Stop solving the instance. Solve the pattern.
Patients eligible for CAR-T live too far from a certified treatment center. There are too few dementia specialists to diagnose early Alzheimer's disease. Insurance coverage for biomarker testing is inconsistent.
Each of these invites an obvious fix: build more centers, train more geriatricians, mandate coverage. Each fix is real, and each gets built one at a time, for one product or one disease — and is not carried forward to the next. The next innovation arrives, the same class of obstacle appears in new clothing, and the work starts over.
Traced to their root causes, these gaps turn out to be instances of a small number of readiness gap archetypes that recur across diseases and innovation types. Biomedical System Readiness identifies the archetype rather than the instance, so that what gets built is reusable.
Archetype examples
The Wrong Pocket Problem is the first in a growing lexicon of readiness gap archetypes. A few examples:
Wrong Pocket Problem — Costs are borne by one actor while the savings accrue to another, or to society at large.
Seen in: durable cell and gene therapies, early detection in Alzheimer's disease, prevention broadly.
The Closing Window Problem — The benefit of acting is available only for a limited time; while the system deliberates, eligible patients pass the point where treatment can still help, and the value is lost to patient and system alike.
Seen in: early detection and prevention, disease-modifying therapies in Alzheimer's disease, time-sensitive diagnosis.
The Evidence Catch-22 Problem — The evidence a payer requires can be generated only once a therapy is covered, yet coverage waits on that same evidence. Each side holds for the other, and the innovation stalls in the gap.
Seen in: cell and gene therapy, digital therapeutics, outcomes-based agreements.
The Last-Mile Problem — The therapy is approved and paid for, yet still cannot reach the patient; too few certified sites, too little capacity, too thin a workforce stand between authorization and delivery.
Seen in: CAR-T, radioligand therapy, anti-amyloid infusion with MRI monitoring.
Why archetypes change the economics
The same archetype turns up in cases with nothing clinical in common. The wrong pocket problem shapes both durable cell and gene therapy and early detection in Alzheimer's disease — different diseases, different products, same structure.
That repetition is what makes a solution portable. Address the instance and you have solved one problem for one product. Address the archetype and the design work carries forward, with the economies of scale that follow.
It also changes what has to be measured. If demonstration sites each measure something different, their evidence scatters instead of compounding and never reaches the threshold that moves policy. Working at the archetype level requires a shared measurement spine — which is what Biomedical Health Efficiency is built to provide.