The three questions that decide whether prevention scales

Most prevention products are priced incorrectly.

You build something that genuinely helps people stay well, and then you showcase it to an infrastructure that analyses costs in quarters and health in decades. So you offer early detection to a health service that won’t bank the saving for ten years. Or a workplace wellbeing programme to a finance director who is cutting costs this quarter and, as far as the budget’s concerned, doesn't see the immediate benefit. The product works. The pitch lands. And still it stalls. The root cause? Expenditure and benefit are sitting in two different pockets, held by two different people, years apart.

I’ve watched this happen to brilliant founders, including my own experience, and it took me a while to understand. It isn’t a marketing problem, and it usually isn’t a product problem. It’s a buyer-and-pricing problem wearing the disguise of a “long sales cycle.” Three questions get underneath it, and in my experience they decide, far more than the strength of the evidence, whether a prevention venture ever scales.

One: who captures the benefit?

Prevention’s structural challenge is that the person who pays and the person who benefits are usually not the same person, and often not aligned in the same decade. The individual benefits from not getting ill. The health system benefits, eventually, from lower treatment costs. But you, the founder, need someone to write a cheque now.

So the first job is to find the buyer for whom the cost and the benefit run in parallel. That buyer exists more often than founders think, but you have to do the research. An insurer can price a lower risk and see it in their claims. An employer is impacted by the cost of an absent, burned-out workforce right now, and sees retention in numbers they already track. A care operator paid for outcomes rather than activity has a direct, this-year reason to keep people well. Each of them is operating in the here and now.

The founders who scale don’t wait for the whole system to reward prevention. They find the specific corner of it that already does, and they build there first. Get this wrong, selling to the beneficiary who can’t pay, or the payer who won’t see the return for a decade, and no amount of evidence rescues you.

Two: do the numbers work on their balance sheet?

Forget the clinical paper for a moment. Consider the buyer metrics, can the numbers stack up this year, in the terms they already use to think about money.

This is where a lot of technically excellent founders come unstuck. They arrive with a beautiful trial and a p-value and present it to a commercial buyer as though efficacy and value were the same thing. They aren’t. A clinician is persuaded by a trial. A finance director is persuaded by a number they track - cost saved, risk reduced, revenue protected. If you can’t show your return in the language that buyer already uses, you don’t have a sale.

The effort here is rooted in translation. Take what your product does and re-express it as what it does to the buyer’s own metrics. Not “we improve wellbeing” but “here’s what this does to your absence rate, and here’s what that’s worth.” Not “we detect earlier” but “here’s the downstream cost you avoid, and here’s roughly when you see it.” The moment the numbers are expressed in their terms, the conversation changes from a favour you’re asking into a decision that’s plainly in their interest.

Three: is there someone whose job it is to buy it?

This is the one question founders skip, and it’s the one that impacts the most deals. You can have the right buyer and a return that stacks up, and still hit a wall, because in that specific organisation there’s no budget line for what you sell, no category it fits into, and no single person whose job it is to say yes.

Prevention runs into this constantly, because most health systems and most companies are built around treating illness, not preventing it. The procurement routes assume someone is already sick. The budgets are organised around treatment. So often a genuinely brilliant preventative product turns up and finds there’s no space for it to sit within.

When that happens, your first task isn’t selling. It’s building the category, and finding, or helping create, the person who can own the decision. That’s a slower and harder process than pitching, and it’s what separates the prevention companies that scale from the ones that stay permanently “in conversations.” Sometimes you’re not closing a sale at all; you’re helping a buyer construct the internal case that lets them buy in the first place.

Put the three together

When a prevention venture is stuck, the founder almost always assumes the problem is upstream, requiring more evidence, a better deck, a sharper demo. However, nine times out of ten one of these three questions has gone unanswered. Fix the buyer, the framing and the mandate, and the objection you’ve been fighting for months tends to dissolve.

None of this makes the science less important, rather it makes it usable and applicable. Prevention is one of the most valuable things we can build.

So, before your next quarter, take time to consider which of the three is the gap in your model right now - the buyer, the numbers, or the mandate? If it’s useful to work through it properly together, my diary’s below. A Commercial Diagnostic is built for exactly this.

With purpose,

Sara