The Relentless Momentum of the Status Quo… Leave a comment
When it comes to understanding the why behind structural stalemate in healthcare, look no further than this “framework” on market access for gene therapies, developed by a working group convened by Blue Cross Blue Shield Association and the Aspen Institute earlier this year: “Increasing Access to Affordable, Life-Saving Medicines: Framework Released by Working Group Headed by Former FDA Commissioners.”
The nut of the problem didn’t even make it on the agenda as a “future direction“:
“Meeting participants did not contemplate a large-scale overhaul of the current reimbursement system in place for the great majority of approved therapeutics. Indeed, care needs to be taken not to disrupt parts of the market that already maintain a reasonable balance between providing incentives that promote bold investments….”
Seriously?
The American Way of healthcare is protected by many weapons of mass entrenchment and shaped by information asymmetries that sustain the businesses positioned as “control points” in the current system of markets; the calcification runs thick, and strategy born with yesterday’s economic thinking will always win the war for budget.
Gene therapy is one of the most compelling concepts in modern medicine — the ability to provide someone with a single treatment that will alleviate a terrible condition for a decade or more, perhaps even for life.
These are interventions without parallel.
Part of the scale problem in getting them “to market” is trying to make these innovations work within the context of a $4 trillion economic system organized to serve the underbelly of the actuarial tables, managed to reward the short-term, and fractured into fragments of value and point solutions, the “division of labor” as the motor for productivity that Adam Smith introduced to the world nearly 250 years ago.
It is hard to avoid the impression that, in confronting the need for “disruption” by the system as a whole, we are enacting a historical pantomime in which, rather than aiming for new storylines, the actors perform similar roles with exaggerated gestures and the audience knows ahead of time at which points to boo and when to cheer.
And so we stay kinetically-trapped in a massive feedback loop, trying to fit the future onto the past, conceptually bound by the Standard Model of thought and inaction.
We have become comfortable with the “organized irresponsibility” of a massive flywheel, one that’s powered by legacy concepts, technical debt and narrative framings, and it incessantly spins around itself as an infinitely recursive problem, the writing being overwritten by the same arrangement of pieces. Healthcare has been stuck for decades in stasis, governed by the veto power of legacy knowledge and culture, moving only in cautious increments.
The next cycle of evolution in the business and economics of “producing health” flows from a different equation altogether, a view of market innovation through market integration: life sciences + healthcare + government = new industry ecosystems as the locus for competition.
At stake is a new category of growth and creative leadership from “system entrepreneurship” — the capability to define and align “value” around shared marketspace, to cast outcomes as a narrative frame ahead of inputs, to begin with a market-based view as the voltage for powerful amplification and induction effects to create new economic systems.
John G. Singer is executive director of Blue Spoon Consulting, a global leader in strategy and innovation at a system level. Blue Spoon was the first to apply systems theory to solve complex market access and integration challenges in the pharmaceutical industry.
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