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In simplest terms, health can be thought of as the product of our “Potential Health” (the best health available to us if we saw the best doctors and received optimal therapy) multiplied by our “Attained Health” (how close we get to achieving this ideal).
That is: Health = (Potential Health) x (Attained Health).
The recent Supreme Court decision upholding key provisions of the ACA is likely to mark a key inflection point in a vital national discussion about how we think about these two important, and often distinct, health parameters.
For at least the last fifty years, most of our efforts have focused on maximizing our Potential Health. To this end, there was considerable interest in medical research exploring the molecular basis for diseases that make people sick, based on the assumption that this would lead to improved treatments for these patients.
For example, pancreatic cancer is a uniformly terrible disease, with a miserable prognosis no matter what doctor you see. A treatment that offered significant benefit to these patients could be described fairly as increasing our Potential Health.
More recently, we have started to place much greater emphasis on our Attained Health – the health individual Americans actually achieve (as a fraction of our ideal or potential health).
According to many health policy experts, there’s a large discrepancy between the best care available and the care many patients receive, and consequently a profound need for research into approaches that will close this gap. The hope is that by improving access to care, and by ensuring the care provided is in accordance with the best medical evidence, our Attained Health can be significantly improved.
While there’s little argument that improving both Potential and Attained health is important, many health policy experts (generally proponents of the ACA) contend that if we want to improve overall health, we’ll get much more bang for our buck (i.e. better value) by focusing more of our attention – and especially our limited resources – on improving the Attained Health component, rather than pouring time and money into tweaking the Potential Health component – usually (it is often asserted) with little discernible success.
To appreciate what this is likely to mean for healthcare innovation, consider these comments last Thursday from a key ACA architect, and current VC, Bob Kocher:
As a venture capitalist, today’s ruling creates an even greater opportunity to invest in innovative companies focused on bending down the cost curve, improving outcomes and creating more effective health care marketplaces. As we expand coverage, we will need more tools to help consumers shop for care, suppliers to redesign their products and services to be more productive, and innovators to re-imagine how to engage doctors and patients in preventing complications and exercising value-consciousness.
This captures beautifully the ambition, language, and rhetoric of Attained Health – and the contrast with Potential Health couldn’t be more striking.
In the giddy heyday of molecular biology, when Genentech and Amgen were founded, VCs used to talk about curing disease and saving lives. Still today, Genentech asserts that “One of the goals we strive toward every day is to find a cure for cancer.” Meanwhile, Amgen’s stated goal remains “to serve patients by transforming the promise of science and biotechnology into therapies that have the power to restore health or even save lives.”
To be sure, many Attained Health proponents would contend that biopharma has enjoyed only limited success in its mission, producing what are often very expensive drugs that in many cases appear to offer only limited benefit. Sure, these critics agree, curing cancer is great – if you can do it; but if you’re just talking about adding a few weeks at most, wouldn’t the resources be better spent somewhere else?
Like many of us, I suspect, I feel more than a little torn; I agree with Kocher that there is a profound need for entrepreneurial innovation in what I’d call the Attained Health space, and have discussed this opportunity at length (see here, here, here, and here, for example).
At the same time, as I’ve also highlighted before (see here in particular, also here, and here), there’s a real danger that in focusing so intently on attainment, and on measurements of communal health, we may overlook the need and the value, of pushing the edge of Potential Health as well – in the research we support, in the companies we nurture, and most importantly, in the patients in our trust. A compassionate commitment to Potential Health is what each individual patients is owed; this promise also reflects the relentless, innovative spirit that has propelled our nation’s biomedical enterprise forward, and enabled it to achieve such worldwide prominence.
If you have pancreatic cancer today, you might be reassured by the promise of value-conscious care – but what you really need, and deserve, is an effective cure – and an innovative biopharma company able to deliver it.
Let’s work towards ensuring that our healthcare innovation ecosystem evolves in a fashion that supports entrepreneurship in Potential Health as well as Attained Health, and ultimately identifies powerful new ways to elevate both.
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