The U.S. healthcare system has a problem. Despite spending more per capita than any peer nation, the system continues to deliver uneven access, middling outcomes, and rising frustration for patients, clinicians, and innovators alike. For entrepreneurs and technology leaders, that creates the challenge of inventing better tools, but also learning how to operate inside a system shaped by entrenched incentives and serious questions of trust and accountability.

Few people understand those tensions as well as Halle Tecco, MBA, MPH. An entrepreneur, investor, and educator, Tecco is the founder of Rock Health, one of the earliest venture funds dedicated to digital health. For the past decade, she has also taught the highly rated digital health investing elective at Columbia Business School, where she helps future leaders make sense of why healthcare innovation so often stalls—and what it takes to move it forward responsibly.

In her new book, Massively Better Healthcare, Tecco argues that healthcare’s difficulty is not a bug but a defining feature. Innovators who succeed are those who learn to work with that complexity rather than fight it, by respecting the slow realities of regulation and care delivery and earning trust through responsible stewardship of data and outcomes. Technology, including AI, can play a powerful role, she notes, but only when paired with the right business models, incentives, and ethical frameworks.

As part of Columbia Business School’s AI & Healthcare initiative, Tecco shares practical lessons from the front lines of healthcare innovation. 

Columbia Business School: What is the problem with U.S. healthcare, and how can entrepreneurs be a part of the solution?

Halle Tecco: We spend more on healthcare than any other country on earth, but our outcomes are no better, and in some ways, they're worse. U.S. life expectancy ranks 32nd among the 38 OECD countries, despite massively outspending all our peers.

But our healthcare system isn’t failing everyone equally. It’s a tale of two cities. In one, wealthy patients have access to cutting-edge therapies, preventive care, and on-demand digital health tools. In the other, people go years without seeing a doctor, skip or cut pills in half in order to stretch their medications, and die years earlier than their wealthy peers. Those with money and privilege benefit from some of the most advanced medicine in the world, while millions of others are systematically left behind.

The result is a healthcare system that both reflects and reinforces inequality. Where you live, your race, your job, and your income predict your health outcomes more reliably than any clinical biomarker. 

In fact, wealthier Americans living in the top 1% of U.S. counties by median household income live on average seven years longer than people living in the bottom 50% of counties. A person living in a small rural county with a median income of $30,000 can expect to live a full decade less than someone in an affluent suburb with a median income of $100,000.

A lot of opportunities for entrepreneurs really stem from that. Can we create new products,tools, and services that give everybody high quality care at a price they can afford?

CBS: The second part of your book is titled The Anatomy of Healthcare Innovation. So what does innovation actually look like? How are AI and other tech involved there?

Tecco: Innovation does not always mean new technology. In the book, I define healthcare innovation as the development and implementation of new ideas, processes, technologies, or business models. Many of the most impactful innovations are not inventions at all! Sometimes it’s about rethinking business models, partnerships, or workflow design.

In my class and in my book, I teach the Healthcare Innovation Pathway Matrix, which looks at innovation along two dimensions:

  • Whether the product or service itself is new or established, and
  • Whether the business model is new or works within existing structures.

This results in four pathways to innovation (breakthrough, upgrade, creative, and competitive solutions), and I’m explicit that no single pathway is “best.” Some of the most successful companies improve healthcare by fitting into existing systems and making something meaningfully better, while others innovate by rethinking how care is accessed or paid for. In many cases, the product is simply the enabler; the real innovation is in how it’s deployed and adopted.