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Dr. Atul Gawande Tapped as CEO of Amazon/Berkshire/JP Morgan Chase Joint Healthcare Venture

June 20, 2018
by Rajiv Leventhal
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Gawande said in a statement that the healthcare “system is broken, and better is possible”
Atul Gawande, M.D.

Nearly six months after Amazon, Berkshire Hathaway, and JPMorgan Chase & Co announced a joint healthcare venture, the organizations today tapped Atul Gawande, M.D., as CEO of the initiative.

Dr. Gawande will start in the CEO effective July 9. The new company will be headquartered in Boston and will operate as an independent entity that is free from profit-making incentives and constraints, the three organizations announced today.

As Healthcare Informatics noted in a news report published on January 30, “With an ambitious-sounding, if vaguely worded, announcement, three corporate giants—Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. announced Jan. 30 that they were launching an initiative to improve satisfaction and reduce costs for their companies’ employees...The three companies, which bring their scale and complementary expertise to this long-term effort, will pursue this objective through an independent company that is free from profit-making incentives and constraints. The initial focus of the new company will be on technology solutions that will provide U.S. employees and their families with simplified, high-quality and transparent healthcare at a reasonable cost.’”

It was reported by CNBC’s Christina Farr that the joint venture had been struggling to find a CEO early on in the process. Farr specifically reported that “Health policy and insurance experts were among the initial targets, with ex-Aetna executive Gary Loveman and former Medicare chief Andy Slavitt on the list, along with Todd Park, who was previously President Barack Obama's technology chief.”

Then, ABC, as the group is called, shifted the search, beginning to look “for a candidate with an entrepreneurial background in technology and health who is far removed from drug supply companies and health plans, which are viewed as part of the problem,” Farr reported in May. Then, even more recently, David Feinberg, M.D., CEO of the Danville, Pa.-based Geisinger Health System, confirmed to CNBC that he will remain in his position at Geisinger, despite some initial discussions that he would be joining the Amazon/Berkshire Hathaway/JP Morgan Chase initiative.

Now, it will be Gawande, who is a well-renowned surgeon, writer and public health innovator. He practices general and endocrine surgery at Brigham and Women’s Hospital and is professor at the Harvard T.H. Chan School of Public Health and Harvard Medical School. He is also the founding executive director of the health systems innovation center, Ariadne Labs.

“I’m thrilled to be named CEO of this healthcare initiative,” Gawande said in a statement. “I have devoted my public health career to building scalable solutions for better healthcare delivery that are saving lives, reducing suffering, and eliminating wasteful spending both in the U.S. and across the world. 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.”

Details behind the initiative are still rather vague, but experts have pointed to reducing healthcare fraud and administrative costs as key areas that the companies will focus on. The lack of clarity has also led to skepticism among healthcare stakeholders. A recent survey from venture capital firm Venrock revealed that the majority of respondents are dubious about the impact of the Amazon/Berkshire Hathaway/JP Morgan healthcare partnership and believe the effort will face substantial challenges and take a lot of time to be successful.

Meanwhile, as Farr has previously reported, the CEO interview process involved asking prospective candidates to write a white paper on how they would fix the healthcare system. Farr wrote at the time of the report, “From those [10] white papers, three people were chosen to go through a harrowing interview loop. First, all three talked to [JPMorgan CEO Jamie] Dimon, who referred his two favorite picks to [Berkshire Hathaway CEO] Buffett. Buffett's top choice then interviewed with Amazon CEO Jeff Bezos, who could have vetoed the pick.

Farr also noted on a recent Healthcare Informatics podcast that it “definitely seems to be Berkshire Hathaway, not the other two companies, that are spearheading this [initiative].”

In a statement today, Buffet said, “Talent and dedication were manifest among the many professionals we interviewed. All felt that better care can be delivered and that rising costs can be checked. Jamie, Jeff and I are confident that we have found in Atul the leader who will get this important job done.”

Bezos added, ““We said at the outset that the degree of difficulty is high and success is going to require an expert’s knowledge, a beginner’s mind, and a long-term orientation. Atul embodies all three, and we’re starting strong as we move forward in this challenging and worthwhile endeavor.”

And Dimon noted, ““As employers and as leaders, addressing healthcare is one of the most important things we can do for our employees and their families, as well as for the communities where we all work and live. Together, we have the talent and resources to make things better, and it is our responsibility to do so. We’re so grateful for the countless statements of support and offers to help and participate, and we’re so fortunate to have attracted such an extraordinary leader and innovator as Atul.”

Industry associations have also started to give feedback on the CEO appointment. Halee Fischer-Wright, M.D., president and CEO of the Colorado-based Medical Group Management Association (MGMA), said in a statement, “Today’s appointment of Dr. Atul Gawande to head Amazon, Berkshire Hathaway, and JPMorgan Chase’s new healthcare venture is welcomed news for future collaborations between some of the best innovators of our time and our nation’s medical practices. As a surgeon himself, Dr. Gawande has dedicated his career to developing models that deliver better care to patients while reducing costs across the board. We know that one of the biggest opportunities to provide cost-efficient delivery models and reduce inefficiencies in our healthcare system is partnering directly at the medical practice level—the point of care. This new venture has the potential to develop interesting new innovations for our industry that can help bring us closer to the medical practice model of the future, one that improves care while cutting costs. We look forward to working with Dr. Gawande to realize that vision.”


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At Partners HealthCare, Bringing Digital Transformation to Clinical Care

September 18, 2018
by Rajiv Leventhal, Managing Editor
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Last spring, Partners HealthCare, founded by Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital, and California-based software company Persistent Systems, announced a strategic collaboration to develop a new industry-wide open-source platform with the goal of bringing digital transformation to clinical care.

Indeed, with the digital platform, Partners’ leaders hope to enable greater exchange of information across healthcare providers everywhere, and make available open source applications to any health system. At the time of the 2017 announcement, officials said that the co-developed digital platform will be based on Substitutable Medical Applications & Reusable Technologies (SMART), an open, standards-based technology platform along with Fast Healthcare Interoperability Resources (FHIR). “The platform will enable provider systems across the country to rapidly and cost effectively deploy industry-leading best practices in clinical care across their ecosystems,” according to the announcement.

Healthcare Informatics Managing Editor Rajiv Leventhal recently spoke with Sandy Aronson, executive director of information technology at Partners Healthcare, about this collaboration, its specific goals and outlook, and how things have come along so far. Below are excerpts of that discussion.

What would you say is the greatest significance behind this collaboration?

I have been at Partners for about 15 years, and the first 13 of those years were primarily focused on the clinical use of genetics and genomics. In that space, we created a suite of applications that was architected differently than health IT applications are typically architected. These were applications that helped with the generation of interpreted reports for genetics and genomics sequencing test results. So, where normally in health IT applications you create a transaction system and then try to bolt a knowledge base on top of it to the extent you can, we decided to architect this in the opposite way.

We built a knowledge base that deeply modeled the tests that a laboratory offers, the genes that are covered by that test, variants known to exist in these genes, variants that are learned over time, and the state of knowledge linking those variances to clinically relevant facts—so disease states, drug response, drug efficacy, etc. So we built this deep knowledge base and built a transaction system on top of it, and made a rule that you can’t report out test results unless you keep the knowledge base up-to-date and consistent with your test results. And that enables you to automate the generation of reports.

But as a result, we wound up with this continually-updated knowledge base, so based on that we created what would now be a SMART on FHIR app that plugs into the EHR [electronic health record] and provides clinicians with alerts if something new and potentially clinically relevant is learned about a variant previously identified in one of their patients. So it created this notion of a knowledge base alert being interjected into clinical care.

We studied this and found that clinicians liked it, but the rate at which this learned was dependent on the number of transactions that flow through the system, because that’s how geneticists would gather the data that would enable them to improve their assessment of variants. So we registered this as a medical device, distributed it outside of Partners, and networked the different instances together, so it could learn not just based on our volume, but other folks’ volume as well. Ultimately, we sold that to Sunquest [Information Systems]. The thing we feel was most important was creating this infrastructure that facilitated new clinical processes and captured, shared, and federated data in a way that enabled learning to care.

After having done that, we took a step back and said OK, what should we do next? The infrastructure we built was very specific to issues where genetics and genomics are the major components to deciding what to do for a patient. So we wanted to look at all of the things that made that infrastructure hard to do, and build a platform to make it easier to build things like GeneInsight [an IT platform company owned and developed by Partners], and then distribute that platform, so that in addition to building examples of a similar infrastructure, others can build those examples, too. We wanted that platform to make it easier to distribute apps that are created by different folks in different organizations, ultimately with the goal of networking those apps together.

We are at a unique point in time where you have these new data types coming online that can be helpful to the care delivery process, you have algorithmic-based medicine starting to come into use, both machine learning-based and not, and you have people looking at transformative ideas on how to alter clinical processes where in order to incorporate these new data types and incorporate algorithmic-based approaches to care, you need new kinds of IT support in order to enable these transitions to occur. And that creates an opportunity, not only related to the specific transitions, but also to start collecting data for specific clinical problems in a much finer-grained way that lays the groundwork for these networks that can build the data that’s required to underlie continuous learning processes.

All of this is happening in a time with incredible cost pressure in healthcare, which does constrain internal investment but also makes organizations far less resistant to change. The goal here is to fundamentally enable clinicals to evolve their practices, their care, new data, ideas, and techniques in ways they haven’t done in the past.

Sandy Aronson

And how are you working with Persistent Systems on this, specifically?

We are building this platform together. The platform is called HIP, or health innovation platform, and the platform itself will be open-source, and it sits on top of the current clinical IT ecosystem. You interface it to underlying systems, and then it handles things like some aspects of security, authentication, and HIPAA, but also access to data as well as incorporating shared algorithms.

The goal is having different places hook up the platform, and once it is hooked up, it should create a uniform surface on top of the platform so that apps built on top of the platform become more shareable and distributable. We are now focused on both building the platform and building certain apps. And the apps get interjected to the EHR as SMART on FHIR apps.

Can you give some examples and details of the apps that are being built?

One example is that we have been working with BWH’s cardiology [department] on this program that they have, where if you look at heart failure, which affects about 2 percent of the population and has a very high mortality rate with a great deal of costs associated with it, there are guidelines that have been shown to really be helpful, yet very few people are treated in a way that actually adheres to guidelines. And that’s because the process of getting them to guideline-based care involves this drug selection and titration process that requires a lot of interaction, some of which can make patients unconformable.

But as it turns out, you can instantiate a process where you use patient navigators to take patients through this drug selection and titration process, interacting with them far more frequently than a cardiologist would ever be able to, to get them to guidelines. It’s a data-intensive process. So we are providing support for that program through the HIP platform today and we are really focused on deepening that support.

What are your goals in the next 12 to 24 months regarding this partnership? What would you like to see happen?

The ideal world is that our group and Persistent Systems will continue to add more capabilities to the platform, and that the platform is reducing costs. So many clinicians have ideas on how to fundamentally improve care but they can’t put those ideas into use without these kinds of IT interventions.

One thing I hope is that this will continuously reduce the cost of building those interventions and as a result, our team, and others, too, will develop more of these apps. We hope to see some cross-institutional adoption of apps built here and elsewhere, that the sharing will begin at the app level and ideally, in two years or so, we will be having real conversations about how we can get the networking between apps really going.


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Cigna to Invest $250M in Venture Fund with Eyes on Healthcare Startups

September 17, 2018
by Rajiv Leventhal, Managing Editor
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Cigna, the Connecticut-based health services company, has announced the launch of Cigna Ventures, a corporate venture fund focused on investing in promising healthcare startups and growth-stage companies.

Cigna has specially committed $250 million of capital to Cigna Ventures to invest in transformative and innovative healthcare companies “that are unlocking new growth possibilities in healthcare and will bring improved care quality, affordability, choice, and greater simplicity to customers and clients,” officials said in a press release.

Cigna Ventures is particularly focused on companies across three strategic areas: insights and analytics; digital health and retail; and care delivery/management. Officials say the venture fund was created to help Cigna identify, assess and sponsor early-stage innovation ideas that warrant deeper exploration through focused pilot and test-and-learn activities with the goal of realizing meaningful business value.

“Cigna’s commitment to improving the health, well-being and sense of security of the people we serve is at the front and center of everything we do,” Tom Richards, senior vice president and global lead, strategy and business development at Cigna, said in a statement. “The venture fund will enable us to drive innovation beyond our existing core business operations, and incubate new ideas, opportunities and relationships that have the potential for long-term business growth and to help our customers.”

As an article in Bloomberg noted, “Health insurers have been starting venture-capital arms to find new ideas to improve their businesses and generate financial returns. UnitedHealth Group Inc., the biggest health insurer, said in November that its Optum unit was creating a venture arm with $250 million in funds. Humana Inc., Kaiser Permanente, and a group of Blue Cross and Blue Shield insurers all have venture units.”

According to officials, the venture fund builds on Cigna's existing venture activity, including collaboration with five venture capital partners and an equal number of existing direct investments. These include leading the C1 round of financing with Omada Health, investments in Prognos, Contessa Health, MDLIVE and Cricket Health.

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The Shock of the New: The Paris Art World of 1916—and the U.S. Healthcare Landscape of 2018

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This year’s “Top Ten Tech Trends” cover story package looks at the emergence of new disruptors to the industry

I’m currently absorbed in a very compelling book, Picasso and the Painting That Shocked the World, by Miles J. Unger, and published this year by Simon & Schuster. This book traces the trajectory of one of the greatest artists of the 20th century, Pablo Picasso, as he moved towards creating a painting that shattered all the artistic conventions of the time: “Les Demoiselles d’Avignon,” a cubist rendering of several women in erotic poses, but with a jagged, savage, pseudo-primitivist artistic treatment that sent shockwaves through the European art world. In choosing an implicitly controversial subject, and moving towards a revolutionary treatment, influenced very strongly by exhibits of indigenous African art that he had recently seen, Picasso relished the opportunity to shock the middle classes—as they say in France, épater les bourgeois. But he also faced a complex set of artistic challenges and dilemmas.

As Unger notes, “By taking up [poet Charles] Baudelaire’s challenge, he was setting up a deliberate contrast, proposing an alternate version of modernism that would not simply substitute a cramped naturalism for the tired formulas of the Academy.” This revolutionary painting, Unger writes, “would have all the metaphysical ambition of a Salon set piece while delivering its message in a language that was completely new: iconoclastic rather than conventional; radical rather than conservative; subversive rather than reassuring.”

Working on and off from late 1906 through late summer 1907, the Spanish artist endured self-doubt, recrimination, and stumbles; work on the painting “consumed him for more than eight months, months of unremitting labor, personal hardship, and spiritual anguish,” Unger reports. And then, when it was finally publicly exhibited in Paris in 1916, “Les Demoiselles” caused shock and furor, before it ultimately became one of the touchstone works of the 20th century. As art critic Hilton Kramer wrote in 1992, “Whereas [Pierre] Matisse had drawn upon a long tradition of European painting—from Giorgione, Poussin, and Watteau to Ingres, Cézanne, and Gauguin—to create a modern version of a pastoral paradise… Picasso had turned to an alien tradition of primitive art to create in Les Demoiselles a netherworld of strange gods and violent emotions.”

And while healthcare industry innovations emerge out of a completely different context from modernist paintings, there is something of the “shock of the new” (to reference art critic Robert Hughes) about some of the new partnerships and delivery and payment innovations taking place these days in U.S. healthcare. Even as the leaders of hospitals, medical groups, and health systems evolve forward into newfangled accountable care organizations and other value-based contracts, unprecedented new business combinations like the planned CVS-Aetna merger and the Amazon/Berkshire Hathaway/JP Morgan Chase initiative, as well as forays by technology giants like Google (Alphabet), Apple, and Microsoft, threaten to shatter l ong-held assumptions about how the healthcare industry will be organized and operated.

This year’s “Top Ten Tech Trends” cover story package looks at the emergence of new disruptors to the industry, as well as a host of other issues facing the industry right now, from the sprint forward towards true interoperability, to the need for patient-generated data to support value-based care delivery, to the question of how industry consolidation will impact physicians in practice. As we’ve done for years now, we editors at Healthcare Informatics bring you the bold, the innovative, the shocking, and the speculative, in a stimulating package of articles that will help you consider some of the top trends impacting the entire industry right now.

No cubist paintings here; but, like the art galleries of Paris in the first decade of the 20th century, a chance to peer into the future of our world.

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