Last week, Amazon, Berkshire Hathaway, and JPMorgan Chase announced that Dr. Atul Gawande will be the leader of their new health care venture. Dr. Gawande is a Harvard-trained surgeon at one of the most acclaimed hospitals in the country, Brigham and Women's, as well as a well-respected writer and public health researcher. Although these companies have largely been secretive about the ambitions of the project, their choice to lead it may indicate at least some of the plans on how it will try to redefine health care. For years, Dr. Gawande has written about quality and costs in medical care, and these pieces provide insights on how he and the joint venture will likely approach the problem. Since many employee wellness programs include clinical tests and interventions, companies would be wise to reflect on Dr. Gawande’s thoughts on health care.
Dr. Gawande is particularly famous for a 2009 New Yorker story that examined why some parts of the country spend far more on health care than others without better results. He showed that these populations spent more and got less even though they did not have sicker populations or higher labor costs. Specifically, the article focused and shared thoughts on McAllen, Texas, an area of the country that Medicare spent $15,000 per patient on in 2006 (twice the national average).
McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers,
– Dr. Atul Gawande
After talking to doctors and visiting hospitals in McAllen, Dr. Gawande concluded that “the primary cause of [the area’s] extreme costs was, very simply, the across-the-board overuse of medicine.” Patients in McAllen were exposed to too many tests, surgeries, and physician visits. Although it is often contrary to common belief, more health care does not mean better health care. In fact, more health care can result in worse outcomes by potentially harming patients. His prognosis for the root cause of a failed U.S. health care system was lauded by industry and political leaders, such as Warren Buffet (CEO of Berkshire Hathaway) and, at the time, President Barack Obama.
It is unclear whether the thesis in Dr. Gawande’s paper was the reason he was chosen to lead the new joint venture, but if it was, one would expect the ambitions of the company to include limiting the overuse of care. A good place to start will be making sure Amazon, Berkshire Hathaway, and JPMorgan Chase remove unnecessary tests, such as biometric screenings, from their employee wellness programs. The research suggests that broad screening of a population does not reduce health care costs and, in some cases, can cause potential harm to employees. Wellable has published a number of blog posts, videos, and podcasts on the shortcomings of screenings, and while the impact has been felt, too many employers still overuse clinical tests, waste money, and harm employees. Hopefully, great organizations like Amazon, Berkshire Hathaway, and JPMorgan Chase will change the way employers think about these services in the context on their employee wellness program.
As one would imagine, Dr. Gawande has been thrown into the public spotlight since the announcement. Most news sources have been relying on his wealth of previously published articles and statements as the basis for the future and focus of the joint venture. Over the weekend, Dr. Gawande spoke at the Aspen Ideas Festival, providing more clarity on his vision for dealing with the most pressing issues in the U.S. health care system. Check out the clip below to see why, despite working for a joint venture sponsored by three large employers, Dr. Gawande feels “employer-based care is broken.”
"Employer-based care is broken," says @Atul_Gawande. To him, it makes no sense to depend on a job when our economy and models of employment are changing. Ultimately, he adds, public policy must address the future of health care. #SpotlightHealth #AspenIdeas pic.twitter.com/fgsPAT7tDk— AtlanticLIVE (@AtlanticLIVE) June 23, 2018