The Fifth P: Profitable Prevention Is the Future of Healthcare

In the world of medicine, we love models. They help us simplify the complex, focus our priorities, and dream of what's possible. One of the most influential models in the last decade has been the so-called “4P Medicine:" Predictive, Preventive, Personalized, and Participatory. First introduced by Leroy Hood and colleagues around 2011, this vision of the future painted a healthcare system radically different from the one we know — where data, genomics, and patient engagement would replace the reactive, fragmented, and disease-centric models of the past.

And honestly, it’s a brilliant framework. It has guided research, inspired policies, and pushed tech developers to think beyond the hospital and toward the human. I’ve worked for years in diagnostics, in both public and private health systems, and I’ve seen firsthand how powerful this mindset can be when applied well.

But I’ve also seen its limits. Because as elegant as the 4P's are, they’re missing something essential, something economic, structural, and uncomfortable.

So, I propose a fifth “P:" Profitable.

Why? Because none of the other P's can scale without someone willing to pay for them. Not in Latin America. Not anywhere. We can talk about predicting diseases with biomarkers and algorithms. We can build preventive strategies powered by AI. We can personalize treatments and invite patients to co-own their care. But if the health system only generates revenue when people get sick, who’s going to fund the future where they don’t?

This is the core paradox we’re living in. On the one hand, we celebrate progress: earlier detection, better outcomes, lower cost per intervention. On the other hand, we operate in systems — public and private — that are still financially tethered to the volume of disease, not the value of prevention.

It’s not just a business model problem. It’s a mindset problem.

Let’s look at how this plays out in real life: An AI tool identifies that a patient has a high probability of developing type 2 diabetes in five years. The model is validated, accurate, and actionable. But now what? Who pays to intervene today to avoid a disease that hasn’t happened yet? Who gets reimbursed for delaying a diagnosis? For avoiding a prescription? For keeping the hospital bed empty?

In most Latin American systems, the answer is: no one. Prevention is still framed as a “cost center,” something nice to have, something ethical, something strategic … but almost never something profitable.

That’s why I believe it's time we call it out.

Nowhere is this tension more evident than in Latin America. Our region is facing a perfect storm: a growing burden of chronic disease, underfunded public health systems, and a rapidly expanding middle class with rising expectations, but limited coverage. We have brilliant physicians, promising startups, public health champions, and enough epidemiological data to light up a continent. But still, we struggle to move from reactive to proactive care.

Why? Because the economic engine of healthcare hasn’t changed. We still measure productivity by the number of procedures performed, beds occupied, prescriptions written. Prevention, by contrast, is invisible on the balance sheet. It shows up as avoided cost, as a risk mitigated, a hospitalization that never happened. That might be good for public health, but it’s bad for business under the current rules.

And herein lies the trap: If prevention doesn’t generate revenue, it will always be undervalued. If staying healthy doesn’t trigger a billing code, it won’t become a priority.

The absurdity becomes clear when you realize how advanced the tools already are. Today, we can use AI to screen for cervical cancer with smartphone-based imaging. We can predict complications in diabetic patients using longitudinal data from glucose monitors. We can identify mental health risks using natural language processing in primary care settings. The tech is here. The data is here. What’s missing is the incentive.

In fact, I often wonder: If we had these tools 30 years ago, would we be using them today any differently? Or would we still be stuck in the same logic, waiting for people to get sick so we can start generating value?

It’s not just governments that face this dilemma. Private insurers, too, often struggle to justify large-scale investment in predictive analytics, simply because the return is long-term and uncertain. Patients switch plans. Governments change. Budgets fluctuate. And so, the default remains: treat the illness, bill the code, repeat.

But we can’t afford to keep playing defense. Not in a region where 75% of total healthcare costs are now related to preventable non-communicable diseases. Not in systems already overwhelmed by inequality, under-resourced public networks, and fragmented access.

We need to change the rules.

Some are already trying.

In Chile, the public health system implemented an early warning model to identify high-risk patients for diabetes and cardiovascular disease using AI-driven registries. The result? Reduced emergency visits and a reallocation of resources to primary care prevention.

In South Africa, Discovery Health pioneered a model where members earn rewards — real, monetary incentives — for achieving health milestones. It’s a business model that aligns prevention with profitability. The healthier the population, the better the long-term margins.

Startups in Brazil and Colombia are building B2B models where employers pay for preventive screenings and behavior-based coaching, not because it’s their legal obligation, but because it reduces absenteeism and long-term healthcare claims.

And in Mexico, we’re seeing early-stage innovation from digital health companies working with insurers to build predictive dashboards, not just to analyze risk but to activate incentives around it.

These aren’t just pilot programs. They’re early signals of a shift. A recognition that the future of healthcare is not about doing more, it’s about getting ahead.

To make this transition real, we need to do five things:

• Redesign reimbursement models to include predictive outcomes and risk-reduction as billable services.
• Create public-private prevention funds that reward providers and patients for avoiding disease.
• Develop digital contracts with built-in incentives for preventive behavior (for example, lower premiums, co-pays, or medication subsidies).
• Encourage health systems to measure success by healthspan, not just lifespan.
• Educate stakeholders that avoiding cost is not losing revenue, it’s building long-term system resilience.

In other words, we must evolve from treating illness to funding wellness.

The good news is that we don’t need to invent new science. We need to realign the incentives around the science we already have.

And yes, this won’t happen overnight. The shift toward Profitable Prevention is not a flip of a switch, it’s a collaborative redesign. It requires governments willing to invest in future savings. Insurers willing to experiment with new pricing models. Investors willing to fund startups that reduce demand instead of fueling overuse. And clinicians willing to work with algorithms not as threats but as allies.

But if we get it right, we won’t just reduce disease, we’ll redefine what value means in healthcare.

And that, in my view, is the real future of medicine, not just Predictive, Preventive, Personalized, and Participatory.

But also, and necessarily, Profitable.

Because the medicine of the future will not be built only with intelligence. It will be built with intelligent incentives.