The Governing Dynamics of the Healthcare Universe: Thinking Lagrangian

September 2008, Vol 1, No 7 - Editorial
Robert E. Henry
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The core editorial mission of American Health & Drug Benefits is to provide a forum for a managerial discussion among stakeholders about evidence in benefit design during this crucial time in which we are witnessing the transformation of healthcare to a value-based system. Our goal is to showcase trends and innovations and examine their effects on the different participants in the process of care. We shed light on the interaction of forces—clinical, business, and regulatory—within the context of the interaction of stakeholders: patients, providers, payors, purchasers, manufacturers, distributors, regulatory agencies, evaluators, and academia.

It is one thing to understand empirical study results, quite another to understand what holds up the healthcare "universe." Both types of understanding are needed to achieve health and drug benefits competency. It is our proposition that each stakeholder needs to be empowered properly, its actions supporting the viability of the others. Unilateral initiatives benefiting one's sector only are divisive and destructive of the pursuit of a productive healthcare system, because every initiative must ultimately find a degree of acceptance from each stakeholder group. Any initiative must not only be good but must also be understood and accepted by others, if it is to find translational application in the real world of health and drug benefits.

The question is one of perspective. How does one stakeholder group understand the place of the others in the healthcare firmament? A time-honored source of comparison is offered in the system of mechanics devised by mathematician John Louis Lagrange. In 1788 he introduced the concept of Lagrangian points, in which the 2 heavenly bodies work together to establish points of equilibrium for another planet, keeping it in position and rotating, and keeping it from colliding or falling out of orbit. It is an inviting simile for healthcare, one referred to by Dr Michael Murphy in the March issue of AHDB. The figurative application of Lagrangian points suggests ways for all parties to bring forth their systems and propositions for healthcare reform.

The key to this simile is that no stakeholder holds the superior ground in terms of providing for the best interests of healthcare. Consequently, our premise is to foster an understanding of the managerial strategies of all stakeholder groups. Thus we will be covering the activities of AHIP and AMCP, IOM and AMA, AHRQ and CMS, PhRMA and BIO, medical associations and think tanks, foundations and ISPOR. The scope of inquiry of AHDB is equal to the decision makers' need to know, and that is profoundly broad. If today's health and drug benefits decision makers are to survive, they must understand the Lagrangian points of balance between research, finance, and regulation; between cost, quality, and access—between all parties affected by their formulary and benefit design decisions.

The factors and participants are sufficiently vast to invite bewilderment and discouragement, but medicine was always a work in progress from the time of Galen. Our goal is simply to open the eyes of benefit decision makers to the possibilities for progress coming from all fronts, and to encourage the proper humility toward one's agendas and consideration for others'. It is to suggest a managerial style—not a conclusive set of metrics with a definitive P value—that will empower decision makers to order up the allocation of healthcare resources in ways supportive of all the planets in the solar system. Patients need them all to align cohesively and achieve equilibrium that is also compatible with the dynamic quality of healthcare progress. We invite your propositions for progress and welcome you to the great healthcare debate and the unending search for new points of equilibrium that benefit us all.

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