Home health monitoring was increasingly common.
Apple Watches, Fitbits, connected blood pressure cuffs, and other devices collected health information throughout the day.
EY's Business Growth and Transformation leads asked what healthcare would look like in 2040. I led the research, built four futures to test ideas against, and defined a service EY could start building toward.
Turning home monitoring into earlier care.
Apple Watches, Fitbits, connected blood pressure cuffs, and other devices collected health information throughout the day.
In 2022, 46% of working-age adults said they had skipped or delayed care because of cost.
In 2018, Medicare began paying providers to monitor conditions like high blood pressure using connected devices. Private insurers followed, but adoption stayed low.
I built Ruth from interview patterns so patient needs stayed visible in every future.
An office manager with high blood pressure who saw her doctor once a year and generally felt fine.
High blood pressure
Annual doctor visit
Private insurance
She felt healthy
What Ruth's insurer paid per year
Monitoring: Medicare's published rate, about $100 a month. Stroke care: the US average per patient per year, from a 2021 review of 46 studies.
Cheaper does not mean people will accept it. Would members let an insurer watch their health?
I researched usage-based auto insurance, where drivers trade driving data for lower premiums. Uptake holds when the trade is opt-in and the payback is immediate, so I built both into Aeglia.
Two uncertainties stood out from the scan: how quickly health technology would be adopted, and who would pay the bills. Crossing them gave four futures.
Monitoring devices were cheap and everywhere. Ruth's insurer paid her hospital bills but not prevention, so the device was hers to buy and she skipped it.
Government paid for both Ruth's monitoring and hospital stays. Keeping her well saved the same payer money, so it funded the device.
Premiums climbed, treatment never improved, and Ruth canceled checkups. Her insurer still covered the bill when a crisis happened.
Government covered everyone, but technology and clinical capacity lagged. Ruth waited longer even though she was covered.
What the futures showed
Prevention emerged as the strongest direction; funding would determine whether it could scale.
Members switch insurers every few years. They asked why any insurer would fund prevention when a competitor collects the savings.
I narrowed the concept to conditions that turn expensive fast. Uncontrolled blood pressure can put someone in hospital inside a single plan year, so the savings land while Ruth is still a member.
Ruth, her doctor, and her insurer each needed a reason to take part.
Give Ruth a reason to keep monitoring, pay her doctor for the work, and give her insurer a credible path to lower avoidable cost.
They flagged the doctor as the fragile point. Another stream of alerts on a full schedule would kill adoption.
I set Aeglia to flag only sustained trends, never single readings, then blueprinted one episode to show exactly what reached her doctor and what it cost.
Every step carries what Ruth's insurer spends on it.
Ruth's cuff sends a reading each morning. Nothing else is asked of her.
Her readings climb for nine days straight. Aeglia flags the climb, not a single bad morning.
She answers three questions on her phone and books a video visit for Thursday.
Her doctor opens the call already looking at the nine days and changes Ruth's medication.
Ruth gets a grocery credit for filling the prescription and taking her readings.
What the episode cost
This episode cost $173. The stroke it prevented would have cost $60,000.
Working reviews built buy-in throughout the project. By the final presentation, EY's questions had been addressed and the rationale behind the recommendation was already clear.
Build the service that turns patient health trends into actionable warnings for doctors.
Run the model with one insurer for one year, comparing avoidable hospitalizations against a matched group.
Use validated savings to expand across insurers.
Three working reviews meant the final direction was one EY had already shaped. There was nothing left to sell at the end.
Visuals build shared understanding faster than an explanation, and give people something specific to react to.
Feedback got sharper the moment the work stopped being about healthcare and started being about Ruth. Everyone could point to where she would fall through.
The map runs outward from Ruth: what she uses daily, what she meets occasionally, and what she never sees.