The tension at the heart of a Digital Health Business

As we build up our business, empowering patients to better navigate healthcare journeys, I keep coming back to the following mental model and reflecting on the challenges built into it:


So what’s the problem?  

Each of these three things can add so much to each other, but each has very different cultures as well as different models of what success looks like – and hence what to focus on:

  • Tech/Digital tends to prioritise users and engagement above all else, and works out the health impact and the business model later.  While this can be wildly successful, the problem is that the impact on the livelihood of your catering to users is unknown – and may even be harmful to their health. (ask Facebook!)
  • This is why health orgs traditionally start from the impact – they build something that they think can work and test it in a clinical trial.   Only once they know that they have something that improves health do they try and tackle engagement and revenue models. The problem with starting there in a digital business is 2-fold however – it takes too long to show results that are too limited in scope, so that the tech is out of date and the funding model is shot by the time you have your proof.  FDA and others are recognising this problem and trying to adjust, but the internal mental space needs to change.
  • And of course, if we just start like a normal business and prioritise revenue first, then we wont have users or positive health outcomes – and we can just pack up before we start.

So where to start?  

Almost certainly (frustratingly) there is no right answer to this question and lots of external factors that would go into a decision on what to prioritise and in which order.  That said, there is certainly a strong need to have a plan for how to tackle all three from the beginning – and to keep pushing on each side and forcing traction on all 3 sides in every iteration of your intervention.  Some legs of the triangle will grow faster in a given time period. But as long as there is always someone caring and pushing each leg forward, I think we can keep the triangle growing as a whole, increasing its surface area – its long-term potential to improve lives.


By Luke Shankland