For the first time in a century, the United States is on the verge of historic demographic change: according to the latest data from the American census, the elderly should be more numerous than children during the next decade. While this transformation takes shape, it leads to an urgent imperative to rethink the way our health system supports aging populations. The elderly face increasingly complex decisions concerning coverage, access to care and social determinants that shape health results.
This is why it was encouraging to see the centers for Medicare & Medicaid Services (CMS) recently published a request for information (RFI) focused on the way technology can improve access, equity and results for medical beneficiaries. It is not only a signal for innovators – it is an opportunity to shape a future where technology can actively resolve the challenges of aging in America.
We have already made a major jump forward. The last large push focused on technology in Medicare was the national accent on interoperability, which laid the foundations for better data sharing through the ecosystem. This foundation is critical – but it is no longer enough. The next jump is action.
We now have the opportunity to go beyond interoperability and rethink the way the beneficiaries interact with Medicare. More specifically, we can make public profit data and readable by machine so that generative AI models can power truly transparent and intuitive navigation experiences. These models may meet the elderly where they are, by reducing friction, by lowering the burden of health literacy and removing the obstacles to coverage which often exacerbates iniquity.
We can also help these same systems understand the clinical needs of a beneficiary and the network of suppliers, connecting them directly to the right care – not only in theory, but in practice. The combination of coverage awareness and navigation on care propelled by agency AI has the potential to transform the way elderly engages with the health system.
In doing so, we unlock three quarters of transformation:
1. Simplify navigation
The Medicare landscape is a labyrinth. The generative AI already allows interfaces that adapt to different languages, cognitive needs and literacy levels. When the services and speed data are accessible and structured for use by these tools, we go from the transmission of information to activation of the action. Navigation becomes personalized and proactive.
2. Connect health and social needs
Many of the most urgent obstacles faced by the elderly are not medical – they are social. AI systems based on agents can unify the advantages of Medicare Advantage with state programs, federal, veterans and community to meet these needs in a holistic manner. They can also go further by guiding the elderly via applications, planning services and confirming the receipt. This is how we are going in the last kilometer.
3. Increase in quality access access
For numerous drug beneficiaries, identifying the care they need, confirming the coverage and making an appointment may look like a full-time job. AI systems can surface the gaps in care, confirm eligibility and plan services – whether it is an annual well -being visit or a specialized reference. When the beneficiaries are guided through these steps in a connected experience, we reduce the delay, improve quality and fill the critical gaps.
The RFI CMS is not only a moment of feedback. It is a plan for the next Medicare chapter, the one where the system works for people, not the other way around.
The goal is not only to help the elderly live longer; It is to give them more life during these years. This means that access, dignity and independence and technology can help us unlock this opportunity.
Photo: GustavoFrazao, Getty Images
Karl Ulfers is co-founder and CEO of Duos. Karl is passionate about the empowerment of the elderly to have more freedom as they age because of his own experience to help his loved ones to sail on their challenges of aging and to fight to find resources they need to age independently. He took advantage of his experiences as the first leader in digital health from 2006 at Optumhealth, part of Unitedhealth Group, and from his more recent experience as a product manager, then CEO of Rally Health to help duets to establish an aging system that allows the elderly and caregivers to easily access support.
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