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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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Report: Massachusetts General Hospital Targeting Various Blockchain Use Cases

December 7, 2018
by Rajiv Leventhal, Managing Editor
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Massachusetts General Hospital (MGH) researchers are partnering with MediBloc, a Korean healthcare blockchain company, with the aim to improve patient data sharing and storing, according to an article in CoinDesk.

Per the article, the Laboratory of Medical Imaging and Computation by MGH and Harvard Medical School will be escalating research in a variety of broad areas “from medical image analysis to health information exchange by leveraging our cutting-edge technologies such as blockchain, artificial intelligence and machine learning,” according to Synho Do who is the laboratory’s director.

Do specifically told CoinDesk, “In collaboration with MediBloc, we aim to explore potentials of blockchain technology to provide secure solutions for health information exchange, integrate healthcare AI applications into the day-to-day clinical workflow, and support [a] data sharing and labeling platform for machine learning model development.”

Interestingly, MGH won’t be using any real patient data for its research, but rather simulated data, according to officials, since the various institutions that have the real patient data keep it in a way “that can’t be shared securely and often is in various incompatible formats.”

MediBloc’s CEO noted that the company is not only developing a distributed ledger for storing and sharing medical data, but also working on a tool that would convert data now held by hospitals from existing formats to a universal one, per the article.

For this initiative, MediBloc has already gotten partners across Asia, including eight healthcare organizations and 14 technology companies, officials said.

Earlier this year, a testing environment version of the blockchain was launched, and the network is expected to go live before the end of the year before becoming fully functional in the second quarter of 2019. Furthermore, there are also apps in the works that are planning to go live next year, with one of them, currently in a beta testing phase, “designed for patients to sell the information about their symptoms and the prescriptions they get to MediBloc. After that MediBloc will analyze that data and sell the analysis to pharmaceutical and insurance companies,” according to the story.

In the end, the main goal of the blockchain project will be to let patients independently decide what to do with their information.

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Medicaid Transformation Project Expands to 24 Health Systems

December 6, 2018
by Heather Landi, Associate Editor
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Seven new health systems have joined the Medicaid Transformation Project, a national effort to transform healthcare and related social needs for the nearly 75 million Americans who rely on Medicaid.

In total, the project now includes 24 health systems that comprise 342 hospitals, more than 65,000 beds, in 25 states with over $121 billion in combined annual revenue.

The Medicaid Transformation Project, which was announced August 28, was formed with the vision that healthcare organizations can work collaboratively to enable better health and outcomes for vulnerable populations, while also reducing costs, through the adoption of digitally-enabled care models. The project is led by AVIA, a network of healthcare organizations committed to digital transformation, and Andy Slavitt, former Acting Administrator of the Centers for Medicare & Medicaid Services (CMS).

The project initially began with 17 health systems, with five health systems anchoring the work—Advocate Aurora Health in Chicago and Wisconsin; Baylor Scott & White Health in Dallas; Dignity Health in San Francisco; Geisinger in Danville, Pa.; and Providence St. Joseph Health in Renton, Wash.

The project worked with health systems to target four critical challenges over the next two years to better meet the needs of vulnerable, low-income populations: behavioral health, women and infant care, substance use disorder, and coordinating community care to reduce avoidable emergency department (ED) visits.

The seven new health systems joining the Medicaid Transformation Project span distinct geographic and socioeconomic markets: BayCare Health System in Clearwater, Fla.; Boston Medical Center in Boston; Cedars-Sinai in Los Angeles; Carilion Clinic in Roanoke, Va.; Children’s Hospital Colorado in Aurora, CO; Jefferson Health in Philadelphia; and University Hospitals, in Cleveland.

According to Medicaid Transformation Project leaders, underpinning this action is an acknowledgement of the current health disparities seen in communities across the country. A leading indicator of such disparity is life expectancy, which is highly correlated with ZIP code, income, and race because care delivery varies greatly based on those factors. Insufficient healthcare access, patient engagement, and social determinants create variations in life expectancy that can be as great as 16 years between communities that are just a mile or two apart. The Medicaid Transformation Project’s commitment is to close the gap in care and outcomes in communities in need through a renewed focus on innovation and investment, leaders say.

“The current healthcare delivery system needs to be disrupted to dismantle health inequities. At Jefferson Health, we believe that collaboration and creativity will drive this necessary transformation,” Stephen Klasko, president and CEO of Jefferson Health, said in a statement. “We’re joining the Medicaid Transformation Project to learn from others across the country and to find the best innovations that improve care and outcomes for the most vulnerable among us.”

The 24 participating health systems have decided to initially focus on transforming the role of the emergency department, and leaders recently convened in Chicago to discuss how to better position EDs for sustainability and care coordination.

To do this, project participants are seeking to improve linkages from the ED to other critical parts of the delivery system, namely primary care, behavioral health, specialty care, and social services and supports. The underlying goals are reducing unnecessary ED visits, reducing avoidable ED visits, and improving patient disposition and sustainable transitions at the moment of discharge, project leaders say.

“By bringing together the nation’s leading health systems, we have a unique opportunity to improve the health of underserved populations in a way that hasn’t been done before. We’re committed to sustainable, durable solutions that improve care and outcomes for people. We must consider the best existing and new ideas and invest in the right ones,” Andy Slavitt, Medicaid Transformation Project Chair, says.

At the Action Forum, Medicaid Transformation Project participants discussed care models that had shown success—but had been previously limited by barriers in labor, cost, or technology. They viewed 10 on-site demonstrations of scalable solutions and engaged directly with company founders to explore relevant care models, ranging from community health worker (CHW) programs to virtual triage. They gathered insights from one other and from leading Medicaid experts, including Molly Coye, M.D., former Commissioner of Health for the State of New Jersey and Director of the California Department of Health Services, and Vikki Wachino, former Director of the Center for Medicaid and CHIP Services.

“The collaborative model of the Medicaid Transformation Project is providing us with a new and necessary lens to view a long-standing challenge, which is improving access and coordination to community care,” Thomas M. Priselac, president and CEO of Cedars-Sinai, said in a statement. “Our team is excited to share what we’ve learned working with our community partners, and to scale new digital solutions that lower long-standing barriers to care.”

The health systems in the Medicaid Transformation Project will next select scalable solutions to extend care models and begin early implementation. “These 24 health systems have put a stake in the ground around transforming the function of the Emergency Department in communities with heightened vulnerability. By acting locally and collaborating nationally, we can create a force-multiplier effect that will inspire ripples across the country. We’re honored to help lead this work,” AVIA President Linda Finkel said in a statement.

The Medicaid Transformation Project will launch its next body of work on behavioral health in January 2019.

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At UVM Health Network, Advancing an Integrated Health System’s Initiatives through Data Governance Strategies

December 5, 2018
by Mark Hagland, Editor-in-Chief
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At the Burlington, Vermont-based UVM Health Network, Leah Fullem is helping to lead data governance processes intended to speed the advancement of key IT strategies

The Burlington, Vermont-based University of Vermont (UVM) Health Network was created in October 2011, when what was then known as Fletcher Allen Health (now the University of Vermont Medical Center) in Burlington, Vermont, and Central Vermont Medical Center in Berlin, Vermont, signed an affiliation agreement. Six hospitals—the University of Vermont Medical Center, Alice Hyde Medical Center, Central Vermont Medical Center, Champlain Valley Physicians Hospital, Elizabethtown Community Hospital, and Porter Medical Center—and the UVM Health Network Home Health & Hospice (formerly the Visiting Nurse Association of Chittenden and Grand Isle Counties) make up the network. As the organization’s website notes, “Working together to better serve our communities makes us stronger, focused on collaboration instead of competition. As a team, The University of Vermont Health Network improves the lives of our patients by delivering outstanding care cost-effectively, as close to patients’ homes as possible,” it adds. “The University of Vermont Health Network cares for communities on both sides of Lake Champlain, from the Adirondacks to the Green Mountains and beyond.”

Bringing together those diverse hospital facilities and healthcare services has necessitated formal data governance processes. And, in that context, Leah Fullem, vice president of enterprise information management & analytics at the UVM Health Network, reached out for consulting support to Stephanie Crabb, co-founder and principal in the Tampa, Florida-based Immersive consulting firm. Recently, Fullem and Crabb spoke with Healthcare Informatics Editor-in-Chief Mark Hagland regarding the journey around data governance at UVM Health Network. Below are excerpts from that interview.

Can you share with me the origins of your initiative to create a formal data governance structure at UVM Health Network?

Leah Fullem: A couple of things made this time the right time to pursue this work. The UVM Health Network—we came together several years ago, anchored by UVM Medical Center, and affiliated with community and critical access hospitals in Vermont and in northern New York. And we had some network structures in place. And a few years ago, we decided to implement a common cost accounting and financial services solution; and now we’re in the initial phases of a rollout of Epic system-wide. The medical center has been on Epic for several years now on inpatient and ambulatory; and revenue cycle components will be included in November 2019. So we’re looking at implementing common tool sets across the network, with common workflow and documentation standards.


Leah Fullem

We’re trying to improve the way in which we capture information, so that we can better work together as a network. That’s why it’s a good time to initiate enterprise-wide data governance. But we still have multiple different areas in which data are consumed, produced, and analyzed, with a lot of different ways of doing that. So we contracted with Immersive about a year ago, and then did a scan, looking at our data resources, tools, data governance and standards we had in place, and gave us a nice set of recommendations and a roadmap.

What were the biggest gaps you found?

Our story is not uncommon; we found that we had multiple areas where we were duplicating effort; analysts in the finance area and quality area, or multiple different areas, were writing different queries with different parameters, across the same subject areas, for reports. And they were using different metrics to calculate from. So we had data silos, which meant that data analyst teams being directed by different supervisors, weren’t able to partner with each other. So there were a lot of knowledge gaps; we had a huge amount of analyst talent, but we weren’t able to leverage the talent we have. We have SQL servers, many other forms of storage, of data; and the Epic rollout will include an enterprise-wide data platform that we’ll implement over the course of the next year, and that will allow us to make sure we’re on common platforms with common platforms.

Stephanie Crabb: One unusual thing about UVM is that UVM has had incredible executive support and sponsorship around data for a long time. Dr. John Brumsted, the current CEO, was the network CMO and chief quality officer; so he’s an individual who’s always been very bullish and visionary around the use of data and information.  And he himself had taken the first pass at implementing data governance when he was the CMO. So it’s really important—we talk a lot about executive sponsorship in data governance, and about whether it’s really there, whether it’s real. And one success factor at UVM was the fact that Dr. Brumstead was a stalwart supporter and leader. And he put forth from the very first meeting that failure was not an option. So he really set the tone, and was open to creative ideas, and was focused on putting ideas into action. That’s how Leah’s position was created.


Stephanie Crabb

What have been the biggest lessons learned so far in all of this?

Fullem: I’m still early on in my involvement in all this; I’ve been in this position six weeks so far, but much work has already been done. We’ve set up a network-wide data governance council with broad representation across business functions and institutions; created a network-wide data governance policy; we’ve begun a project on provider dictionaries/better data management processes; and we’ve been focusing on data governance, stewardship, and moving forward with a new structure. When Dr. Brumsted first started talking about instituting data governance, there was no locus of authority for participating in data governance or collaboration efforts; now, that’s here.

And in the first six weeks of my job, I’ve been going around speaking with as many people as possible in Vermont and northern New York. And we’re talking about the way people access data, and what tools analysts might be using. So I had expected some pushback, but overwhelmingly, people across this network have been enthusiastic and supportive of this, which was surprising. The commonality is someone saying, “I had something that I thought was easy, but it wasn’t, and no one could get back to me in a timely way, and I had to wait six months, and by then, it wasn’t relevant to me.” And we’re moving heavily into population health and care management, so there’s a great deal of interest.

The biggest lesson we’re learning in process is that this is a cultural change more than anything. Yes, data is involved. I report up to the chief population health and quality officer. This is a cultural change. We will improve access to data, improve the quality and accessibility of data and information, to allow us to make better decisions on behalf of our patients and people. We have people who still only trust the data given to them by their analysts, or data they’ve extracted themselves. And yet there are conflicting numbers all over the place. So creating trust, to open people up to changing the way people receive or experience data, through new ways of looking at the information, involves a huge change effort.t So above all, I need change agents.

Crabb: Lessons learned from our point of view through the work—to augment the change piece—have been several. One thing that UVM has done very well is that they didn’t just do an assessment and roll forward with a roadmap; they were really honest about their strategic, tactical, and cultural readiness. And I applaud Leah up and down, because she has a really tough job, it’s an ambitious agenda. But in the first year of their preparation, they’ve been really attentive, have set the right objectives, have taken the best of what they’ve learned and are trying to apply that very tactically. Second, they’ve focused on the people and organizational structure piece. One of our recommendations to them was, don’t throw a bunch of tools at this; if you don’t have the people and processes and organizational structure that make sense, it won’t help. Creating Leah’s position as a network organizational position, that was a huge demonstration of good faith and commitment. Not only did they say they wanted Leah, they agreed to a leadership team of eight or nine positions in her office that she’s currently fulfilling, positions in data management that are needed.

So, the lesson is, not just giving lip service to it, but putting skin in the game and following through. And this 25-person-plus data governance council that started meeting in February of this year, was incredibly important. It was incredibly well constructed, with critical business functions. That team has rallied from day one, and has gotten an incredible amount of work done in five short meetings. And the charter they created for themselves, and coupled with creating a good operating environment to carry out the mission, are two very important things, and indications of the seriousness with which they’ve taken this.

What would your advice be to CIOs and CMIOs who will be facing similar data and IT governance situations and challenges?

Fullem: This is common advice, but we need to make sure that we’re meeting the needs of our clinicians, our finance departments, our operational leaders, since data is the key to making good decisions. All of this has to be done in a way that we make technology available to our users in ways that are easy to use and access, with the right information security principles, to move forward as a business.

Crabb: That our data land information leaders are important partners to our CIOs and CMIOs. This initiative originated out of IT, was led by Dr. Doug Gentile, our CIO. But the goals far exceeded the boundaries where IT is drawn in that organization today. And it wasn’t a tug of war of any kind; it was a natural extension of work that was incubated in IT. It’s been a healthy, symbiotic relationship that was first incubated in IT, and allowed to fly, understanding that data as an asset deserves its own center of excellence, just as IT is a center of excellence.

 


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