A Chance to Rethink Health Care

Jan 08, 2019

Building blocks with medical symbolsPut together three massive employers with dynamic CEOs, add rising health care costs, and you just might get a new company poised to advance and implement new ideas in health care. Although little is known about the nascent health care partnership formed between Amazon, Berkshire Hathaway, and JP Morgan Chase, the prospect alone is thought provoking. How might three of the nation’s largest private-sector employers pioneer long-overdue changes to health care? The move itself indicates that the partners are confident they can disrupt the status quo and create a new ecosystem of care for their employees. The three companies haven’t yet signaled what strategy they plan to take, but to truly break the mold, they need to take stock of what’s already been done. Here, we offer three ways these companies can learn from the past to meaningfully affect the health and well-being of their employees and their bottom lines.

1. Create a truly patient-centered system

Amazon is in a great position to fulfill the promise of patient-centered health care. The company has tapped into unmet needs before, revolutionizing the way consumers shop by reducing barriers of time and transportation. Its previous success is no happy accident—Amazon’s business model is rooted in understanding its market, generating new insights about specific customers, and creating products to meet the needs of the market and its customers. Amazon has the opportunity and capacity to bring a data- and consumer-oriented approach to health care, which has long struggled to become patient centered. Clunky tools, confusing information, and long-misaligned incentives create an atmosphere of uncertainty for those interacting with our current health care system. Amazon can do what it has done before with other industries: gather evidence to help create a system that centers on its consumers, or, in this case, patients.

How? Amazon and its partners should leverage the relationship they have with employees to capture and build patient preferences into their data infrastructure, a critical gap for many existing entities.Efforts such as the Centers for Medicare & Medicaid Services’ payment model, the Comprehensive Primary Care Initiative, have brought payer and provider organizations together to create more patient-centered care, but even these more cutting-edge practices lack the infrastructure to consistently capture and adapt to changing patient preferences. With data in hand, this new health plan can set up a segmented, smart approach to creating programs and tools.

2. Nudge providers toward better care delivery

Aligning payment with patient outcomes makes sense. We should financially reward providers who give great care. But we know that this concept isn’t a panacea for improving patient well-being. Money is not always a strong motivator, and the lives of clinicians and health administrators could use plenty of simplifying. We’ve seen great potential in designing programs to incorporate nonfinancial incentives through our behavioral science work. To make an impact, decision makers at the new company should holistically understand the provider viewpoint—the good, the bad, and the ugly of their daily workflows. From there, the company can create programs that ease burden and enhance the provider experience. Atul Gawande has built a reputation for communicating about and innovating on this exact challenge, and, as CEO of this new enterprise, he is well positioned to implement more effective incentive models that reduce per capita patient costs and improve patient care, population health, and provider satisfaction.

3.  Make the right thing the easy thing

Traditional players in health care are starting to understand how important it is to not treat health as somehow separate from the rest of a person’s life. But because few have the benefit of starting from scratch, that change will be slow. By pursuing mental health parity, flexibility in paying for treating substance use disorders, and screening for and addressing social determinants of health through models such as Accountable Health Communities, the government has made important moves to integrate a more expansive view of what influences health outcomes. Important initiatives such as those set forth by the University of Michigan’s Center for Value-Based Insurance Design have worked to bring awareness to low-value care and to tweak state benefit structures to address the needs of different populations, such as offering discounts on high-value medications that help manage diabetes. Though the center and its partners, including the state of Connecticut, have made major strides, these principles are not yet widespread. Dr. Gawande and his teams have a chance to structure their benefits differently from the very start. The health plan should step back and consider preventive care to be anything that is proven to provide a benefit to the patient’s health, whether that’s prescriptions for food, preventive physical therapy, gym memberships, mindfulness apps, or housing. This approach to preventive care has the potential to meaningfully improve health and reduce lifelong health-related expenses for employees.

Building arrangements that pay for nontraditional services would require the team to look for new ways to measure and observe whether their approaches work. Current measures primarily assess the quality of traditional health care delivery, with limited focus on patient outcomes that are hard to change. Amazon, Berkshire Hathaway, and JP Morgan Chase bear the costs not just of medical bills, but of other health-related issues such as decreased productivity and so-called presenteeism. These are difficult—but not impossible—to measure, and the health system of the future should not shy away from such challenges. Through research and engagement of employees, providers, and clinicians, these partners can understand what has the greatest influence on their businesses and find ways to measure the outcomes that truly matter.

Although other health care companies are also moving toward payment for outcomes, transparency in prices, and putting the patient first, traditional players can be constrained by the systems and processes they already have in place. This new partnership will have a unique opportunity to start fresh. With a clean slate and significant analytic resources, Amazon, Berkshire Hathaway, and JP Morgan Chase might be able to make improvements to health care delivery that have eluded the field until now.

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The opinions expressed are those of the author(s) and do not represent those of Mathematica Policy Research.

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