What Darwin Never Knew—And What We’re Just Learning Now About Value-Based Healthcare
One of the most enlightening popular science-focused documentaries I’ve ever seen is the NOVA documentary “What Darwin Never Knew,” first broadcast on PBS on December 21, 2011, and readily available now on YouTube.
Charles Darwin has universally been recognized as one of the greatest scientific minds in history. Based primarily on observation—including his observations of finches, iguanas, and other species during the trip he took to South America aboard the S.M.S. Beagle from December 1831 to October 1836—he developed his theory of evolution and natural selection, which turned science—and global knowledge in general—on its head.
Though Darwin was able to achieve an understanding of evolution that was astonishing considering the lack of modern scientific tools at his disposal, he was not able to figure out how evolution occurred; that was the key missing piece of the puzzle—the “how.” As evolutionary biologist Sean Carroll of the University of Wisconsin said in the documentary, “He didn’t know any of the mechanics of that process. He didn’t understand the physical forces that would actually change the way species appeared.” “But today,” the documentary pointed out, “we can answer the questions that Darwin could not. We can look under the hood of evolution, and see exactly how this mysterious process gives rise to such astounding diversity.”
And, speaking of Darwin’s extensive study of embryos under microscopes, Darwin was able to deduce tremendous revelations, including that humans “must be descended from fish. And so Darwin arrived at an astonishing conclusion: one that would become central to his understanding of the diversity of life,” and became the core of his “Tree of Life” theory and to evolutionary theory. Importantly, the documentary noted, “Scientists can now do something Darwin never could: they can “look inside the animal’s DNA. The study of DNA is one of the great triumphs of modern science. It has taken our understanding of how creatures evolve and develop, to a level that Darwin could never have dreamed of.”
I thought about Darwin’s development of the theory of evolution while writing this issue’s cover story on the leveraging of data and analytics to support value-based healthcare delivery and payment. Well do I remember the earlier incarnation of managed care in the 1980s and 1990s, which exhibited some fundamental flaws: among them a lack of true alignment between payers and providers in what remained a largely discounted fee-for-service environment; and the lack of available data and information.
And that’s one of the key things that’s changed in the past 20 years: we now have the information technology to provide providers and payers with the key data points continuously needed to support the delivery and payment of value-based healthcare. We also now have a far better alignment of shared incentives under accountable care organization (ACO) and other models than we ever did 20 years ago.
And thus, we now have genuine, authentic payer-provider collaboration, with data-sharing to support the population health management and clinical performance improvement. And that is a huge thing.
In reporting for the cover story, I spoke to senior leaders at health plans including Anthem, Blue Cross and Blue Shield of Minnesota, and L.A. Care, and provider organizations, including Mercy Health (St. Louis), Nemours Children’s Health, and Advocate Aurora Health. All those executives and their teams are drilling down intensively right now to find the truth behind the data—and are developing highly successful initiatives based on what they’re learning. So in U.S. healthcare now, just as in natural science 180 years ago, missing puzzle pieces are being fitted in. Darwin the scientist would be fascinated.
