It's important to remember that an insurance company has very little to zero incentive to lower costs. The only incentive an insurer has is to ensure costs are predictable. It doesn't matter if costs go up 20% next year as long as they know costs will not go up 25%. The extra cost gets shunted into the premium.
There is no party in the current healthcare system whose incentive is to lower prices. Medicare/Medicaid can achieve low costs by fiat, but it's broadly accepted that the whole system as structured today couldn't operate on those prices [1]. This means private insurance picks up the delta.
Doctors, Hospitals, Pharmacies, Drug companies, Medical device companies all have zero incentive to lower prices. You might think technology that makes doctors visits (to pick one example) would just win out in the marketplace, but there's a flawed assumption there. Most people are insured, so most people are paying the insured cost. For something like a doctor's visit, you pay your copay (say, $25) and the insurer pays the rest (lets say up to $70). Assume you could get an app or a technology that gets that price down to $35. This would be a huge achievement and you'd go out of business because it's more expensive than what the consumer sees.
Ah yes, but maybe you can pitch to insurers, surely they would love a lower cost! Probably not. You're small so you can't reduce their costs across the board. Even if you succeed, they have caps on how many profits they can take (usually something like 15-20%) so if you drop their costs, that might actually force them to refund customers. Good, but not the primary driver for profitability.
Let's even grant that the above isn't true. You're still a small player, you basically need to fit inside their (extremely cumbersome) protocols to be able to bill them. Now you have to do all sorts of billing and management, maybe you need to hire extra staff to run billing. That $35 now financially doesn't make sense, maybe it's now $55. Still cheaper but now you're in the system and don't have much of a competitive advantage that's visible to the consumer. Now you differentiate by offering better services, maybe a good online portal, that costs more engineers, and now we're back up to $70. Insurer doesn't care much, you're just another provider, they'll pay, you'll make money, and we're back to square one.
We're not even considering the, "Is the cancer doc that costs 25% less the same value as the other guy?" problem, which is damn hard on its own.
Healthcare is really hard, and the incentives across the board are perverse. I'm increasingly skeptical a solution that doesn't dramatically reshape the market is likely to make a difference.
[1] https://www.healthcarefinancenews.com/news/mgma-majority-pra...