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Prevention-as-a-Service: A business model that will fix healthcare

To date, investments in health research, healthcare policy, infrastructure and services are largely geared towards treating people once they become sick … but not helping them stay healthy. This ‘sick care’ model has brought us to the brink of a health crisis. As an example, greater than half of US adults have at least one chronic condition and one in three is suffering from multiple chronic conditions. Further, over 100k American adults have died from diabetes alone for the second consecutive year, and if current trends persist, nearly one in three Americans will develop type II diabetes alone in their lifetime. In addition to diabetes, the prevalence of other chronic lifestyle conditions such as obesity, heart disease, inflammatory bowel disease, chronic kidney disease and arthritis are growing exponentially. An equally daunting mental health crisis has emerged exacerbated by the Covid-19 pandemic. Significantly, neuropsychiatric disorders and inflammation have been demonstrated to be closely intertwined, powering each other in a bidirectional loop. Thus, these two terrible epidemics may have compounding effects wreaking havoc on our societies.

Coupling this grim outlook with research findings showing that just 10 minutes of daily exercise will save an additional 110,000 lives each year in the US and just 30–60 minutes of strength training per week reduces all-cause mortality by 20%, you soon realize that a sick care system which relies largely on medical interventions is grossly inadequate for improving health outcomes. And, it runs counterintuitive to literature and public health experts that suggest upwards of 70% of health outcomes are driven by factors beyond medical interventions. With sick care spending having grown to nearly 20% of US GDP, we simply cannot afford to manage, let alone treat chronic inflammatory conditions in the conventional way, the bulk of which remain preventable. All while, two-thirds of all personal bankruptcies in the US cite medical issues as the main reason.

Why have we found ourselves here? An oft-cited reason is that approximately 90% of the US health budget is spent via a fee-for-service reimbursement structure, which incentivizes volume and complexity of interventions. At the outset, this logic seems reasonable: one should only receive, and therefore pay for, an intervention if needed. The problem, of course, is this system does not account for, nor incentivize approaches to prevent the disease from happening in the first place, thus obviating the need for these costly interventions. Given incentives drive decision making it should come as no surprise that prevention has to date fallen short of becoming a viable business model, let alone one which can scale. But there is a recognizable paradox that has historically challenged preventative care: how can one distinguish the need for and therefore the outcomes and value of a preventative method?


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