NEJM Interviews NEJM Interview: Robert Huckman on the dearth of successful business models aimed at keeping people healthy.
Dec 3, 2025
Robert Huckman, a Harvard Business School professor and health care expert, dives into the complexities of business models aimed at keeping people healthy. He discusses how current payment incentives favor procedures over health outcomes, leading to a misalignment in goals. Huckman examines the challenges digital and chronic-care ventures face in securing funding for preventive services. He highlights the importance of social determinants, data sharing, and the need for innovative partnerships to create sustainable, health-focused business models.
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Three Numbers Drive Provider Viability
- Hospital and physician finances pivot on three simple variables: revenue per unit, cost per unit, and number of units provided.
- This framing explains why delivering fewer interventions can actually threaten current provider margins.
Payments Reward Activity Not Health
- Current payment largely rewards interventions like visits, tests, and procedures rather than the health those services generate.
- That payment structure creates incentives for more downstream care instead of preventing illness.
Digital Firms Target Chronic Care
- Many companies build digital apps for chronic diseases like diabetes and heart failure to avoid downstream hospital use.
- These firms struggle because payers must decide which offerings actually reduce utilization and are worth paying for.