Prevention-as-a-Service™: Aligning incentives, values and outcomes for a healthier world

In Prevention-as-a-Service: A business model that will fix healthcare, we argued that technology is mature enough to create a dynamic health score that, among other functions, could link small changes in an individual’s health status to economic value. An agreed upon standard of value creation for positive health changes could then be shared between the person, and all stakeholders who are dependent upon said individual staying healthy, such as employers and healthcare paying entities. This establishes a foundation where economic incentives become tightly coupled to healthy behavior changes, a key condition that allows for preventative health to be woven into the fabric of a society.

We were under no illusions at the time of writing our first article that establishing a broadly accepted health score that tracks small changes in health over time, which are correlated to quanta of health outcomes and economic value creation would be a long process. To put this into perspective one only needs to consider the history of HbA1c (A1C)—perhaps one of the most well-known and studied clinical markers used to diagnose, manage and predict broader health complications of diabetes. In 1968, A1C was observed to be elevated in people with diabetes. In 1975 it was suggested that A1C is related to metabolic control. Finally, in a 1993 landmark study, the Diabetes Control and Complications Trial (DCCT), established A1C as a valuable clinical marker in people with type 1 diabetes (a different study was completed in 1998 to demonstrate a similar result in people with type 2 diabetes). Not until 2010 did the ADA recommend using the A1C test to diagnose diabetes. And, as recently as 2022, there have been debates in the literature on the overall clinical predictability of A1C. So, for ~55 years since the first observation that it might be linked to diabetes, the medical community is not entirely set on the predictive value of A1C. That isn’t to suggest that the development of it as a clinical marker hasn’t yielded tremendous value in the diagnosis and treatment of diabetes—it has. It does, however, demonstrate the complexity in establishing markers and scores as commonly accepted surrogates that are predictive of long-term outcomes.

While there are a few efforts to develop a comprehensive ‘health’ score, we believe that society can ill afford to wait upwards of 50 years to establish and integrate a prevention score into our economic systems. Short of a massive shift in posture from governments to create policy and funding to dramatically accelerate preventative health—which, we don’t anticipate—there has to be an unconventional solution to dramatically hasten how prevention is implemented and scaled to reverse the dire trends in health and wellness that are now threatening the competitiveness of economic super powers like the US.

We don’t believe the solution lies in developing more bright, shiny objects that are marketed to the top 1% who have the disposable income, health literacy, and time to consume these things. Unfortunately, it seems that these gadgets are developed by people with similar profiles that assume everyone has $1000s, if not more, to throw at tech products; providers have gobs of time to figure out how to incorporate them into their practice; and hospital CFOs are just aching to write a check for a new toy. If this assumption seems a little off to you, it’s probably because it is. There is scant evidence that this approach has had any meaningful impact on population health, although gadgets like Fitbit have been around since the mid-2000s. In fact, a few studies have pointed out the precipitous drop-off in engagement of many healthcare apps and gadgets with lack of any measurable benefit. If you don’t have a competent plan for how to provide access to the 99% and help them change their behaviors in a sustainable way while accounting for the nuance of their cultural and socioeconomic context, then you don’t have a scalable preventative solution.

The key to developing a scalable preventative health solution is aligning incentives, values and outcomes between a population and economic entities that benefit from them staying healthy. Paradoxically, we don’t believe this can be orchestrated within the medical economy we know today. Most health systems, even those that are “universal”, are not incentivized nor set up to adequately deliver prevention. Beyond the lack of incentives, health systems are not capable of reaching their populations on a frequent basis and accomplishing long-term behavior change that is foundational to an effective preventative health program.

There exists another powerful economic force, however, that is proficient at engaging people in their everyday lives to effect behavior change and has the appropriate incentives to help people become healthier. Behold, the ~$3 Trillion (with a “T”) global consumer-packaged goods industry. “The consumer-packaged ‘what’ industry?” You ask. Yes, the brands that you know and love that are in your everyday life have a much more powerful economic incentive to help you live healthier than the conventional health system. When a population is healthier, they tend to earn more money than less healthy populations, with the correlation of having greater disposable income to spend. By helping people live healthier, by default, brands have a powerful lever to increase their customer lifetime value. This alone is a powerful incentive, but it doesn’t compare to the opportunity brands have in unlocking the next generation of engagement with consumers.

As brands seek to find more meaningful ways to engage their customers, we can envision few better ways then partnering with them live a healthier, more productive life. Currently, social media is a core channel for brands to engage consumers in an n-of-1 dynamic—the holy grail of marketing. The challenge of course is that there is mounting evidence that social media, in its current manifestation, has detrimental effects on health and wellness, particularly in some of the most vulnerable populations. Increasing backlash against these platforms and the evolving consumer expectations of values-driven brands, particularly in younger, more health- and socially- conscious generations, is creating the conditions for an entirely new engagement paradigm to emerge.

A third powerful incentive emerges for consumer brands with ESG investing gaining prominence over the last few years. By supporting the health and wellness of the customers they serve, not only do consumer brands stand to improve the key business fundamentals discussed in the previous paragraphs, but they have the chance to better align with investor expectations. This could drive a virtuous cycle where companies source more capital to drive an ESG strategy that directly impacts their income statement, which in turn leads to more capital, most likely at better valuations, to access future growth aspirations more efficiently than competitors. If—or when, as we like to think—a tipping point is reached where supporting the health of their consumers becomes a de facto aspect of competition, there will be a tremendous benefit accrued to society and governments as well.

The question becomes: If powerful economic incentives for consumer goods exists to support the health of their consumers, why aren’t they doing it en masse? For one, it’s a matter of timing. Most of the trends that have created the fundamental conditions for this alignment of incentives for consumer goods to support the health outcomes of their customers have only recently emerged. But, there also exists a not so insignificant barrier for companies to act on this opportunity.  They must possess a unique combination of capabilities including digital proficiency, experience creation and health acumen. Many consumer companies may possess one or two of these capabilities, but rarely all three. This is where Prevention-as-a-Service™ comes in. It's the future of deep and meaningful brand engagement. It's about seamlessly weaving health and wellness into a brand’s products and services, creating personalized experiences that empower consumers to take charge of their wellbeing - a true win-win for both consumer and brand.

So, what if? What if consumer brands, who are incentivized to keep consumers healthy and are looking for new, more meaningful ways to engage them catalyze Prevention-as-a-Service™?

Broad adoption would in theory, create the resources and data to scale a universal prevention score. If this can be achieved, we might just be able to avoid the collapse of our health systems, which are becoming increasingly vulnerable as the epidemic of chronic illnesses rages on globally.

It’s time to unleash health.

This article is a collaboration between Dr Ramin Rafiei and Dr Jocob LaPorte.