{"id":27784,"date":"2026-06-24T09:07:54","date_gmt":"2026-06-24T13:07:54","guid":{"rendered":"https:\/\/www.insightpartners.com\/?p=27784"},"modified":"2026-06-29T15:00:51","modified_gmt":"2026-06-29T19:00:51","slug":"ai-primary-care-innovation","status":"publish","type":"post","link":"https:\/\/www.insightpartners.com\/ideas\/ai-primary-care-innovation\/","title":{"rendered":"How AI is rebuilding America’s primary care system"},"content":{"rendered":"

Nearly half of<\/a> U.S. primary care physicians report burnout \u2014 one of the highest rates among high-income countries \u2014 and administrative burden is the top reason<\/a>. Primary care physicians (PCPs) would need to work nearly 27 hours per day<\/a> to complete all recommended care and administrative tasks, and it’s costing the system $260 million annually<\/a> in turnover alone. More physicians are leaving. And the patients who depend on them most are being left without a front door into the healthcare system.<\/p>\n

At Insight Partners, we believe the cycle of increasing resources with steady, suboptimal outcomes must end. AI, used thoughtfully by PCPs, is a powerful lever. Paired with creative care delivery models, AI offers the greatest hope for stronger outcomes, lower costs, and excellent care regardless of socioeconomic background or geography.<\/p>\n

The cost of healthcare is rising,\u00a0yet outcomes are not improving<\/h2>\n

U.S. health insurance premiums have <\/span>skyrocketed over the past\u00a030 years, growing around 6% annually<\/a>,\u00a0far\u00a0outpacing inflation and wage growth<\/span>, but outcomes have remained mixed. For example, while mortality rates from chronic illness have decreased, life expectancy has stagnated, and\u00a0<\/span>chronic illness prevalence has increased<\/span><\/a>.\u00a0<\/span>The U.S.\u00a0has the lowest life expectancy<\/a>, the highest maternal mortality<\/a>, and higher admissions for chronic ailments<\/a> compared to peer nations.<\/span> The U.S. does lead, however, in the ability to treat many chronic illnesses<\/a>, <\/span>such as\u00a0cardiovascular emergencies\u00a0and post-operative complications.<\/span>\u00a0<\/span><\/p>\n

As healthcare spending rises, population health is not improving \u2014 only our ability to treat late-stage chronic illness.<\/span>\u00a0<\/span><\/p>\n

Why is this the case?<\/span>\u00a0<\/span><\/p>\n

A primary care system stretched to its limits<\/h2>\n

The primary care crisis isn’t just a supply-and-demand mismatch \u2014 it’s the product of decades of structural choices. The way physicians are trained, paid, and asked to practice has made primary care an untenable career, even as the need for it grows.<\/p>\n

More patients, same system<\/h3>\n

Demand for primary care in the U.S. is outpacing supply \u2014 driven by an aging population, a more health-conscious public, and a healthcare system that increasingly routes everything through a single front door.<\/p>\n

The numbers tell the story. Average new patient wait times have surged from around 20 days in the early 2000s to over a month in 2025<\/a> as demand for care has skyrocketed and physician supply has lagged. But the wait time is a symptom, not the cause. Three converging forces are driving the pressure.<\/p>\n

The first is demographic. The U.S. population is aging rapidly, with Baby Boomers<\/a> driving a significant increase in the number of Americans aged 65 and older. Older patients often live with multiple chronic conditions, see specialists more frequently, and need more from their primary care providers \u2014 placing real strain on a system that’s already stretched thin.<\/p>\n

\"Baby
Source: ChildStats.gov<\/figcaption><\/figure>\n

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The second is behavioral. Rising health literacy, direct-to-consumer healthcare advertising, and the proliferation of consumer health information online have led patients to be more proactive in seeking care<\/a>. Preventative screenings, mental health services, and chronic disease management have all seen increased utilization as awareness grows, expanding the demand placed on PCPs who serve as the entry point to the system.<\/p>\n

The third is structural, and in many ways the most stubborn. As medicine has become more specialized, PCPs have often become referral coordinators rather than comprehensive care providers. Each visit often generates follow-up referrals, additional testing, and return appointments\u2014a self-reinforcing cycle that multiplies patient touchpoints and amplifies the pressure from the first two forces.<\/p>\n

Why fewer doctors are choosing primary care<\/h3>\n

If the demand side of the primary care crisis is about more patients needing more care, the supply side is about a profession that has made itself increasingly hard to enter \u2014 and harder to stay in.<\/span><\/p>\n

The most visible pressure is burnout. Physician shortages<\/a> are driven by PCPs retiring early and leaving medicine altogether, as administrative burden crowds out the work that drew most physicians to the field in the first place. Almost half of clinicians<\/a> report burnout tied to tasks like electronic health records (EHRs) and prior authorization management \u2014 work that has little to do with patient care. The consequences are stark: 40% of PCPs<\/a> are considering leaving medicine, and 80% of internal medicine residents<\/a> are choosing to subspecialize rather than enter primary care.<\/p>\n

But burnout alone doesn’t explain why fewer physicians are choosing primary care in the first place. The economics don’t add up. Medical school debt has ballooned to over $200,000<\/a>, up from around $90,000 in 2000<\/a>, while inflation-adjusted primary care salaries have declined<\/a> over the same period. For a medical student doing the math, primary care is underpaid relative to the value it creates in prevention, cost containment, and longitudinal patient relationships.<\/p>\n

And even for those who want to enter primary care, the pipeline itself is constrained.\u00a0Medicare, under the Balanced Budget Act of 1997<\/a>, largely funds residency positions, capping the number of training slots available regardless of demand.<\/span>\u00a0In 2026, there were nearly 6,500 more medical school graduates<\/a> than available residency positions \u2014 a structural ceiling on how quickly the workforce can grow.<\/p>\n

The result is a profession being squeezed from every direction: Too much administrative burden for those already practicing, too little financial incentive for those considering it, and a training pipeline that can’t scale to meet the need. We believe the most viable path forward is equipping the physicians we have with AI tools that enable them to do more \u2014 risk-stratify patients, support diagnosis, and coordinate care \u2014 without adding to their workload.<\/p>\n

Fee-for-service models can create misaligned incentives<\/h3>\n

Fee-for-service (FFS) models have dominated healthcare reimbursement since the 1930s<\/a>. The premise is simple: Providers are paid a negotiated rate for delivering episodic healthcare services. The result has been a system optimized for doing more \u2014 more procedures, more interventions, more billable visits \u2014 often, at the expense of keeping patients healthy in the first place. PCPs see 20 to 30 patients per day<\/a>, with each getting only around 15 to 20 minutes of their doctor’s time, and limited innovation in population health screening and care coordination technologies.<\/p>\n

The shift to value-based care<\/h2>\n

Value-based care (VBC) emerged from the shortcomings of FFS and was implemented nationally through the Affordable Care Act<\/a> (ACA 2012) and the Medicare Access and CHIP Reauthorization Act<\/a> (MACRA 2015). The ACA introduced outcome-based payment models through multiple programs, including <\/span>Hospital Value-Based Purchasing<\/span><\/a>\u00a0(VBP),\u00a0<\/span>HAC Reduction<\/span><\/a>\u00a0(HACRP),\u00a0<\/span>Readmissions Reduction<\/span><\/a>\u00a0(HRRP), and\u00a0<\/span>Medicare Shared Savings<\/span><\/a> (MSSP) \u2014 all designed to reward quality and cost reduction rather than service volume.<\/span>\u00a0<\/span><\/p>\n

The Centers for Medicare and Medicaid Services<\/a> (CMS)\u00a0deployed these programs gradually, driving\u00a0recent\u00a0innovation across three\u00a0phases:<\/span>\u00a0<\/span><\/p>\n

Measurement<\/h3>\n

Initial programs had low penalties and bonus potential\u00a0for\u00a0quality metric reporting and basic performance benchmarks.\u00a0For example,\u00a0<\/span>HRRP began with a 1% penalty in 2013<\/span><\/a> for hospitals and new accountable care organizations (ACOs). With light financial incentives tied to quality-of-care reporting, hospitals adopted technologies to provide unified views of their patients, leading to companies such as Innovaccer and Datavant that link longitudinal patient records across providers and payers.<\/span>\u00a0<\/span><\/p>\n

Management<\/h3>\n

As penalties grew to 3% over time<\/a> and downside risk was introduced to both ACOs and individual providers through MACRA, focus shifted to improving care quality and closing care gaps through better coordination. This need led to the success of companies such as Aledade, making ACO participation easy while closing care gaps.<\/span>\u00a0<\/span><\/p>\n

Prevention\u00a0<\/span><\/h3>\n

With reporting infrastructure maturing and quality benchmarks tightening, systems now face pressure to prevent chronic disease rather than just manage it. Companies like Cadence Care embed remote patient monitoring into health system workflows to proactively manage patients with chronic diseases between visits.<\/span>\u00a0<\/span><\/p>\n

Each phase of financial pressure\u00a0has\u00a0unlocked a new layer of the care management technology stack \u2014 from infrastructure, to coordination, to prevention.<\/span>\u00a0<\/span><\/p>\n

CMS hasn’t stopped pushing. The ACCESS Model<\/a> represents its most direct move yet toward paying for outcomes rather than visits. VBC arrangements are increasingly focused on innovation in prevention, prioritizing technologies that can identify and proactively manage chronic conditions.<\/span>\u00a0<\/span><\/p>\n

How AI expands what primary care physicians can do<\/h2>\n

Value-based care has meaningfully shifted the financial logic around prevention, but better reimbursement doesn’t fix a primary care practice’s day-to-day issues. AI’s ability to automate administrative burden and coordinate care addresses this gap in ways previously not possible.<\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

We see the purview of primary care expanding over time as diagnostic technologies democratize,\u00a0enabling PCPs to perform tech-enabled triage and minor procedures once reserved for specialists. The result is a system where both PCPs and specialists spend more time practicing at the top of their licenses.<\/span>\u00a0<\/span><\/p>\n

\"Primary<\/a><\/p>\n

Advanced screening technologies enable PCPs to catch disease earlier and more holistically<\/h3>\n

PCPs are often the first to see a patient before a disease develops. The problem is that they rarely have the technology to catch it. New technology deployed in the primary care setting will help PCPs measure nuanced biomarkers and screen and evaluate patients more comprehensively. When the right tools reach primary care, physicians can catch what they would otherwise miss, while specialists can focus on the patients who need them most.<\/span><\/p>\n

Novel measurement modalities will likely be a key enabler for PCPs to track and quantify biomarkers. Companies such as Dermasensor, which enables PCPs to visualize and evaluate skin lesions, and Optain Health<\/a>*, which allows PCPs to screen for diseases such as diabetic retinopathy, are two examples of these technologies. Each can be used at the PCP level to catch disease earlier, enrich referral pipelines, and free up specialist time to focus on higher-severity, more complex patients.<\/span>\u00a0<\/span><\/p>\n

Referral management<\/h3>\n

Better diagnostics can improve efficiency if patients follow up with the right specialists, but unfortunately, <\/span>up to 50% of subspecialist referrals\u00a0are\u00a0never completed<\/span><\/a>. The referral journey is riddled with failure points, including:
\n<\/span><\/p>\n