The reason 64% of Americans have never shopped for health care services isn't a lack of interest: It's a lack of usable information.

The myth of the "non-shopping" health care consumer

When UnitedHealthcare's Surest plan made it easy for members to price compare health care services, 70% of them used the tool before scheduling a surgery or office visit.

This plan has become UnitedHealth Group's fastest-growing offering, with 90% year-over-year member retention.

Until now, three major barriers have prevented true health care consumerism:

Overwhelming complexity: The American health care system uses over 10,000 unique billing codes. A single procedure like an MRI has six different CPT codes plus numerous modifiers that can dramatically change pricing. As our research found, even something as seemingly simple as a sleep study can cost $3,268 in a hospital but just $687 at home — a 500% difference most consumers never know exists.

Information asymmetry: A 2018 Accenture study found that 52% of consumers cannot navigate the health care system on their own, with consumers who have low health literacy being three times more likely to contact customer service. This isn't an education problem: 48% of consumers with low health literacy have college degrees.

Inaccessible price data: Recent price transparency regulations have required hospitals and insurers to publish their negotiated rates, but this data is locked in massive, technical machine-readable files, or MRFs, that are unusable for average consumers.

The result? Approximately $4.8 billion in direct administrative waste and $26 lost per member from avoidable service costs, according to Harvard Business Review.

AI: The bridge between complexity and accessibility

Generative AI fundamentally changes this equation. For the first time, we have technology that can:

Balance information asymmetry: Rather than requiring patients to become health care experts, AI serves as their health care interpreter and navigator, helping them make informed decisions with the same level of understanding as industry insiders.

Make billing understandable: AI can convert the unintelligible health care system — with its CPT codes, modifiers, specialist terms, and benefit designs — into plain English that anyone can understand.

Make price transparency data accessible: AI can process the massive, technical price transparency files that hospitals and insurers are required to publish, turning raw data into actionable insights about where to get the best value care.

The evidence: consumers will shop when empowered

◆ The research supports this transformation. McKinsey's 2023 consumer survey found that:

◆ 89% of consumers expressed interest in shopping for at least one category of health care if given the option

◆ 57% would shop for primary care appointments

◆ 49% would shop for lab work

◆ 45% would shop for specialist care

◆ 40% would shop for urgent care visits

The survey revealed that 61% of consumers trust health insurers most to provide accurate cost information — more than any other health care entity. And contrary to common belief, consumers are willing to change providers: 52% would switch to a different health care provider for a $100 incentive, while 41% would switch for just $50.

Approximately 73% of U.S. commercial health care claims spending — about $800 billion annually — is potentially "shoppable." If just one-third of consumers began comparing prices for these services, we could see cost optimization affecting 20% to 25% of all health care spending in America. That's over a trillion dollars.

What's different this time?

Previous attempts at health care consumerism relied on clunky tools, incomplete data, and required consumers to understand complex medical terminology. Now, AI can provide:

Personalized guidance: AI can recommend providers based on a patient's location, condition, preferences and insurance benefits.

Real-time transparency: Patients can instantly understand what services will cost them out-of-pocket before scheduling care.

Alternative options: AI can reveal lower-cost alternatives consumers might never know exist, like home sleep studies instead of lab-based ones.

AI navigation tools address this by building a consumer-friendly layer on top of our complex system.

Just as Amazon makes it easy to compare products without understanding supply chain logistics, AI health care navigators can make it simple to find high-value care without having to dig into petabytes of data.

The health plans that will win in this new era aren't the ones with the strictest prior authorizations or the most complex benefit designs. They're the ones making it ridiculously easy for members to make smart health care choices.

What this means for the future

Health care AI tools that make benefits navigation simple and accessible represent a fundamental shift in how Americans interact with the health care system. For the first time, consumers will have the same advantages as industry insiders when making health care decisions.

This isn't just about saving money — it's about reclaiming power. When consumers can finally control where they spend their health care dollars, the shift will transform health care's incentives, rewarding those who offer exceptional experiences and transparent pricing while eliminating the opacity that has allowed inefficiency to flourish and costs to skyrocket.

The health care system doesn't need a complete redesign but a better interface. Generative AI is providing exactly that.

Beth Ann Lopez is the founder and CEO of Outfox Health, a tech company using AI to to support health insurance coverage and pricing communications. She previously started Docosan, a venture-backed digital health startup that reached over 5 million users. She is a World Economic Forum Technology Pioneer.

Michael Cardamone is the CEO and managing partner at Forum Ventures. He previously was one of the first 30 employees at Box and then led partnerships at AcademixDirect. He is also an angel investor in a dozen companies, including in the seed round for Flexport.