By TREVOR VAN MIERLO
Most of us know the story of the Model T – but what’s often overlooked is how it applies to other industries, especially digital health. Let’s revisit:
In the early 1900s cars were custom built. You’d meet with a consultant, design the car, place your order, and wait for months for delivery. Once your car was delivered, it was difficult to operate. Many owners hired chauffeurs because at the time, cars required technical know-how, constant maintenance, and a fair bit of strength (power steering wouldn’t arrive for decades).
Then came the Model T in 1908, which led to Ford developing his assembly line in 1913. He recognized a problem in the industry and saw an opportunity. He saw the opportunity for scale:
- Standardization: “Any color, as long as it’s black“
- Mass production = affordability: Prices dropped from $850 in 1908 to $300 within a decade
- Accessible ownership: anyone could walk into a Ford dealership and drive away
On the right side of the above image is a cutting-edge digital health program from August 2000. I know it well – because I helped build it. Since then, I’ve worked on well over 100 digital health interventions. Probably closer to 200. Here’s the thing: what’s inside hasn’t changed very much. Behavioral science doesn’t move that quickly (although my recent work in AI is changing that).
And yes – digital interventions look better, are easier to navigate, and coding languages have evolved – but practically, digital health is still building custom cars – not Model Ts. That’s why tens of millions can’t open a browser and get the help they need.
What’s Blocking Digital Health’s Model T Moment?
1. Enterprise Sales (Death by Pipeline): Most digital health tools are sold through enterprise channels: RFPs, procurement departments, tenders, security reviews, and legal teams. The average sales cycle is 6-18 months. That’s fine for a $5M contract, but it’s lethal for a $50,000 contract. The problem isn’t the product – it’s the process.
2. The Vanishing Champion: I’ve experienced this dozens of times, and I’ve taken deep breaths watching it unfold on webinars: a digital health company demos their solution alongside a client champion. Priorities shift. The champion leaves. The reference project dies. Most contracts aren’t lost on merit – they’re lost to turnover.
3. Healthcare Pricing ≠ Software Pricing: Most patient-facing tools are priced like services, not products. That’s a symptom of the enterprise sales trap. Vendors charge annual fees regardless of usage. Clients expect hand-holding for these custom products. Pricing needs to reflect modern SaaS models – freemium, tiered access, per-user billing.
4. Static Products in a Dynamic World: Consumer software updates weekly – sometimes daily. Digital health tools? They launch, then stall. Feedback loops are weak. There’s no culture of iteration, and no expectation of continuous improvement.
5. Nobody Markets to the User: The best-designed tools fail if no one uses them. Lack of engagement is a systemic issue, yet many programs are launched without onboarding plans, email campaigns, or even prewritten content for TikTok or Instagram. Users don’t know what the tool is, why they received access to it, how they access it, or how it fits into their care. That’s not a product issue – it’s a marketing failure.
We Need to Build the Systems, Not Just the Tool
Henry Ford didn’t invent the automobile, but he’s remembered because he built a system. He looked beyond the engine, the chassis, and the tires. He focused on standardization, distribution, and access.
Digital health needs the same. Right now, too many solutions are trapped in a loop – custom-built for small populations, sold through enterprise channels, with no realistic path to scale.
The Good News? We’re Close
Cloud infrastructure, AI, and behaviorally intelligent platforms are finally catching up. We can now personalize at scale, launch instantly, track engagement in real time, and iterate fast. But to get there, we have to let go of the custom-built carriage mindset and embrace the assembly line. That’s not a compromise in quality – it’s a commitment to reach.
- We don’t need more pilots – we need platforms.
- We don’t need more bespoke builds – we need scale.
Digital health doesn’t have a technology problem – it has a delivery problem.
Until we achieve that, we’re just making nicer carriages – while the world waits for its Model T.
Dr. Trevor van Mierlo has built mental health and patient support products for more than two decades and is the CEO of Evolution Health
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