# Health & Human Flourishing

Vida's domain spans the structural transformation of healthcare from reactive sick care to proactive health management. Two layers: the industry analysis (where value concentrates, which business models win, what regulations shape the transition) and the civilizational argument (healthspan as infrastructure that enables everything else). Healthcare consumes 18% of US GDP while producing declining life expectancy — a system that profits from sickness rather than health.

## Attractor State
- [[the healthcare attractor state is a prevention-first system where aligned payment continuous monitoring and AI-augmented care delivery create a flywheel that profits from health rather than sickness]] — the full attractor state derivation: five convergent layers, moderate-to-strong attractor
- [[healthcares defensible layer is where atoms become bits because physical-to-digital conversion generates the data that powers AI care while building patient trust that software alone cannot create]] — three-layer model for where value accrues in the transition
- [[Function Health drives down diagnostic conversion costs to 499 per year for 100-plus lab tests making atoms-to-bits health data generation accessible at consumer scale]] — atoms-to-bits at the diagnostics conversion point

## Biometrics & Continuous Monitoring
- [[continuous health monitoring is converging on a multi-layer sensor stack of ambient wearables periodic patches and environmental sensors processed through AI middleware]] — the attractor state architecture for health monitoring: 4 sensor layers unified by AI
- [[AI middleware bridges consumer wearable data to clinical utility because continuous data is too voluminous for direct clinician review]] — the integration gap between consumer data and clinical workflows
- [[consumer CGMs are going mainstream as behavioral change tools not clinical diagnostics because real-time glucose visibility changes food choices even without randomized trial evidence]] — OTC CGM transition from medical device to wellness tool
- [[the FDA now separates wellness devices from medical devices based on claims not sensor technology enabling health insights without full medical device classification]] — regulatory framework enabling the wellness-to-clinical spectrum
- [[Oura controls 80 percent of the smart ring market with patent-defended form factor while a demographic pivot from fitness enthusiasts to wellness-focused women drives 250 percent sales growth]] — category-dominant smart ring with patent moat and demographic expansion
- [[WHOOP subscription-only wearable model generates $260M revenue but trails Oura at half the revenue and a third the valuation because fitness-first positioning limits the addressable wellness market]] — subscription-only wearable testing fitness-first positioning

## AI in Clinical Care
- [[healthcare AI creates a Jevons paradox because adding capacity to sick care induces more demand for sick care]] — AI optimizing the 10-20% clinical side while 80-90% of outcomes are non-clinical
- [[AI diagnostic triage achieves 97 percent sensitivity across 14 conditions making AI-first screening viable for all imaging and pathology]] — Aidoc, Viz.ai, DermaSensor evidence
- [[the physician role shifts from information processor to relationship manager as AI automates documentation triage and evidence synthesis]] — PwC $1T spending shift projection
- [[ambient AI documentation reduces physician documentation burden by 73 percent but the relationship between automation and burnout is more complex than time savings alone]] — Abridge, DAX Copilot, Epic AI Charting
- [[OpenEvidence became the fastest-adopted clinical technology in history reaching 40 percent of US physicians daily within two years]] — AI clinical decision support as beachhead
- [[medical LLM benchmark performance does not translate to clinical impact because physicians with and without AI access achieve similar diagnostic accuracy in randomized trials]] — the benchmark-to-clinical gap
- [[human-in-the-loop clinical AI degrades to worse-than-AI-alone because physicians both de-skill from reliance and introduce errors when overriding correct outputs]] — physician overrides degrade AI from 90% to 68%
- [[healthcare AI regulation needs blank-sheet redesign because the FDA drug-and-device model built for static products cannot govern continuously learning software]] — Wachter's physician-licensing model for AI regulation
- [[AI scribes reached 92 percent provider adoption in under 3 years because documentation is the rare healthcare workflow where AI value is immediate unambiguous and low-risk]] — fastest-adopting clinical AI category; beachhead for broader AI trust
- [[AI-native health companies achieve 3-5x the revenue productivity of traditional health services because AI eliminates the linear scaling constraint between headcount and output]] — structural unit economics shift: $500K-1M+ ARR/FTE vs $100-200K
- [[consumer willingness to pay out of pocket for AI-enhanced care is outpacing reimbursement creating a cash-pay adoption pathway that bypasses traditional payer gatekeeping]] — RadNet: 36% pay OOP for AI mammography, 43% higher detection

## Value-Based Care & Devoted Health
- [[Devoted is the fastest-growing MA plan at 121 percent growth because purpose-built technology outperforms acquisition-based vertical integration during CMS tightening]] — proof of concept for purpose-built payvidor model during CMS tightening

## Value-Based Care & Social Determinants
- [[value-based care transitions stall at the payment boundary because 60 percent of payments touch value metrics but only 14 percent bear full risk]] — the gap between VBC participation and actual risk-bearing
- [[healthcare is a complex adaptive system requiring simple enabling rules not complicated management because standardized processes erode the clinical autonomy needed for value creation]] — Porter/Larsson framework connecting VBC to complexity science
- [[SDOH interventions show strong ROI but adoption stalls because Z-code documentation remains below 3 percent and no operational infrastructure connects screening to action]] — the SDOH implementation gap
- [[four competing payer-provider models are converging toward value-based care with vertical integration dominant today but aligned partnership potentially more durable]] — structural landscape of healthcare delivery
- [[medical care explains only 10-20 percent of health outcomes because behavioral social and genetic factors dominate as four independent methodologies confirm]] — evidence base for why VBC and SDOH matter

## Drug Discovery & New Therapeutics
- [[AI compresses drug discovery timelines by 30-40 percent but has not yet improved the 90 percent clinical failure rate that determines industry economics]] — AI drug discovery: proven speed, unproven efficacy
- [[GLP-1 receptor agonists are the largest therapeutic category launch in pharmaceutical history but their chronic use model makes the net cost impact inflationary through 2035]] — GLP-1 economics: $63-70B market, oral breakthrough, durability problem
- [[gene editing is shifting from ex vivo to in vivo delivery via lipid nanoparticles which will reduce curative therapy costs from millions to hundreds of thousands per treatment]] — scalability breakthrough for curative medicine
- [[personalized mRNA cancer vaccines show sustained 49 percent reduction in melanoma recurrence after five years representing a genuinely novel therapeutic paradigm]] — mRNA platform beyond COVID
- [[the healthcare cost curve bends up through 2035 because new curative and screening capabilities create more treatable conditions faster than prices decline]] — net cost trajectory: inflationary through transition
- [[FDA is replacing animal testing with AI models and organ-on-chip as the default preclinical pathway which will compress drug development timelines and reduce the 90 percent clinical failure rate]] — FDA April 2025 roadmap: animal studies to become "exception" within 3-5 years

## Mental Health & Digital Therapeutics
- [[prescription digital therapeutics failed as a business model because FDA clearance creates regulatory cost without the pricing power that justifies it for near-zero marginal cost software]] — Pear, Akili, Woebot: the DTx autopsy
- [[the mental health supply gap is widening not closing because demand outpaces workforce growth and technology primarily serves the already-served rather than expanding access]] — structural workforce deficit
- [[social isolation costs Medicare 7 billion annually and carries mortality risk equivalent to smoking 15 cigarettes per day making loneliness a clinical condition not a personal problem]] — loneliness as public health crisis

## Capital & Market Dynamics
- [[healthcare AI funding follows a winner-take-most pattern with category leaders absorbing capital at unprecedented velocity while 35 percent of deals are flat or down rounds]] — bifurcated VC landscape

## Regulatory
- [[CMS 2027 chart review exclusion targets vertical integration profit arbitrage by removing upcoded diagnoses from MA risk scoring]] — CMS targeting acquisition-based vertical integration
- [[anti-payvidor legislation targets all insurer-provider integration without distinguishing acquisition-based arbitrage from purpose-built care delivery]] — structural separation bills threatening payvidor model
- [[Kaiser Permanentes 80-year tripartite structure is the strongest precedent for purpose-built payvidor exemptions because any structural separation bill that captures Kaiser faces 12.5 million members and Californias entire healthcare infrastructure]] — Kaiser's 80-year precedent for purpose-built integration
- [[CMS is creating AI-specific reimbursement codes which will formalize a two-speed adoption system where proven AI applications get payment parity while experimental ones remain in cash-pay limbo]] — category I/III CPT codes for AI-assisted diagnosis

## Epidemiological Transition & Risk Landscape
- [[the epidemiological transition marks the shift from material scarcity to social disadvantage as the primary driver of health outcomes in developed nations]] — the fundamental discontinuity
- [[Americas declining life expectancy is driven by deaths of despair concentrated in populations and regions most damaged by economic restructuring since the 1980s]] — US life expectancy reversing
- [[Big Food companies engineer addictive products by hacking evolutionary reward pathways creating a noncommunicable disease epidemic more deadly than the famines specialization eliminated]] — food industry creating disease
- [[modernization dismantles family and community structures replacing them with market and state relationships that increase individual freedom but erode psychosocial foundations of wellbeing]] — dissolved social structures
- [[famine disease and war are products of the agricultural revolution not immutable features of human existence and specialization has converted all three from unforeseeable catastrophes into preventable problems]] — historical context for health transition

## Demand Signals (claims referenced but not yet written)

**Devoted Health-specific** (highest priority — Cory works at TSB which led Devoted's Series F and F-Prime):
- `Devoteds atoms-plus-bits moat combines physical care delivery with AI software creating defensibility that pure technology or pure healthcare companies cannot replicate`
- `Devoteds Orinoco platform eliminates healthcare data silos by building a unified AI-native operating system from scratch rather than assembling from legacy components`
- `Devoted Health proves that optimizing for member health outcomes is more profitable than extracting from them`
- `UnitedHealth and Humana exhibit textbook proxy inertia where coding arbitrage profits rationally prevent pursuit of purpose-built care delivery`

**Structural health claims** (needed to complete reasoning chains):
- `US healthcare incentives are fundamentally misaligned because every participant profits from sickness not health`
- `healthcare costs threaten to crowd out investment in humanitys future if the system is not restructured`

**Known thin areas**:
- GLP-1 economics beyond launch — durability/adherence problem, second-generation oral formulations
- Behavioral health infrastructure — what DOES work for scalable mental health delivery
- Provider consolidation dynamics — hospital/health system M&A effects on VBC transition
