Misaligned incentives have plagued our healthcare system for far too long. They hinder meaningful progress, particularly when it comes to scaling preventive health efforts, keeping us in this sick care hamster wheel. The complex flow of money between PBMs, providers, payers and pharma manufacturers keeps financial incentives high when patients are utilizing the system, seeking more care and taking more drugs. On the flip side, employers and patients are often bearing the cost brunt of this high utilization, but they don’t often have a seat at the table to advocate for change. A healthier population would benefit everyone, but the financial incentives are currently structured in ways that disproportionately rewards the status quo rather than encouraging prevention. The disconnect between stakeholders, including a shrinking primary care footprint and a focus on episodic care, creates a system that doesn’t function as a true free market. Incentives matter, and unless the right players come to the table to get aligned, only minimal progress will be made.