Confidence in the health insurance system has been eroding steadily. Recent reports suggest that only 54% of customers describe health insurance as trustworthy. According to Joshua Resnikoff, founder of Sunstone Health, this may be driven by rising premiums, delayed access, and outcomes that rarely feel proportional to cost. National health expenditure in the United States has now crossed over $5 trillion, and private health insurance enrollment increased to 214 million in recent years, yet Resnikoff observes that patient satisfaction has continued to decline. In his view, the system is optimized for short-term accounting rather than long-term health, which becomes visible when care involves genetic diseases.
“Many Americans are displeased with the healthcare system,” Resnikoff says. “My frustration is just an amplification of everybody else’s frustrations. If you’re waiting six months to see a dermatologist for something that isn’t serious, that’s already broken. Now imagine what families go through when the stakes are much higher.”
He notes that those higher stakes affect more people than most assume. According to John Hopkins, approximately 10% of the U.S. population lives with a rare disease, which roughly translates to 30 million individuals. He notes that collectively, rare and genetic diseases are associated with approximately $1 trillion in annual healthcare spending, a figure that encompasses uncovered medical costs, outpatient costs, medications, inpatient care, as well as transportation and forced retirement. “Calling these conditions rare is a misnomer,” Resnikoff says. “They were only considered rare because we didn’t know how to interrogate genetics properly.”
From an insurance perspective, Resnikoff notes that genetic diseases reveal the inefficiencies embedded in coverage models. According to him, many commercial health plans operate on actuarial horizons of two to three years, reflecting how frequently members change insurers. Resnikoff believes this short-term view discourages investment in earlier, more precise care.
That delay, he believes, compounds harm. Studies routinely show that patients with rare or genetic conditions experience long diagnostic odysseys. Resnikoff emphasizes that those years are not clinically neutral. “That’s not years of stability,” he explains. “That’s years where symptoms progress, stress increases, and families are making life-altering decisions without information. Can you have another child? Can you take a new job? Do you need to move closer to care? Those questions ripple through households, workplaces, and communities.”
Additionally, Resnikoff has observed that lost productivity, absenteeism, and employee attrition have not been underscored as a result of delayed care, even though their economic impact is substantial. He argues that this separation between medical cost and human cost distorts decision-making. “Parents don’t compartmentalize their fear,” he says. “If your child is sick and you don’t have answers, you’re not fully present at work.”
Sunstone Health was built to address that gap by reframing how insurers and employers identify and manage genetic risk. The company analyzes existing health insurance claims data to surface early patterns associated with genetic and developmental complexity, including epilepsy and autism. “We’re not diagnosing off claims,” he says. “We’re saying these individuals need a second or third look as fast as possible, because time is the most expensive variable in this system.”
Once cases are approved, Sunstone Health coordinates diagnostics, specialist input, and care guidance through an integrated platform, reducing the need for families to assemble fragmented services themselves. Resnikoff asserts that this approach can compress a diagnostic timeline that often spans years into a matter of weeks. From an insurance standpoint, he believes the value lies in alignment. “We built a financial model that allows payers to save money by doing the right thing sooner,” he says.
Resnikoff believes the infrastructure to improve outcomes already exists within pharma, diagnostics, and clinical care, but incentives need to be realigned. “The train tracks are laid,” he says. “We just need to run a different train on them, one that matches patients to the care and therapies that actually fit their biology.”
The healthcare system, Resnikoff argues, is already under strain. In his view, for families affected by genetic disease, that strain can feel closer to abandonment. “No one should accept that this is the best we can do,” he says. His perspective positions health insurance as a lever capable of accelerating clarity, reducing waste, and restoring trust.
About Sunstone Health
Sunstone Health is a precision medicine company dedicated to ending the diagnostic odyssey for families with rare diseases. Led by CEO and co-founder Joshua Resnikoff — who was inspired by his own multi-year struggle to find answers for his son’s rare condition, PFAPA syndrome — the company leverages proprietary AI to identify high-risk patients through health insurance claims data. With deep roots in biotech, Sunstone bridges the gap between translational science and scalable healthcare, with a mission to ensure health plans provide faster, precision care so no family has to face the battle of a rare disease alone. For more information, visit www.sunstonehealth.com.
Media Contact
Lauren Damon
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