Jons Jacob Berzelius was an important historical figure almost no one knows. After being orphaned in Sweden at a young age, he became a bright student and eventually obtained his medical degree at Uppsala University.
He worked initially as a clinician, but his talents were in chemistry, and over time his accomplishments in that field were without peer. Among them were the discovery of the distinction between organic and inorganic compounds, the identification of several elements, including silicon, and the law of constant proportions (i.e., how combined substances are composed of elements in reproducible proportions—for example, water is always two parts hydrogen and one part oxygen, or H2O.) Characterizing organic compounds was a foundational component of understanding the scientific underpinnings of life, the law of constant proportions made chemical synthesis possible (think “drug development”), and if you don't know the importance of the element silicon during the past couple of decades, you could be a Luddite.
Berzelius also first described “catalysis”—the acceleration of chemical reactions by catalysts—another incredibly important consideration in modern chemistry. He suggested catalysts were important “third parties” in chemical reactions, accelerating interactions between other substances and changing them without being changed themselves.
In contemporary life, we now deem anyone or anything that accelerates something as a catalyst.
While we have been writing and talking about impending significant change in the business and care-delivery models of American medicine for some time, the pace has been maddeningly slow. Some change is occurring at the margins, but catalysts seem lacking for large-scale acceleration. While a slower pace of change can make it more tolerable (recall the “boiling frog” analogy), it can also provide more opportunities for retrenchment. (For whatever reason, the frog just happens to jump out of the pot as it slowly heats up.)
However, I would urge persistence, as there are three catalysts indeed beginning to drip into healthcare “chemical reactions.” As more is added to the mixture, the reactions will soon gather both speed and heat.
• Provider risk management: Providers are currently paid to intervene, but when they promote “health,” insurers often pocket the marginal gain. This is a fundamental impediment to provider investment in technologies and processes to manage populations. The number of healthcare provider organizations taking on financial risk, either through new value-based partnerships with commercial payers, or through their own provider-based health plans, is growing. Most experts believe the tipping point for a willingness to manage much more risk is reached when providers are managing 35% to 40% of a population's financial, as well as medical risk. We have already reached that percentage, or are rapidly moving toward it, at a growing number of institutions.
• Consumer use of treatment and wellness tools: The digital revolution may soon cool in terms of investment, but the innovations will keep coming, since Moore's Law is not going to be reversed. Smaller, faster, more mobile, cheaper and smarter tools for individuals will continue to be advanced. These tools will not only allow individuals seek more convenient care, but to avoid the traditional interface altogether at times. People are just beginning to embrace and use these tools and there is much more to come.
• Public opinion: Gore Vidal once said public opinion is fraught with “superstition, misinformation and prejudice.” While this may be true, public opinion also pressures policymakers to change the rules of engagement. Recall the dynamics of change that occurred during the emergence of HMOs, and that period's politics of public disenfranchisement. Americans are just now beginning to understand our healthcare delivery enterprise is not the best in the world—by far, in some cases—when compared to other medically developed countries. This reality will increasingly permeate our discussions, and pressure for change will accelerate substantially.
These are three catalysts that will accelerate change and improvement in healthcare delivery for the near term. Like Berzelius' description, they will act on and change the components involved in the reaction—both the clinical delivery of care and its business model. However, unlike his characterization, since the “third party” catalysts here are technologies and human beings, they too will be changed. The technologies will evolve and improve, and if the conditions of the reaction are optimal, we will all be healthier.
Dr. Roy Smythe is chief medical officer for Chicago-based Valence Health.
