Fund prevention by aligning incentives and creating shared savings

Prevention often stalls because the people who must pay aren’t the ones who benefit. A maintenance team saves the company money by replacing filters, but their budget gets cut because things “look fine.” A clinic keeps patients out of the hospital and then loses revenue because the payment model rewards procedures, not health. That’s the wrong‑pocket problem.

A housing group faced this with evictions. The city paid for shelters when tenants fell behind, but landlords held the power to file or to flex. The team ran a pilot: if mediation and small bridge payments prevented an eviction, the city documented avoided shelter costs and routed a portion of those savings to the landlord association in the form of reduced fees and faster inspections. A coordinator helped with paperwork so the program didn’t add friction. Within six months, filings dropped by a third among pilot properties.

In a health network, a primary‑care practice negotiated a simple shared‑savings arrangement. If emergency visits for a set of patients fell below an agreed baseline, the payer shared a portion of the savings. The clinic used the funds to extend hours and hire a care manager. Patients liked the access, clinicians liked practicing upstream, and the numbers improved. It wasn’t magic. It was alignment.

The idea is straightforward: find the mismatch, measure avoided costs credibly, and divide the gains among people who make prevention happen. Start small, prove it works, then expand. When every pocket wins, prevention finally gets paid.

Map who would need to invest in prevention and who would benefit if failures drop, and circle the mismatches that block action. Draft a basic shared‑savings model with a clear baseline, a fair split, and simple administration, then recruit one payer to pilot with a small population. Document avoided costs and human outcomes clearly and use that story to scale. Start with one manageable pilot to show it can be done.