Some more views on (and by) Atul Gawande on the JP Morgan-Berkshire-Amazon health combine

Often the best indicator of the success of a person in a new venture is to examine their own words. An interview with Dr. Gawande in STAT a few days after the Big Reveal of his new position as CEO of the JPM-BH-Amazon healthcare nonprofit indicates that he has an excellent grasp of the task before him. His main points:

  • Before accepting the position, he established that the healthcare company would be an independent entity and not part of the three companies
  • It is also non-profit and not expected to return money to those companies
  • He will be devoting 100 percent to the new job and have it be the number one priority, but he will be with patients and his surgery through at least the summer
  • “My job for them is to figure out ways that we’re going to drive better outcomes, better satisfaction with care, and better cost efficiency with new models that can be incubated for all. That is a tall fricking order. But what they’re saying to me is that resources won’t be the problem. Human behavior will be. And achieving scale will be.”

His speech at AHIP (America’s Health Insurance Plans) annual meeting a day after the announcement pointed out that unnecessary tests and treatments account for about 30 percent of healthcare spending, that our system fails the chronically ill in their needs to be asked about what they want to achieve through treatment, and for doctors to deliver the right and considerate treatment especially in end-of-life care. “Precision medicine has to be matched by precision delivery.”  Healthcare Finance

For the 1 million employees of the three companies, there may not be a lot of chronic illness or end-of-life consideration (people tend to fall out of the workforce under those circumstances). What kind of model will apply to them and save on the 25 percent of estimated healthcare spending which is wasted? The article in Forbes by another ‘big thinker’, Robert Pearl MD, sees a 5-10 year time frame for Dr. Gawande’s task: “…to fundamentally change how healthcare is structured, paid for and provided. He was hired to disrupt the industry, to make traditional health plans obsolete, and to create a bold new future for American healthcare.”

But in the meantime, how will those bank tellers, packers, IT workers, ice cream slingers, and railway workers fare with their health? What will they benefit from in two to three years time? And will the long-term backing and the promises to Dr. Gawande remain after Mr. Dimon, Mr. Buffett, and Mr. Munger (of BH, and possibly why Dr. Gawande is on board) are gone?

Is the Amazon Effect good or bad for consumers–and health tech?

Your busy Editor, who has been on business assignment this past month, has noticed the relative quiet around the subject of How Amazon is Rattling Healthcare. We’ve already noted here the retail and pharmacy/pharmacy benefit effects with CVS-Aetna, Albertsons-Rite Aid, and Cigna-Express Scripts. Aside from the bottom line, and Cigna finally closing a gap with other insurers with pharmacy benefit management services (PBM), is it good for the healthcare consumer as promised? 

Max Nisen’s article in Bloomberg Gadfly (sic) says ‘not so fast’. His argument is as follows:

  • Companies are largely following the lead of UnitedHealth and its Optum units, which integrate not only insurance and PBM but physician groups and analytics.
  • Deals will continue. There’s other insurers like Anthem, Humana, and the regional Blues; urgent clinics like CityMD, AtlantiCare, and MedExpress. Looming above all with clinics and retail pharmacies is Walgreens Boots and on the retail side, other supermarkets like Publix and Ahold Group.
  • Consolidation means fewer alternatives, competition, and thus less downward pricing pressure for both providers and consumers, as options decrease into what resembles a closed system. The merged companies will have debt to pay off, with pressure to pay off lenders and shareholders.

All this is regardless of what Amazon does with JP Morgan Chase and Berkshire Hathaway. Their admirable, seemingly altruistic reasons for this joint venture, in this view, has multiple unintended consequences and negative effects for ordinary folk–and doctors.

As for healthcare technology, when a Big Trend takes the air out of the room–EHRs, ACA, Watson/big data, even wearables, IoT and Big Data– more mundane everyday tech like remote patient monitoring and telecare, which depend on integrating into  healthcare/wellness/chronic care management systems and reimbursement (by those same insurers), tend to suffocate. 

Also of interest: Cigna may be too late to the PBM party (InvestorPlace)