‘How do you create an Amazon Prime for health care?’ and other challenges for head of effort to reinvent medical care

Dr. Atul Gawande.
Aram Boghosian for The Boston Globe
Dr. Atul Gawande.

They’ve made a big splash, but three powerful business leaders who want to reinvent health care have been short on details about their venture. They took a notable step forward on Wednesday, recruiting Boston surgeon and prolific author Dr. Atul Gawande to head their new, still-mysterious company.

Berkshire Hathaway chief Warren Buffett, Amazon’s Jeff Bezos, and JPMorgan Chase chairman Jamie Dimon aim to improve medical care and lower its cost for their employees, and become a national model. But exactly how they envision doing that is unclear — especially in a field with no shortage of ambitious plans and ideas.

“The lack of details makes it a little bit of a shot in the dark,’’ said Dr. Lisa Bielamowicz, cofounder and president of Gist Healthcare, a health care consultancy in Washington, D.C. It “doesn’t point to a lot of meat there yet.’’


So far, little else is known about the venture, other than that it will be based in Boston, and that it has the medical world abuzz because of the big names and big aspirations.

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The Globe asked Bielamowicz and several other experts where Gawande should start in taking on overhauling health care.

 It’s all about Amazon and customer service. Bielamowicz said that employer health care coalitions have made only incremental progress in the past — using group purchasing to negotiate lower prices on prescription drugs, for example — but have failed to produce transformative ideas.

“But one of the things Amazon has done very well is they view consumer value as the guiding light for every decision they make,’’ she said.

A case in point: Free shipping. It seemed counterintuitive at first but has “been core to developing a deep relationship with customers. How do you create an Amazon Prime for health care? How do you deliver so much value that people want to be a member?’’ she asked.

Andrew Dreyfus, chief executive of Blue Cross and Blue Shield of Massachusetts, agreed that Amazon should bring its deep analysis of customer needs to the health care industry.
Pete Marovich Images/File 2014
Andrew Dreyfus, chief executive of Blue Cross and Blue Shield of Massachusetts, agreed that Amazon should bring its deep analysis of customer needs to the health care industry.

Andrew Dreyfus, chief executive of Blue Cross and Blue Shield of Massachusetts, agreed that Amazon should bring its deep analysis of customer needs to the health care industry.

Health care is “generally designed around the needs of institutions and health professionals and not around the needs of individuals,’’ Dreyfus said. “Whether we call them patients or consumers, they find health care confusing, fragmented, and sometimes even hostile to their needs. In the retail environment, we expect on a 24/7 basis to be able to search, purchase, and have an easy transaction. Those adjectives do not describe the health care experience.’’

Patients who have a better experience, Dreyfus said, may be more motivated to follow their doctor’s advice and take their medications.

Amass data and then tackle easier problems with big returns. Dr. Ashish Jha, a professor of global health at the Harvard School of Public Health, said the founders of the new venture, which does not have so much as a name yet, probably are counting on “the new leadership to articulate and develop that vision and execute on it. That’s why the companies have said, ‘We are not going to discuss details.’ ’’

Since an initial aim appears to be improving medical care for the 1.2 million employees of the three companies, Jha said a first step should be to analyze data about the cost of their care and their health status. “That is going to be the thing you want to track in how you move the needle,’’ he said.


Then, he suggests starting with “low-hanging fruit” like addressing so-called price variation in medical spending. This phenomenon is well-documented in Massachusetts, where insurers and consumers pay hundreds of dollars more for imaging tests at top Boston teaching hospitals than they pay at outpatient centers — with no appreciable difference in quality.

Convincing employees to go to lower-cost sites would bring relatively large savings quickly, Jha said. Insurers try to steer patients in this way, but people don’t like to be told where to go, and sometimes patients go where doctors refer them, especially if they are not paying.

But Jha said patients may not mind restrictions on where they can get imaging tests as much as they do on which doctor they can see. And, he said, the companies could provide bigger incentives to patients who get care from lower-cost providers, such as a $100 gift card for Whole Foods Market, which Amazon bought last year.

Gawande “should go for sizable but easy victories up front,’’ Jha said.

In this photo made on Monday, June 18, 2018, shows Hydrocodone Acetaminophen pills in Zelienople, Pa. (AP Photo/Keith Srakocic)
Keith Srakocic/Associated Press

Attack high-cost areas such as care of the chronically ill and prescription drugs. About 5 percent of patients, many who have long-term chronic illnesses, account for half of all health care spending. Dreyfus said that group is ripe for innovation.

“This has long been a target of health care organizations and some have recently been making some progress, but no one has really broken through in a big way,’’ he said.

Often, providers will improve care and save money for a narrow population, such as elderly patients in one community with congestive heart failure, but the success won’t be replicated. That ability to apply solutions on a large scale plays directly to Gawande’s strengths; he worked with the World Health Organization to bring pre-surgical checklists to hospitals around the world to reduce operating room errors and infections.

Prescription drugs are another logical focus, said John McDonough, a former state representative and consumer advocate and now a professor of the practice of public health at the Harvard School of Public Health. But he said it would be presumptuous to suggest how the new venture should approach its goals when the very point is to think outside the box.

“They are making it up as they go along,’’ McDonough said. “It’s new, it’s ambitious, and it’s supposed to be out of the box. They are being thoughtful and careful about what they want this to be and how it will unfold. Putting someone in charge is a big step forward and they are almost looking to [Gawande] to figure it out.’’

Liz Kowalczyk can be reached at