Pratap Khedkar co-wrote this blog post with Paul Darling.

2122_Follow_up_BerkshAmazMorgan_blog_img-430635-editedBoston-based Atul Gawande needs a new name plate as he adds CEO to an already long list of titles including surgeon, professor, writer and executive director. Gawande is a crusader who’s focused on improving healthcare delivery and accessibility, so company leaders Jeff Bezos, Warren Buffett and Jamie Dimon are confident that Gawande’s background and passion make him the ideal ambassador to advocate for and deliver a revamped healthcare experience for their collective employees in their joint healthcare entity, which we like to call “BerkshAmazMorgan.” For Gawande, this chief executive post likely is an appealing opportunity to experiment with an entirely new care delivery paradigm that one day could be applied outside these corporations’ walls.

Details about the tasks included in the newly appointed chief executive’s jurisdiction are hazy, but there’s rampant speculation about what the triumvirate’s CEO selection says about their planned venture. And while Gawande is well-equipped to take on the BerkshAmazMorgan partnership’s quest to lower healthcare costs without raising risks, a few gaps in his background could present unique challenges. One thing we know for sure is that this CEO will have a far greater chance of success if he builds the right team around him and appoints a capable COO to handle the brunt of the operations. Let’s take a look at what Gawande’s medical and academic training will—and won’t—enable him to do.

  • 1. Establish a link between medicine and evolving healthcare models. Physicians are well-suited to help patients buy into our country’s quest for wellness, a journey that needs to give equal weight to a patient’s diet and exercise habits, mental and social well-being, and necessary medical interventions. Physicians can evaluate when it’s appropriate to intervene clinically vs. when to nudge patients to make the right choices for better health, a premise that likely will be central to BerkshAmazMorgan’s approach.

    An area where physicians often fall short, however, is understanding how to shape others’ behaviors so that well-intentioned patients make changes. In this case, those changes will be directly tied to providing real value for the organizations and likely will require more frequent interactions between HCPs and patients (employees) and the use of a new breed of interventions. We’re left wondering: Can Gawande adequately stand in as a behavioral economist? Is he equipped to deliver strong directives to employees? Is he prepared to help patients navigate an entirely new patient journey?

    2. Make changes to optimize care delivery models. As health systems across the country aim to do more with less, physicians have first-hand experience with the effects of changing workflows and improving care delivery. In Gawande’s case, he may have experience in switching up the surgeon’s pre-op checklist and other initiatives aimed at improving efficiencies in the operating room. But how can that experience translate to BerkshAmazMorgan’s anticipated plan to move from the primary care provider’s office to a distributed care environment that provides on-site care to employees?

    To flip the familiar healthcare model to one that’s more heavily focused on prevention, BerkshAmazMorgan will need to introduce new and more frequent modes of healthcare encounters that provide more opportunities to engage patients, improve health outcomes and contain costs—and that’s a tall order. Some of this can be accomplished by bringing in digital patient engagement tools, hiring more health coaches, and revamping common practices in our healthcare system like billing physicians for services that nurse practitioners and physician assistants are trained to provide at a lower cost. Along the same lines, we expect Gawande to use his new platform to continue his work to shift the end-of-life care model to palliative care. The trick will be to introduce these new measures while discontinuing healthcare encounters that produce unnecessary waste. 

    3. Reposition technology’s role in creating a better healthcare experience. Physicians are expected to see their job duties shift as technologies like AI and machine learning begin to assist in day-to-day practice demands and take on larger roles in the diagnosis and treatment of patients. While the long-term possibilities are exciting, what’s needed most in the interim is an empathetic leader. Physicians like Gawande have first-hand experience with the “digital burnout” that’s impairing the medical community and can voice the concerns of the physicians to ensure that BerkshAmazMorgan softens the blow of this unprecedented shift. We expect that Gawande will work to advance data-rich and technology-based interventions, but even with Amazon’s data and analytics prowess at his disposal, we envision this to be a longer-term play.

    4. Carve out a spot at the center of the healthcare business model. The modern-day physician spends her time interacting with nearly every stakeholder in the ecosystem including payers, suppliers, patients, etc. BerkshAmazMorgan needs to find a way to leverage Gawande’s expertise in these areas to build an entirely new way to provide care for employees and then retain them as patients for many years—beyond episode bundling. 

    As employers, Berkshire Hathaway, Amazon and JPMorgan Chase are in a good position to take the long-term view, but they’re hardly the first on the scene. As it turns out, others have cracked the code to what BerkshAmazMorgan is after: Rosen Hotels and Resorts in Orlando has been operating its own self-funded healthcare model since 1991 with savings to the tune of $340 million. However, the comparison between an organization with fewer than 5,000 employees and one with more than 1 million has its limits. Can this approach be done at scale? And will it inevitably require BerkshAmazMorgan to own care delivery?  

Gawande Needs to Surround Himself With the Right People

For Gawande, juggling the duties of CEO alongside what he’s already to committed to on the operating table, in the classroom and at his writing desk will be no small feat, and as we’ve discussed, his background as a physician will only get him so far. The key will be to find the right people to complement his talents, enforce his vision and, most importantly, do the dirty work. In creating an employer-driven healthcare experience, Gawande and his team will need to not only design new business arrangements but also execute on every corresponding detail, from monitoring and correcting provider and employee behavior, and introducing new contracting terms, to hiring and firing partners of all kinds.

Although Gawande has founded a company, this new post marks the first time that he finds himself at the helm of a large organization and all that it entails. With his medical and social credibility, however, Gawande is prepared to fight the good fight as BerkshAmazMorgan’s ambassador. Gawande can be the idea man, the spokesperson, the advocate and the cheerleader, dangling the carrots to motivate all parties to engage in a new form of health management and care delivery. Then he needs a capable (and likely hawkish) chief operating officer to carry the stick, negotiating with partners and stakeholders throughout the healthcare ecosystem. With the right kind of muscle behind him, Gawande certainly could be the face that this venture needs.


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Topics: Pratap Khedkar, healthcare ecosystem, Paul Darling, healthcare delivery, BerkshAmazMorgan, health management, employer-driven healthcare