Tag: Trevor Van Mierlo

Henry Ford, the Model T, and Digital Health

Jul 8, 2025

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

*Left: Early car assembly (pre-Ford) Right: A leading digital health interface, 2000*

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

Mental Health’s Unfinished Digital Revolution

Dec 11, 2024

By TREVOR VAN MIERLO

In 2021, digital mental health and substance use startups attracted a record-breaking $5.1 billion in funding. Despite the surge, the promise of scalable, transformative digital health platforms remains unfulfilled.

Following the surge, investment plummeted. Unlike other industries that have been revolutionized by digital-first solutions, digital health struggles with models that fail to address cost, complexity, and access.

What we’re left with entering into 2025 are a smorgasbord of solutions clamoring to attach themselves to traditional enterprise incumbents (Health Insurance Providers, Electronic Health Records, Hospital Systems). These incumbents have achieved scale – but not the type of scale that digital health needs to flourish.

Investment in Digital Mental Health (2010-2023) — *Digital Mental Health Investment (2010-2023*)

Incumbents Build Deep, Startups Go Wide

Incumbent scale is infrastructure-heavy, slow, and linear, and focuses on deep integration within their established markets.

In contrast, startups aim for technology-driven, exponential, and global scale, leveraging digital platforms to serve millions of users quickly. While startups have the speed advantage, achieving scale similar to incumbents requires win-win partnerships and fundamental shifts away from established business models.

Incubent Scale vs. Startup Scale — Incumbent Scale vs. Startup Scale

The investment market does see the tremendous opportunity: a massive, growing global customer-base proactively demanding help as social stigma decreases. And as time passes, this customer-base grows exponentially with technology pervasiveness.

What investors see is unmet demand for mental health and substance use treatment, and a historic opportunity for digital health to step up and deliver solutions that are scalable, accessible, and affordable.

However, the delivery mechanism to these populations, though digital, is obfuscated through the blurred lens of incumbent purchasing power. We can’t get past incumbents’ size, their reach, and their connection to patients. In this common view, incumbents are the customer. This view is promoted by both industry and academia.

Software Living in an Enterprise World: Why Digital Behavioral Health Can’t Gain Traction

Sep 17, 2024

By TREVOR VAN MIERLO

Let’s face it: for the past 25 years, digital behavioral health has struggled. Yet, we keep reinventing (and funding) the same models over and over again.

How It All Started

In the beginning (mid-1990s), a handful of developers, researchers, and investors envisioned high reach, lower-cost, highly tailored, anonymous interventions reaching millions of people with limited healthcare access.

The initial focus was never healthcare providers and insurers. These organizations were seen as too slow to adopt new technologies, and there was a general distrust of integrated care and insurers. Many digital health companies feared these organizations (and pharma) would leverage their power to learn from smaller companies, and then redevelop interventions internally.

Instead, the focus was on partnerships and B2C sales. Funding was easier to obtain from granting agencies, and there was ample development support flowing from sources like the tobacco Master Settlement Agreement (MSA). The primary concern was 1) whether the population could access these revolutionary tools and, 2) who would pay for them.

The Digital Divide

Back then, funders were often short-sightedly obsessed with the digital divide – the gap between people who had access to digital technology (mostly educated, higher-income earners in large cities) and everyone else. The argument was, “Why should we fund digital tools that will only benefit those who already have access to healthcare?”

Data was available, so academics armed themselves with ANOVA and relentlessly examined variables such as hardware costs, processing speed, age, gender, race, ethnicity, geography, income, and education. If you check Google Scholar, you can see the prevailing sentiment was that it would take decades for the digital divide to narrow, and new policy was desperately required to fix the problem (see: here, here, here, and here).

No More Excuses

Fast forward to 2024. According to a recent article in Forbes, there are 5.4 billion internet users worldwide (66% of the global population). In the U.S., 94.6% of Americans have internet access. Most US households have multiple devices, and according to Pew Research Center Research, 97% own a cellphone, of which 90% are smartphones.

As a Gen X’er who used a typewriter in college before upgrading to a Compaq Deskpro 286 from Future Shop (for about $400), my adult life has been a witness to the rapid progression of digital. Now, my 9-year-old daughter is teaching me how to play Fortnite (Epic Games), my 11-year-old is the only kid on his hockey team without a smartphone (this won’t last), and STARLINK allows me to chat face-to-face with my parents in rural Northern Ontario.

All aspects of technology are pervasive and accessible – but if you search Google or Bing for immediate, evidence-based behavioral help, you can’t get it. If you can find access it’s behind a paywall: through your employer (contact HR), health plan (call to see if you’re covered), or subscription ($19.99 per month).

That’s not meeting the original vision – and we have the technology. So, what’s the problem?