Prevention-as-a-Service: A Business Model that Can Fix Healthcare

To date, investments in health research, healthcare policy, infrastructure and services are primarily 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. For example, more than half of US adults have at least one chronic condition, and one in three suffers greater than half of US adults have at least one chronic condition. One in three is suffering from multiple chronic conditions. Further, over 100k American adults have died from diabetes alone for the second consecutive year.

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 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 mainly on medical interventions is grossly inadequate for improving health outcomes. And it runs counterintuitive to literature, and factors beyond medical interventions drive 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 cannot afford to manage, let alone conventionally treat, chronic inflammatory conditions, the bulk of which remain preventable. At the same time, 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 preventing the need for these costly interventions. Given incentives drive decision making; it should come as no surprise that prevention has fallen short of becoming a viable business model, let alone one that 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 preventive method?

The answer to resolving the prevention paradox is linking small behavioral changes to changes in personal health status (positive and negative) which can then be connected to economic value (creation and destruction). Such a capability has not existed to date. Yet, rapid developments of the internet of things, the cloud and AI/ML have given rise to the behaviorome (quantified characterization of behaviors) and environmentome (quantified characterization of social determinants of health), yielding nuanced insight into how daily decisions and behaviors in a given environment impact a person’s health.

As the behavioromes and environmentomes of a population become better characterized over time and linked to outcomes, a personal, dynamic health score could be calculated for individuals in that population. This dynamic health score could enable the prediction and assessment of a preventative intervention for an individual, potentially before the onset of detectable symptoms of chronic conditions, ultimately paving the way for a sustainable Prevention-as-a-Service (PaaS) business model. This new paradigm would aim to keep people healthy and dramatically alter the unsustainable course of the current healthcare model by bringing about significantly better outcomes at a lower cost.

The scalability of PaaS relies on modern data analytics methodologies such as machine learning that are well-suited for analysis, pattern recognition, and adaptive recommendations based on individual and population aggregate-level data. One can now begin to (a) create genuinely ‘personalized’ preventive programs and incentives that are more effective and (b) link small changes in an individual’s health status to value through a meaningful health score, which correlates with the value of prevention on an individualized basis.

If one can do this, then Prevention-as-a-Service becomes a sustainable business where there is an agreed-upon value creation standard through health score changes. Created value can then be shared between the person and all stakeholders dependent upon said individual staying healthy, such as healthcare paying entities. Moreover, this approach could employ behavioral economic models to support behavior change more effectively than today’s population-level best practices.

We believe that the infrastructure for PaaS is already here and that value creation through a dynamic health score will deliver, for the first time, a viable business model for prevention which is both scalable and sustainable. A platform dedicated to PaaS will empower citizens with health education and literacy, ensure inclusivity & health equity, and deliver convenience and community, all while leveraging behavioral economic models based on individualized health scores to incentivize each person’s health journey.

Preventing citizens from falling sick to lifelong chronic conditions may have sounded utopian in the past — it no longer is. Now is the time to do something about it.

It’s time to unleash health.

Credits: This article is a collaboration between Dr. Ramin Rafiei, CEO and Co-Founder of Reformulate Health and Dr. Jacob LaPorte, Co-Founder and Global Head of the Novartis Biome with equal contributions by both authors.