The broken status quo
Something is wrong with the way healthcare reaches patients. The leaders we spoke with live it every day. Even the simplest tasks are harder than they should be or take longer than they should.
"Booking an appointment with your doctor is the most difficult thing in US healthcare right now. Whether you're looking for a primary visit or the most complex visit – can it be simplified just like you get an appointment with your real estate agent? A banker?"
Nowhere is that friction more visible than in the workflows that sit between a prescription and a patient.
"Historically, we've always picked up the phone. We need a human to call a human to have that interaction. You call 1-800-Whoever, you might have a 30-minute hold time. You're waiting to get connected to someone."
That description – 1-800-Whoever, thirty minutes, waiting – isn’t a legacy edge case. It’s a daily reality for patient support teams across the industry. And it’s one that consumes time those same teams could be spending with patients.
Ask frontline workers what stands between them and their best work, and the answer is consistent.
"Many team members, if you ask them what keeps them from doing their best work, it's truly the process, the administrative burden, working hand in hand with trying to figure out exactly what's going on with data."
The enrollment process is another flashpoint. For decades, patient support programs have relied on product-specific enrollment forms (many still submitted via fax) as a gateway. The universal enrollment form has long been held up as the solution.
But as one leader sees it, the fix should go further.
"We should soon be at a point where there could be some sort of standard data exchange for the fields that are always included on an enrollment form, just arranged differently – and to simply be able to have the provider push permission to transmit those data fields to the manufacturer's hub. Not even be talking about an actual enrollment form, and certainly not one that has to be faxed."
The irony is that the data needed to smooth this process already exists. It’s just locked away.
"A lot of the data that's required so that patients can have transparency is secured with the companies that own them – largely the big three PBMs or the payors themselves."
At Infinitus, we’ve seen this dynamic play out across hundreds of client engagements. The problem isn’t a lack of will or a lack of technology. It’s a system that was built for a different era and hasn’t been structurally redesigned since.
The question is no longer whether AI can fix this. The leaders in this report are already working on it, and the next five sections show how they’re approaching it.
