Healthcare’s next challenge isn’t technology. It’s alignment

Healthcare leaders spend considerable time discussing artificial intelligence, digital transformation, interoperability, and innovation. Those conversations matter.

But after spending several days with chief pharmacy officers, health plan executives, health system leaders, technology innovators, and pharmacy experts at the recent TPG Chief Pharmacy Officer Summit, we left with a different conclusion.

Healthcare’s biggest challenge is alignment.

The industry has never had more tools available to improve care delivery. The use of artificial intelligence (AI) is accelerating. Digital health continues to expand. Automation is streamlining administrative work. Data is becoming increasingly accessible. Yet many of healthcare’s most persistent challenges remain unchanged. Patients still struggle to navigate a fragmented system. Providers continue to face an administrative burden. Healthcare costs continue to rise. Organizations pursuing the same goal —improving patient outcomes — often operate under different incentives.

At the same time, something else is happening. Consumers are changing healthcare faster than healthcare organizations are changing themselves. Patients increasingly expect healthcare experiences that mirror every other service they use. They want convenience. Transparency. Digital access. Personalization. Speed. Healthcare, however, was largely designed for a different era.

Organizations such as Amazon Pharmacy, Lilly Direct, and other direct-to-consumer healthcare models are not simply introducing new services. They are reshaping expectations. Patients are becoming less willing to navigate complexity and more willing to seek alternatives that reduce friction. In many ways, healthcare consumerism is becoming one of the most powerful forces driving transformation. But meeting those expectations requires more than new technology or new delivery models.

Patients expect healthcare to function as one system. The industry still operates as many

The challenge is that healthcare's infrastructure was not built around consumer expectations. It was built around organizational structures, reimbursement models, and regulatory requirements. That disconnect is becoming increasingly difficult to ignore. Perhaps nowhere is this more evident than in the evolving role of pharmacists. For decades, pharmacy reimbursement has largely centered on dispensing medications. Yet healthcare's future increasingly depends on services that extend well beyond dispensing.

As chronic disease continues to rise, physician shortages persist, and value-based care expands, pharmacists are positioned to play a larger role in medication optimization, preventive care, chronic disease management, specialty care coordination, and patient education. The capability already exists. The challenge is the business model. Healthcare leaders continue to ask pharmacists to improve outcomes, close care gaps, and support population health initiatives while operating under reimbursement structures that often fail to recognize those contributions.

The obstacle is not capability. It is reimbursement.

That observation extends far beyond pharmacy. It reflects a broader reality across healthcare. Many of the industry's challenges are not driven by a lack of innovation. They are driven by incentives that reward individual activities rather than shared outcomes. This became particularly apparent in discussions surrounding pharmacy benefit management, affordability, biosimilars, and formulary design. Each stakeholder is attempting to optimize value from within its own position. Health plans focus on affordability and risk. Providers focus on clinical outcomes. Pharmacies focus on access and adherence. Manufacturers focus on innovation.

Collectively, however, they often create complexity that patients experience as confusion, delays, and higher costs. Patients expect healthcare to function as one system. The industry still operates as many. AI provides another example. AI was one of the most discussed topics throughout the summit. Organizations are actively exploring their use across prior authorization, clinical documentation, medication management, workflow automation, customer service, care coordination, and predictive analytics.

The opportunities are substantial. AI can improve efficiency. It can reduce administrative burden. It can support clinical decision-making and identify opportunities for earlier intervention. But one observation surfaced repeatedly. AI can automate workflows. It cannot fix a broken incentive structure.

Technology can make existing processes faster. It cannot resolve competing stakeholder priorities. It cannot eliminate fragmentation on its own. And it cannot create trust. That final point may be the most important. Throughout the summit, conversations repeatedly returned to transparency, affordability, communication, and patient trust.

Trust is often discussed as a patient experience metric. Increasingly, it is becoming an operational requirement. Patients must understand how decisions are made. They must believe healthcare organizations are acting in their best interests. They must have confidence that affordability, access, quality, and outcomes are being balanced fairly.

Without trust, even well-intentioned reforms face resistance.

Without trust, technology adoption slows.

And without trust, healthcare transformation becomes significantly more difficult.

For all the attention currently focused on AI, digital health, and emerging technologies, healthcare's next chapter may ultimately depend on something far less technical: alignment.

Alignment between payers and providers. Alignment between reimbursement and outcomes. Alignment between technology and patient needs. Alignment between innovation and affordability. Alignment between healthcare organizations and the people they serve.

The future of healthcare will not be determined by which organization adopts AI first. It will be determined by which organizations are able to align incentives, simplify care, reduce friction, share information, and earn patient trust.

Healthcare does not suffer from a shortage of innovation. The industry suffers from a shortage of alignment.

Increasingly, that is the challenge healthcare leaders must solve.

Perry Cohen, PharmD, FAMCP is CEO of The Pharmacy Group and the TPG family of companies, including TPG International Health Academy, and a longtime member of the Managed Healthcare Executive editorial advisory board.