Highly readable, this book draws on the deceptively simple intellectual model of a sand pile. When the cone of sand first develops, it’s very easy to predict its dimensions. However, as it becomes a progressively larger pile, it will eventually reach a critical mass at which a ‘sandslide’ will occur somewhere on the surface. It turns out that as the experiment is repeated, the sandslide varies in size and stage. What’s more, it is impossible to mathematically model just when and how each slide will develop. As it grows in size, a simple sand-castle phenomenon witnessed many times by the DMCB and its spawn is just too much for our largest supercomputers.
So what are the lessons for healthcare? While translocations in the health and cost status of populations may not receive front page news, it still happens. For example, despite the best planning, health plans can experience big drops in their State and national NCQA rankings, incurred but not reported (IBNR) can gyrate up or down, COX II’s can kill, State Attorney Generals can sue, cost trends can spike and primary care appointments can vanish. New laws and new regulations may or may not help, but they will certainly make the sand pile even more complex. Inputs like: ‘electronic records,’ output: ‘health care savings’ or input: ‘cover all Americans,’ output ‘access to care’ in a world of genetic testing, possible insurance mandates, an insatiable appetite for technology, growing pharmacologic options, an aging population and H1N1 viruses (to name a few) are not only simplistic, they’re naïve and by no means assured.