The 50,000 foot pick as CEO of the JP Morgan Chase-Berkshire Hathaway-Amazon health joint venture

US healthcare is abuzz at the choice that JP Morgan Chase-Berkshire Hathaway-Amazon made to head their healthcare JV: Dr. Atul Gawande, currently practicing general and endocrine surgery at Brigham and Women’s Hospital and teaching as a professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School. Dr. Gawande is presently an executive director of Ariadne Labs, a healthcare innovation center, a writer of four best sellers on healthcare and noted as an outspoken theorist on how the ‘broken’ healthcare system in the US can be fixed. (This Editor’s definition of ‘broken’ is slightly different, encompassing countries like Venezuela, Cuba, Zimbabwe, post-WWII Germany, and the Ceausescu-era Romania where the basics are simply not there for the average person.)

Dr. Gawande will transition to chairman of Ariadne and retain his surgical and teaching positions.

Praise for Dr. Gawande comes from many quarters. Andy Slavitt, the former head of CMS during the previous administration, said “There are few better people in health care” and praised his ‘moral leadership’ when approached by Messrs. Dimon, Bezos, and Buffett. Jeff Bezos: “We said at the outset that the degree of difficulty is high and success is going to require an expert’s knowledge, a beginner’s mind, and a long-term orientation. Atul embodies all three, and we’re starting strong as we move forward in this challenging and worthwhile endeavor.”

What is missing from this sterling public health advocate and practitioner’s resumé is obvious: real business management experience. Among his three soon-to-be-bosses, there is plenty of pontificating from 50,000 feet–for but one example, see this Editor’s POV on Jamie Dimon’s annual shareholder letter [TTA 10 Apr]. Here is what they stated as the purpose of the JV back in January: “partnering on ways to address healthcare for their U.S. employees, with the aim of improving employee satisfaction and reducing costs” and setting up an independent company “free from profit-making incentives and constraints. The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent healthcare at a reasonable cost.” And more in that vein. (Whew!) It was eye-rolling, even shortly after the announcement back in February.

But actually getting this done is not a TEDTalk. First, there is the hard in-the-trenches work to bring both the management and the 1 million employees of three very different companies onto the same page. Second, it is running the gauntlet of regulations on the national level (that CMS and HHS) plus in 50 states, if this combine chooses to operate as an insurer or PBM. Third, if they don’t, there is getting the cooperation of insurers (payers) who aren’t in business to lose money. There is not only regulation, but also what they are willing and can afford to do. This Editor noted back in January that large companies, including these three, “generally self-insure for healthcare. They use insurers as ASO–administrative services only–in order to lower costs. Which leads to…why didn’t these companies work directly with their insurers to redo health benefits? Why the cudgel and not the scalpel?”

This Editor would expect that a group of skilled senior, operationally focused executives will be hired to work under Dr. Gawande in Boston, where this unnamed-yet venture will be headquartered. There may be some more high-profile senior executives with unconventional backgrounds. From this (lower than 50,000 feet) perspective, Dr. Gawande will be the attention-getting CEO, spokesman, and pace-setter; others will be doing the heavy lifting behind the scrim. 

Beyond the usual glowing coverage on CNBC and TechCrunch, those in the business of healthcare are already expressing more sanguine opinions on the enterprise and how Dr. Gawande will be leading it with multiple medical, teaching, and writing commitments. Modern Healthcare has a fairly balanced article.

Three of the best – digital health events at the Royal Society of Medicine for 2016

The Royal Society of Medicine has two unbeatable benefits to offer conference attendees: virtually every world expert is keen to present there and, because it is a medical education charity, charges are heavily subsidised. As a result you get the most bang for your buck of any independent digital health event, anywhere!

And just now the offer is even more attractive as if you book for all three in the next 14 days (ie by 12th February) the RSM will give you a 10% discount on all three!

On February 25th, the RSM is holding their first 2016 conference: Recent developments in digital health. This is the fourth time they have run this popular event which aims to update attendees about particularly important new digital heath advances. For me the highlight will be Chris Elliott of Leman Micro who plans to demonstrate working smartphones that can measure all the key vital signs apart from weight without any peripheral – that includes systolic & diastolic blood pressure, as well as one-lead ECG, pulse, respiration rate and temperature. When these devices are widely available, they will dramatically affect health care delivery worldwide – particularly self-care – dramatically. See it first at the RSM!

I’d also highlight speakers such as Beverley Bryant, Director of Digital Technology NHS England, Mustafa Suleyman, Head of Applied Artificial Intelligence at Google DeepMind (who’ll hopefully tell us a bit about introducing deep learning in to Babylon), Prof Tony Young, National Clinical Director for Innovation, NHS England and Dr Ameet Bakhai, Royal Free London NHS Foundation Trust. It’s going to be a brilliant day!

Book here.

On April 7th the RSM is holding Medical apps: mainstreaming innovation, also in its fourth year. Last year the election caused last minute cancellations by both NICE & the MHRA, who are making up for that with two high-level presentations. Among a panoply of other excellent speakers, I’m personally looking forward especially to (more…)

Still need some help with healthcare innovation? (UK)

These days it seems you cannot get away from talk of innovation in the NHS – even the London Business School, this editor’s alma mater, is holding a conference on it, on 20th October. Then there’s the NHS Innovation Accelerator programme, the Accelerated Access Review (AAR), that this reviewer is involved with, the National Information Board (NIB), that this editor is also involved with, NHS Test Beds, the topic of a recent popular TTA blog, the NHS Vanguards, the NHS Pathfinders, the Integrated Care Pioneers and many others all seeking the holy grail of healthcare: improved patient outcomes, ideally at lower cost (or is that lower cost ideally with improved patient outcomes?).

If all this is too much and you have lost your way, the Royal Society of Medicine & NHS Innovations South West (NISW) have the solution: (more…)

European Assistance for Innovative Procurement (eafip) Conference Manchester, Nov 24th

When this editor first saw European, Innovative and Procurement in the same title, he thought he’d misread it as one of the complaints that has been made at almost every recent meeting attended, especially those relating to the Accelerated Access Review, is how European procurement rules disadvantage small suppliers who are typically the principal source of innovation in the health & care sector.

So here’s your opportunity to hear from the experts and to make your concerns known to them, in this European Commission sponsored joint NHS England/eafip event on ICT solutions procurement.

Date is 24th November; more details here – booking for this free event will open soon apparently.

NHS seeks pioneering healthcare innovators – yes really!

When this editor first read about the scheme, his thoughts went to headlines like “NHS seeks oxymorons”, as that organisation is not noted for its cherishing of innovators. (Indeed at a recent event in Manchester I was told by a speech & language therapist who was saving the NHS two orders of magnitude in lower costs in helping stroke victims to swallow again by using remote consultation vs in-patient hospital stays that her boss had told her there was no place for her in the NHS.)

However it seems they seek innovators outside the NHS to enable it to adopt innovations at scale and pace: “NHS England is inviting healthcare pioneers from around the world to apply to develop and scale their tried and tested innovations across parts of the NHS.”

“Applicants should be experienced innovators in healthcare who are currently leading or working on new technologies, services and processes that have the potential to make a real difference to patient outcomes.”

Details of the NHS Innovation Accelerator Programme are here, and the Digital by Default news item, here.

Police innovation fund – closing date 30th April 2014 (UK)

Of possible interest to readers is the offer of £50m of Home Office funding for the use of innovative technology to improve policing. Interest is indicated in everything from wearables, such as body-worn cameras, to shared digital infrastructure with other services, such as health. Bids need, obviously, to involve one or more police forces and be signed off by a Police & Crime Commissioner.

Read Damian Green’s speech introducing it. Further details, including the application process, are here.

Hat tip to Prof Mike Short.

Disruptive innovation in healthcare hasn’t begun yet: Christensen

Clayton Christensen, as many of our readers know, pioneered a theory of disruption in business models and a three-step cycle of innovation (empowering, sustaining and efficiency, now quite broken indeed). With two other writers, he applied these theories to healthcare in the 2009 book ‘The Innovator’s Prescription’ which this Editor heard co-author Jason Hwang, MD present in 2009 at the Connected Health Symposium and at a private meeting in 2011. One would think that we’d be well into disruption, which is part of the empowering innovation cycle and which the authors championed in the book as underway.

The surprise at the end of this Mobihealthnews article on his recent presentation at “Better Health” in Boston, a McKesson-sponsored meeting series, was not what constitutes disruption, but that it has not really started yet, four years later. This will be much to the surprise of many successful and unsuccessful companies (Misfit ShineZocDoc, Zeo, 23andMe) and health plans which have stoutly touted their products and services as The True Disruptors. Sorry, you may be only a part of the Big Shift: decentralization. Decentralization will push out parts of healthcare off the hospital (more…)

Three takes on adopting new technology

Last week saw three very contrasting reports on technology adoption by care workers.  The first, by NESTA, was a fascinating read entitled Which doctors take up promising new ideas? New insights from open data. Unsurprisingly for those of us who have attempted to peddle new technology to GP practices, the key findings are that larger practices are more likely to be early adopters, and that early adopting practices tend to influence those close to them, resulting in islands of early adoption. (The first is not an inviolate rule I found – sure larger practices can specialise so can focus more on innovation, however a larger workforce can also mean a greater probability of a technophobe with a bee in their bonnet about a pet project that the technology is drawing funds from.)

The report is a great example of big data in action (more…)

Innovation in large healthcare organizations: set up to fail?

Are innovation-oriented internal groups or subsidiaries, designed to reinvent their large healthcare provider parents, doomed to fail? Dave Chase of Avado writing in Forbes seems to think that is the truth more often than not. “The challenge is it’s hard for a big company to take seriously a new market segment when its initial revenue impact is a tiny fraction of their existing business”. The metrics of success may not be recognized or validated, lunch is eaten by stealthy competitors, and new models/behaviors stump managements used to the old ways of what constituted success and profit. His own experience was at Microsoft, where he observed the success of Xbox (fresh blood unshackled from MSLand) contrasting with MSN, the latter processed and staffed largely by Office/Windows veterans.  In this Editor’s experience, the only part that Mr. Chase has missed is the high resistance, often personally driven, of process-oriented, bureaucratic organizations to meet outside or inside change which dooms high-minded efforts at setting up ‘skunk works’. Health orgs dooming their “innovation” to failure (Please note Editor’s comment under article is ‘called-out’)