathways for healthcare professionals looking to specialize in and adopt the new technology.

Health Assurance in Action: Real-World Impact

These initiatives aren't merely theoretical or academic, they represent tangible opportunities for healthcare transformation. Consider what's possible:

• Thousands of hospital systems nationwide could implement AI-powered sepsis detection tools that identify warning signs hours earlier than traditional methods, potentially saving tens of thousands of lives annually while reducing ICU admissions and healthcare costs.
• Patients with complex conditions like cancer could securely share their complete medical histories through AI-powered platforms that connect all their healthcare providers, eliminating billions in redundant tests while ensuring real-time care coordination.
• Through AI-enabled care networks connecting FQHCs, health systems, and academic medical centers, patients with conditions like heart failure could access top-tier specialist care regardless of location, potentially preventing hundreds of thousands of hospitalizations annually.

Health Assurance & National Resilience: A Call to Action

The time for transformative action in U.S. healthcare is now. Through market-driven approaches that leverage innovative technology while prioritizing value-based outcomes and patient safety, we can create a healthcare system that truly delivers — for all Americans.

At General Catalyst, we're committed to backing the founders and companies leading this transformation. We believe that by empowering entrepreneurs with the right frameworks, partnerships, and capital, we can collectively build a healthcare system that is more accessible, affordable, and resilient than ever before. GCI, our in-house policy offering, will be taking this work to corridors of power and educating our lawmakers on its potential to transform how we look after our people. 

The journey toward health assurance requires bold vision, strategic action, and cross-sector collaboration. Join us in transforming U.S. healthcare delivery through innovations that catalyze better outcomes, advance needed technologies, revitalize patient care, expedite fiscal responsibility, and strengthen our healthcare workforce.

Together, we can build a future where healthcare works for everyone.