“The first cars were easier to produce, but they didn’t have brakes, airbags, air conditioning, or navigation. Healthcare is evolving in a similar way: AI-driven care will probably become more expensive, but also safer,” according to Anna van Poucke, founder and CEO of Global Health Transformers. In an interview with ICT&health Global, she explains why fee-for-service models block the benefits of digital transformation and which top skills leaders need today to make healthcare organizations fit for the future.
You have advised healthcare leaders worldwide. Which countries today are the most successful in digital health transformation, and what specifically are they doing better than others?
I think there’s a very clear distinction when it comes to leadership in digital healthcare. It’s a bit like the Tour de France. There’s one real champion, and for me, that frontrunner is Israel.
If you look at what they did during COVID with vaccine campaigns and appointment management, what they are doing with remote care, with data exchange between primary care and hospitals, and how they manage and collect data, Israel is definitely leading.
Then there is a second group following closely behind: the Nordic countries, especially Sweden and Finland. In the US, some healthcare systems are managing digital transformation very well, while others are not. A lot of AI and digital technology is being used for claims reconciliation, which is much less about healthcare delivery itself and much more about administration.
You also see countries in the Far East, such as Taiwan, China, and Korea, accelerating rapidly.
What exactly are they doing better? Can we take a copy-and-paste approach and transfer the best experiences and practices to countries lagging behind in digital transformation?
For me, it’s interesting because I am chair of the supervisory board of the Dutch Patient Federation, and from that perspective, I also participate in a very large national program called Home Doctor, which is a digital patient portal. In that role, I drew on my international experience to understand what should and should not be done.
What I see as one of the most important success factors is that digital development is deeply ingrained in the medical process itself, with medical professionals very closely involved.
If you look at Finland’s Health Village program, which covers more than 400 disease groups, every single “village” was developed together with doctors, nurses, patient representatives, experience designers, and data specialists.
Also, university medical centers are increasingly becoming involved in this space, and they are successful because the work is so closely connected to the medical profession itself. Having clinicians on the development team is crucial. If a medical specialist is not familiar with the system, they will not accept it. It has to feel like something developed by and for the profession itself.
Another key point is that digital solutions must be developed as an integrated part of care delivery. That is essential for implementation and scaling. Then, there is the issue of data availability. So, for me, the key ingredients are medical professionals' deep involvement, a strong data infrastructure, digital tools integrated into care delivery, appropriate reimbursement models, and solutions developed by the healthcare sector itself rather than solely by large commercial players.
The ingredients you mentioned can be divided into soft and hard factors. One of the hardest is reimbursement, because digital transformation requires healthcare to be financed very differently than it is today. Most healthcare budgets still flow into medicines and hospital care. So how can healthcare systems shift investments toward areas such as primary care and digital care models, rather than continuing to focus primarily on hospitals?
I think we first have to differentiate between CapEx (capital expenditures) and OpEx (operational expenditures). How will you invest in digital transformation, and where will the funding come from? And once you have invested, how will you reimburse the care that is actually being delivered?
Successful digital care often means that waiting rooms become emptier. It may mean fewer patients physically visiting hospitals. So the question becomes: how do you deal with that financially?
If I look at the countries where digital transformation works well, success usually comes from either large health insurers or regional governments, such as those in the Nordics, that have the authority to redirect investments. They can say: " We are not going to invest more in buildings or hospital beds, we are going to set money aside for digital transformation instead.”
Another successful model is what I see at university medical centers. They often have large research budgets and the ability to build consortia with commercial partners that can co-invest. That gives them the capacity to create investment capital. Realizing digital transformation in healthcare does not work well in a fragmented system where insurers often do not want to invest, and hospitals do not have the money themselves. As a result, you get many small initiatives here and there, but nothing truly scales. So we need governments, regional authorities, or insurers willing to make strategic investment decisions. And at the same time, those actors need the ability to redefine how operational funding is allocated.
For example, if digital COPD care allows you to keep half of the patients out of the hospital, the department cannot continue operating on the same budget. If the department previously had a budget of €200 million, it may now need to operate with €150 million. That is how you create the financial space for further investments. Both investment and reimbursement have to be managed together. If your system is not aligned in that way, it becomes extremely difficult to make digital transformation work. But we have to realize that financial change is also a big transformation for providers, hospitals, and doctors alike.
Does that mean we need to move from a fee-for-service model to a fee-for-outcome approach to achieve real digital transformation?
Definitely, either fee-for-outcome or capitation models combined with quality or outcome incentives. I always say: if you want to change healthcare delivery but continue paying fee-for-service, then don’t even start, because it won't work.
I gave the example of a pulmonary care solution in Germany that kept half of the patients out of the hospital. After a year, the pulmonary specialist said, “This is great, but we need to stop the pilot because we are losing money.” As long as providers are still paid through fee-for-service, they are not incentivized to deliver care differently.
So, while we often focus heavily on technology and what it can do, much of it already exists. The real challenge now is different: how do we engage the people who will use it? How do we help them integrate digital tools into their workflows? And how do we reimburse care in a way that supports that transformation?
I worked with a client in the Netherlands who wanted to invest, alongside primary and long-term care providers, in digital support solutions. The insurers said: “Yes, we can invest €100,000 here and €100,000 there.” But that is nowhere near enough to make a real difference.
At the same time, hospitals were told, “It’s great that you reduced production, but because you are treating fewer patients, we are also reducing your funding without helping you in that transformation.” That is the perfect way to make sure the transformation fails.
What is needed is much stronger alignment between payers and providers, with shared incentives and shared benefits.
When you talk to healthcare leaders, do you feel they already understand what digital transformation is really about? Do they realize that we have to change the healthcare system itself to make the best use of digital tools?
Some do, some don’t. Some are really able to think about it from a systems perspective. They understand that digital transformation is not only about technology and are already starting the necessary conversations. Others begin a digital transformation process and then quickly run into barriers. Suddenly, they realize: it’s not just about the technology, we also need to change the surrounding system. So they learn by doing. And then there are leaders who are simply excited by the tools and possibilities. They say, “Let’s do it,” and then get stuck in pilots here and there without a real value add.
Some hope that AI will fix healthcare or at least make healthcare systems cheaper. Will it?
That’s a very difficult question. Recently, triggered by the fact that artificial intelligence still doesn’t seem to reduce workforce pressure in the way many people expected, I compared the production time of the original Ford Model T before the assembly line. After the assembly line was introduced, modern car production using AI and robotics was finally adopted by brands like BMW and Tesla.
Where it once took around 1.5hours to build a Model T Ford, it now takes around 40 hours to build a BMW. That sounds paradoxical. We automated production, introduced robotics and AI, yet production became more complex. But of course, nobody today would want to drive a Model T on a busy holiday motorway. It had no airbags, no seatbelts, no navigation, no air conditioning, no advanced braking systems, or cruise control.
What happens is that as technological possibilities increase, consumer expectations also rise dramatically. And healthcare is no different.
Twenty years ago, if you had cancer, the message was often: “You have cancer; unfortunately, you are going to die.” Today, people ask: “What personalized treatment can I get? What targeted therapies are available?”
So I don’t think AI will necessarily make healthcare cheaper. The more important question is whether it will allow us to deliver more personalized, more preventive, and higher-quality care. Will it help people live longer in good health? To that question, my answer is yes. But there is an important caveat. For people like you and me, this transformation will probably work quite naturally. We already use ChatGPT and digital tools to search for information and manage aspects of our health ourselves. If I have to wait a month for a doctor’s appointment, I can often already look up exercises, advice, or possible solutions in the meantime.
But my 90-year-old neighbor, who is starting to develop dementia, will never be able to use these systems in the same way. The same applies to people with very poor digital skills.
So for me, AI is not mainly about reducing costs. It is about improving the quality of life. But if we do this the wrong way, we risk creating a healthcare system that mainly benefits the digitally skilled, while making health inequalities even worse.
That means we have to think very carefully about inclusion. In the Dutch digital health platform we are currently developing, one of my main questions is: how will we ensure that people with limited digital skills can still access these services? How can we use AI agents or support teams to guide people? How can we create extremely simple entry points?
For example, I currently have a problem with my heel. The waiting time to see a doctor is one month. In the meantime, I can already look up exercises and ways to improve my condition. There’s a good chance that after a month, I may not even need the appointment anymore.
That adds value to patient care, as the doctor can then use that appointment slot to help someone who is not able to do the same.
So digital skills are a key factor for benefiting from digital transformation. Historian Yuval Noah Harari often discusses AI in healthcare in the context of inequality, saying that AI will likely make healthy people even healthier. Do you agree with that?
Yes, absolutely. I often use a different example, but it illustrates the same point. Think about what happened during COVID when children had to study from home. Children with highly educated parents, two children in the household, laptops for everyone, and parents working from home who could help them generally managed quite well.
But children from families with five children, maybe one laptop or none at all, and parents who had to leave the house for work because they were cleaners, bus drivers, or worked other essential jobs, were much more likely to fall behind. AI in healthcare could create exactly the same pattern if we are not careful. That is why, for me, one of the strongest priorities on national policy agendas must be this question: how will we support people who lack digital skills?
If we move now from the healthcare system level to the healthcare providers level, healthcare professionals are often blamed for being resistant to change and reluctant to adopt new technologies. In your experience, is the problem really on the side of healthcare workers, or rather on the side of leadership within healthcare organizations?
I think the reality is that it’s both.
I actually wrote my PhD dissertation on radical innovation in knowledge-intensive service firms. I was less interested in the innovation itself and more interested in how organizations adapt and implement change. What you always see is the same pattern: a group of frontrunners who are very willing to innovate. Then there is a silent majority who are more traditional, not against innovation, but also not very open to adopting it. And a small group that is consistently opposed to change.
Healthcare workers do tend to be relatively conservative. Many think, “I already know how to take care of people, so why should I change?” That mindset can become a barrier.
That is why education is so important. Doctors and nurses need more exposure to innovation and digital thinking during training. Doctors are often slightly more open to innovation because of their scientific background and more inquisitive mindset. Nursing education has traditionally focused less on that aspect.
At the same time, I often see that AI and digitalization are treated mainly as the responsibility of the CIO, CTO, or CDO. But digital transformation should also be a priority for the CHRO (Chief Human Resources Officer), the CEO, the CFO, and the COO, because this is not simply about plugging in new technology. It is a transformation of the entire work process, and organizations need to lead their people through it.
And of course, there will always be people who resist. If you go right, they will say you should have gone left. If you go left, they will say you should have gone right. Whatever you do, there will always be opposition. In German, there is a wonderful word, “kaltstellen”. That small group will always remain skeptical, and honestly, you should not give them too much attention. At some point, they need to recognize that if they do not keep pace with the organization, they will not move forward.
The real focus should be on the frontrunners. Position them well within the organization and use them to bring the silent majority along through a step-by-step change process.
What I also notice is that adoption depends on the specific technology. For example, doctors are very enthusiastic about ambient listening tools because they are so overworked and see immediate value. Nurses are often more hesitant because they worry about privacy or practical implications. So organizations need to continuously support people through these changes.
In the end, though, it is fundamentally a leadership issue.
So what makes an effective leader in AI and digital transformation?
First of all, it should not be just a technology geek who understands everything about digital tools, while the rest of the organization is somewhere completely different. That approach will not work. For me, leadership is about building the right team. You need a team that covers all the necessary dimensions of transformation.
The CFO needs to understand how investment capacity will be created and how operational budgets will change as reimbursement models evolve. The CHRO needs to consider transformation capabilities: how people will adapt, how change will be managed, and how the workforce will be supported. The COO needs to rethink operational processes and workflows. The CMO needs to consider the role of medical professionals, where priorities should lie, and how clinicians can be supported in the transition.
And the CEO’s role is to bring all these elements together. Great CEOs are usually not deep specialists in one particular area. Their strength is the ability to connect all these perspectives and steer the organization as a whole.
Traditionally, many healthcare CEOs came from medical backgrounds, and I still think that remains important because it helps them gain credibility and acceptance within healthcare organizations. But today they also need a much broader perspective. They need to understand technology, organizational change, and digital transformation. They do not have to be the leading technology expert themselves, but they must be able to appoint the right specialists to the leadership team and understand how all the pieces fit together.
Healthcare systems around the world are struggling with workforce shortages, medical errors, rising costs, and the need to maintain the quality of care. Do you think AI is truly the technology that can finally make healthcare systems more sustainable, or is it more of a promise, a kind of holy grail that everyone hopes will solve these problems?
I don’t really believe in holy grails – they don’t exist. Even if you had the most sophisticated and perfectly fine-tuned AI system, if your workforce policy is poor, you still won’t have the people you need to run the system properly.
I believe AI can relieve several tensions within healthcare systems. Take ambient technology as an example. If it helps doctors avoid spending two extra hours every evening on administration and electronic patient records, then it immediately relieves pressure.
For me, the real opportunity lies in how AI can help patients with less complex conditions manage more of their own care and monitoring.
My husband recently had surgery for stenosis. I looked up exercises for him using ChatGPT, and honestly, he is doing much better because of it. I currently have a problem with my heel, and I am also using digital tools and exercises to improve my condition. These kinds of tools can reduce unnecessary pressure on healthcare systems. So yes, I do think AI can relieve some of the tension. But no, I definitely do not think it is a holy grail.
You speak to many leaders. Has AI already become the central topic in healthcare, or is digitalization still seen as a nice-to-have add-on?
If you look at large university medical centers such as Charité, Erasmus MC, or Karolinska Institutet, AI probably accounts for 60% of what they discuss today. And honestly, it should be, because the transformation potential is enormous. But if you look at a small hospital in a rural area, the reality is very different. AI is not yet central there.
That is also why I believe we need frontrunners within the sector that actively develop these solutions. At the same time, governments and insurers need to help translate those innovations into solutions that smaller hospitals can actually adopt and use.
So yes, in leading institutions, AI has absolutely become one of the dominant topics. It is a little bit like the beginning of the electricity era. If you were not working with electricity, you were falling behind. But at the same time, many small farmers lacked electricity for years. The same will happen with AI. Large institutions will be the pioneers and innovators, while smaller institutions will eventually become users of these technologies rather than inventors.
