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June 22, 2018

What might Gawande do at the helm of the Amazon-Berkshire-JP venture? Experts weigh in.

Daily Briefing

    Since news broke that Atul Gawande will lead the Amazon, Berkshire Hathaway, and JP Morgan Chase health care venture, stakeholders have offered predictions about how Gawande will approach the job—with some applauding the pick and others questioning whether the respected surgeon and thought leader has the business acumen the job might demand.

    8 stories that explore Atul Gawande's views on health care

    About the new venture

    When Amazon, Berkshire Hathaway, and JPMorgan announced the partnership in January, the three companies said their goal was to identify "technology solutions" that would provide "simplified, high-quality, and transparent health care at a reasonable cost" for their employees. The three companies said the new health care company will be "free from profit-making incentives and constraints."

    In February, Berkshire Chair Warren Buffett in a CNBC interview added that the venture aims to find a lower-cost way of delivering better health care. 

    And on Wednesday, they announced Gawande beginning July 9 would assume the role of CEO.  Gawande in a note to friends and colleagues said he would not be stepping down from his roles at Harvard—where he teaches in the medical and public health schools—or Brigham and Women's Hospital—where he's a surgeon However, he said he plans to transition from his current role of executive director at Ariadne Labs, which works on solving problems affecting health systems around the world, to chair of the organization.

    What Gawande might do

    Health care stakeholders have pointed to Gawande's past efforts as examples of how he might approach the Amazon- Berkshire-JP venture.

    For example, Bruce Japsen in Forbes wrote that Gawande's work might be informed by his work on surgical safety checklists. Adriadne Labs worked with South Carolina hospitals to implement the World Health Organization's Surgical Safety Checklist, which Gawande helped to create. The checklist offers a way for surgical teams to check and document steps in the surgical process as a way to reduce human errors. In South Carolina, surgical deaths fell by more than 20% over several years in part because of the checklists.

    According to Japsen, the idea "was a simple one that came from outside of the walls of an inpatient facility or a health care executive suite."

    Andrew Joseph writes for STAT News that Gawande might focus attention on end-of-life care, given his previous work advocating for reform around end-of-life care. Gawande's argued that, instead of treating terminally ill patients at all costs, the health care system should focus helping patients with terminal illness achieve what matters most to them. He even authored a book on the topic, Joseph writes.

    Based on that background, Brenda Doherty, partner at Buffkin/Baker, an executive search agency that specializes in placing C-suite executives, said Gawande may focus his work on ways to reform care delivery models to move care away from the hospital into outpatient, home-based, and virtual settings.

    "He will have the financial backing to create scalable solutions that have never been attempted before," Doherty said.

    Surgeon, thought leader—but what about his business background?

    While Gawande is "one of the most respected thought leaders in the industry," according to Modern Healthcare, some have questioned whether his background is right for the job.

    In addition to practicing surgery and leading Ariadne Labs, Gawande has written for the New Yorker and advised former presidents Bill Clinton and Barack Obama on health care policy. However, he has a "limited business background," according to Modern Healthcare.

    Craig Garthwaite, a health economist at Northwestern University, said, given the venture's ambitious goal, it would help to have a leader with more experience in health care business as well as more time to devote to the job. "I am disheartened to see that he will maintain all these other jobs while running the firm," Garthwaite said. He added, "I don't see how you can have yourself involved in all these other ventures at the same time and be effective."

    However, Garthwaite also noted it's not clear whether the role will be more of a thought leadership position than a conventional CEO role.

    Lyndean Brick, CEO of the Advis Group, said Gawande "has to surround himself with a team of hard-nose professionals." She added, "He may be the grand educator and front guy but he is going to have to have a hard team of people to deal with Big Pharma, supply chain, and IT companies. He has to be prepared for this to be politicized."

    Nonetheless, Brick praised the choice, saying Gawande "is exactly the kind of messenger needed to deliver these tough messages and changes brought about if you are going to reduce the cost of health care."

    Bunny Ellerin, Columbia Business School's director of health care and pharmaceutical management program, said Gawande is just what health care needs: He's a compassionate, empathtic, practicing physician who applies a patient-centered philosophy. "He is someone who believes that we can do better and deliver improved health care if we focus on what's important to the individual patient and to society more broadly," Ellerin said in a statement.

    For his part, Gawande in a statement announcing he'd been picked for the job, said, "I have devoted my public health career to building scalable solutions for better health care delivery that are saving lives, reducing suffering, and eliminating wasteful spending both in the US and across the world." He added, "Now I have the backing of these remarkable organizations to pursue this mission with even greater impact for more than a million people, and in doing so incubate better models of care for all. This work will take time but must be done. The system is broken, and better is possible" (Japsen, Forbes, 6/20; Joseph, STAT News, 6/20; Baker, Axios, 6/21; Kacik, Modern Healthcare, 6/20; Harvard release, 4/17/17).

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