The phrase “Moonshot Thinking” originates from President John F. Kennedy’s inspiring speech in 1962. He challenged the United States to put a man on the moon for the first time in history. Nobody knew how that could be achieved, and the technology for this pursuit wasn’t even remotely ready. Against all odds, Neil Armstrong landed on the moon just eight years later.
The current head of Google’s Moonshot factory, Astro Teller, defines modern moonshots as “going 10X bigger while the rest of the world is trying to grow 10%.” Mr. Teller goes on to describe three principal reasons why moonshot thinking is so valuable:
1. When you try and do something ‘radically hard’, you approach the problem differently than when you try to make something incrementally better.
2. When you attack a problem as if it were solvable, even if you don’t know how to solve it, you’ll be shocked by what you come up with.
3. Aiming for something that is 10x better instead of just 10% better is 100 times more worth it, but is never 100 times harder.
Applying “Moonshot Thinking” To Primary Care and Disease Prevention
Proponents of Moonshot Thinking assert that three key pieces comprise this type of thinking: a clearly defined problem, a radical proposal to fix the problem, and a scientific reason to believe the problem can be solved.
1. Clearly define the problem: Approximately 88 million American adults have pre-diabetes; of these, only 15% are aware of their condition. Incidence of prehypertension, a precursor to heart disease and stroke, stands at 36.3% of the U.S. population. With the recent COVID-19 pandemic and its serious disruption of preventive healthcare services, healthcare professionals anticipate the accelerated development of these diseases into an unprecedented increase in diabetes and hypertension. Apart from the disease burden, there is also a significant cost burden to the U.S. healthcare system. Seventy-five percent of the (now) $4.0T healthcare costs in the U.S. stem from these preventable diseases.
2. A radical proposal to fix the problem: Utilize the highest value, lowest cost provider in the care system to solve the largest problems in both prevalence and cost.
3. Scientific reasons to believe the problem can be solved: The science behind it has been around for a long time. We know what needs to be done to prevent chronic conditions, and how humans adapt and improve their behaviors over time. It’s not a matter of knowing what, it’s a matter of how we choose to do it. For a long time, we’ve overlooked the primary care provider in this conversation. The constant question in the public and population health discussion is “how do we reach the people who need the interventions?”. Products and programs for prevention are targeting self-insured employers, health plans, and even consumers directly. How do we help the patients with sore throats or gallbladder pain? We reach them through a PCP. Why should primary prevention be any different?
Our Moonshot Mission
At PreventScripts, we believe the most drastic cost reductions and health outcome change can be produced with a focus on the Primary Care Provider. We know the size and complexity of the chronic disease problem. We know the scientific, medical, and behavioral practices that can make an impact. Lastly, we know the Primary Care Provider is already the highest value and lowest cost provider in healthcare. Unfortunately, today’s healthcare system leaves Primary Care Providers undervalued and sub-optimally utilized in the fight against chronic disease. Existing products on the market focus on the prevention of disease and are primarily created for insurance companies, hospital systems, or employers. These products are leaving the primary care provider out of the preventive circle of care.
There is an opportunity to accelerate the value of the Primary Care Provider with a proactive population health approach. If the onset of chronic diseases like diabetes and hypertension are intervened in their early stages, all of the downstream costs go away. Secondary and tertiary prevention efforts create incremental change and 10% gains in our healthcare system. In Contrast, disease prevention through the primary care system gives us the 10x kind of Moonshot we are looking for. This is the power of Healthcare Moonshot Thinking.
The Moonshot Effect
We are proud to be part of an incredible group of entrepreneurs working to solidify 10 HealthCare Moonshots at Startup Health. When Joe Biden was the Vice President in 2016, we kicked off the Health Moonshot concept at the Cleveland Clinic Summit. Mr. Biden was particularly interested in the cancer moonshot, but we think his comment applies to all health moonshots.
“The Moonshot is all of us who understand the urgency and need to reimagine the cancer fight for the 21st century. It’s the spirit of discovery that defines this country. And it gives me every confidence that we are going to make enormous progress,” said President Biden. “The Moonshot is fundamentally about two things, it’s about injecting the urgency of now into this fight. Not tomorrow, not in two hours, now! And it’s about changing the culture and coming up with a new strategy for this fight. Not the strategy left over from 1971.”
We can also have a big impact on other health moonshots by focusing on primary care prevention:
1. Access to Care Moonshot: By utilizing the extensive reach of the primary care provider and arming them with tools and financial support to intervene with pre-disease patients, we can access our most vulnerable Medicare and Medicaid populations. This demographic is where 37% percent of the US healthcare spend lies.
2. Cost to Zero: Largely preventable and manageable chronic diseases account for 75 cents of every dollar we spend on healthcare in the U.S. In contrast, we spend less than 5 cents on prevention. This disparity in healthcare spending persists despite extensive data that begs for cost allocation change. For example, the WHO and CDC estimate that 80 percent of heart disease and Type 2 diabetes could be prevented by doing three things: exercising more, eating better, and avoiding tobacco. Utilizing the highest value, lowest cost provider to implement evidence-based upstream primary prevention interventions within primary care creates the greatest possible cost reductions in our system.
3. Preventing and Curing Disease: Primary care providers are the only providers with access to patients over the many years and health stages during a patient’s lifetime. Primary care providers are providing health services and have built deep relationships and trust within generations of families. We need to incentive and empower our primary care providers on the front lines of healthcare to identify these patients early and utilize interventions to change patient behavior before the onset of disease.
We are on a mission to launch the primary care provider to the moon. Through enabling PCPs with the tools and financial resources needed to tackle primary prevention, we will expand access to care, bring the cost to zero and cure chronic diseases by preventing them in the first place. PreventScripts helps providers identify, intervene, and systematically create iterative behavior change in their population while bringing meaningful and much-needed revenue to primary care offices.
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