Amazon’s Jeff Bezos is building a new health care company in partnership with Berkshire Hathaway and JP Morgan Chase. They have hired Dr. Atul Gawande to lead it. Will he able to improve care for the companies’ one million employees and, better still, for our health care system?
The new health care company, as yet to be named, is charged with finding smart ways to improve health care for company employees. There are so many smart things companies can do, if they want to, including eliminating copays and deductibles that keep people from getting needed care, applying evidence-based medical protocols and paying for best value drugs. The issue is always how to drive these improvements.
Without a federally administered plan to drive health system improvements, systemic improvements tend not to happen. For one, lots of learning is not shared publicly. And, even when it is, hospitals and doctors are often set in their ways. Peter Pronovost, MD, became famous for his protocols/checklist for reducing hospital infections. But many hospitals have resisted applying them.
How much power will these three companies have to effect change? They are big. But insurers and hospitals are also powerful and have their own agenda. And, what changes will Gawande focus on? Leana Wen, Baltimore’s Commissioner of Health, makes an important point about the value of Gawande focusing on social determinants of health—good housing, nutrition, safety, transportation—if he wants to get to the root driver of health care use, But, it’s hard to believe he’ll focus on those issues given the demographics of the workers at Amazon, Berkshire Hathaway and JP Morgan Chase.
Megan Ranney, an associate professor of emergency medicine at Brown University Medical School smartly suggests Gawande look at how emergency rooms can link patients to the array of services and resources they need. Right now, emergency rooms are huge cost centers. But, emergency rooms could do a lot more to keep patients out of hospital.
Andy Slavitt suggests Gawande avoid the road traps created by commercial interests and stay focused on public health issues. Will he be able to do that given his employers?
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