Why Removing Humans from Care May Undermine Outcomes
May 4, 2026 – 6:53 pm
The pitch deck version of digital health goes something like this:
AI replaces the clinician, costs drop, access expands, outcomes improve, everyone wins. The pitch has been effective. Venture capital has poured billions into companies built around the premise that removing humans from the care loop is both possible and desirable.
However, Ruben Sandoval Davila, co-founder and CTO of Avena Health, highlights a problem with this premise using data from his own platform:
Two percent. That is the share of active users remaining after three months on a clinical nutrition platform that, according to its internal data, had previously retained 40% of patients for eleven months or longer.
Sandoval, who built and then rebuilt Avena Health’s automation after observing its failure, emphasizes that patient engagement is not solely dependent on AI functionality. While the AI performed correctly, patients left.
"Healthcare doesn’t scale because providers are bottlenecked by time, not demand,” Sandoval explains. “What we’re building shifts that constraint. The provider’s capacity isn’t limited by skill or willingness. It’s limited by the administrative overhead surrounding every patient interaction."
He argues for a more nuanced approach where human specialists remain involved at specific clinical touchpoints, combining personalization with expert oversight, leading to higher retention rates.
"Fully automated AI systems often struggle with retention. The edge comes from combining hyper-personalization at the patient level with expert oversight."
The key takeaway is that patient behavior is influenced by human interaction, even when AI handles most tasks, and this impacts platform survival beyond year one.