NY Times best selling author Dr. Atul Gawande speaks at The New Jewish Home 3rd Annual Himan Brown Symposium at the AXA Auditorium in New York, NY on October 2, 2015. (Photo by Stephen Smith) *** Please Use Credit from Credit Field *** (Newscom TagID: sipaphotosfive712869.jpg) [Photo via Newscom]

What to know about Atul Gawande on his first day

As the new CEO of the Amazon-Berkshire-JPMorgan Chase healthcare venture, Atul Gawande begins his first day as the head of the future health brand. To mark this moment — which could have a huge impact on how employers select and pay for healthcare and prescriptions in the future — Employee Benefit Adviser has gathered 10 points those in the healthcare industry may not know about the new executive.

These highlights range from his views on the group healthcare market, the dilemma of medical waste and his support for the Affordable Care Act. Information was pulled from Gawande’s articles in The New Yorker as well as coverage from Forbes, Bloomberg, CNBC and Reuters.
A blood pressure monitor stands in the diagnostic imaging area at the Hong Kong Integrated Oncology Centre in Hong Kong, China, on Tuesday, Nov. 3, 2015. Equipped with biopsy facilities, body scanners, and quiet 'VIP' chemotherapy rooms, the Hong Kong Integrated Oncology Centre is the first of a string of such facilities that TE Asia Healthcare Partners, a portfolio company funded by TPG Capital, is planning in Asia. Photographer: Xaume Olleros/Bloomberg

The push for incremental care

In Gawande’s June 26, 2017, article in The New Yorker,How the Senate’s health-care bill threatens the nation’s health,” the noted surgeon and Harvard educator emphasized the importance for Americans to have regular checkups at their local physician rather than waiting for extreme medical cases to arise:

Conservatives often take a narrow view of the value of health insurance: they focus on catastrophic events such as emergencies and sudden, high-cost illnesses. But the path of life isn’t one of steady health punctuated by brief crises. Most of us accumulate costly, often chronic health issues as we age. These issues can often be delayed, managed, and controlled if we have good health care — and can’t be if we don’t.

Support for Medicaid

In the same article, Gawande addresses Republican dismissals of Medicaid being inadequate or unsatisfactory. He says compared to private coverage, Medicaid produces at least as much improvement in access to care, measures of health and morality reduction:

Polls indicate that recipients like Medicaid more than private coverage, even with the difficulties finding doctors who take Medicaid, because the program provides them with better financial protection.
Certified nurse practitioner conducts a check-up on a patient at a Community Clinic Inc. health center in Takoma Park, Maryland, U.S. Photographer: Andrew Harrer/Bloomberg

Having healthcare available to all

Gawande published an article, “Is health care a right?” on Oct. 2, 2017, where he explains that as humanity has developed more advanced means of extending life and curing illness, the government, particularly in the United States, has struggled to regulate care effectively:

Medical discoveries have enabled the average American to live eighty years or longer, and with a higher quality of life than ever before. Achieving this requires access not only to emergency care but also, crucially, to routine care and medicines, which is how we stave off and manage the series of chronic health issues that accumulate with long life. We get high blood pressure and hepatitis, diabetes and depression, cholesterol problems and colon cancer. Those who can’t afford the requisite care get sicker and die sooner. Yet, in a country where pretty much everyone has trash pickup and K-12 schooling for the kids, we’ve been reluctant to address our Second World War mistake and establish a basic system of health-care coverage that’s open to all. Some even argue that such a system is un-American, stepping beyond the powers the Founders envisioned for our government.

Tying healthcare to employment; a generations-old error

While many American receive their healthcare from their employer, Gawande insists this is an error that has made it disastrously difficult to discipline costs and insure quality, while severing care from America’s foundational agreement, that when it comes to the most basic needs and burdens of life and liberty, all lives have equal worth:

The prospects and costs for health care in America still vary wildly, and incomprehensibly, according to your job, your state, your age, your income, your marital status, your gender, and your medical history, not to mention your ability to read fine print .
A demonstrator in support of U.S. President Barack Obama's health-care law, the Affordable Care Act (ACA), holds up a "ACA is Here to Stay" sign after the U.S. Supreme Court ruled 6-3 to save Obamacare tax subsidies outside the Supreme Court in Washington, D.C., U.S., on Thursday, June 25, 2015. The U.S. Supreme Court upheld the nationwide tax subsidies that are a core component of President Barack Obama's health-care law rejecting a challenge that had threatened to gut the measure and undercut his legacy. Photographer: Andrew Harrer/Bloomberg

Support for the ACA

Long before tax overhaul became law, Gawande wrote in a March 6, 2017, article, “Trumpcare vs. Obamacare that the Affordable Care Act had done a lot of good for the country. Despite ending the individual mandate — the requirement by law for most individuals to purchase health insurance coverage or pay a penalty — having continuous coverage would mean that people who lose their insurance temporarily, because they change of jobs or suffer a financial setback, would also lose their preexisting-condition protections:

For these people and for others left behind, Price and Ryan advocate state-run “high-risk pools.” But, in the thirty-five states that offered high-risk pools to the uninsurable before the A.C.A., inadequate funding delivered terrible coverage, with extremely high premiums and deductibles, and annual limits as low as seventy-five thousand dollars. Hardly anyone signed up.

Disrupting the healthcare market

In a recent article in Forbes,Why Atul Gawande will soon be the most feared CEO in healthcare,” Dr. Robert Pearl highlighted that because Gawande lacks the experience of running an insurance company or contracting with providers, it does not prove him unqualified. In fact, the industry is ripe for disruption:

Jeff Bezos, Warren Buffett and Jamie Dimon did not hire a big-thinking industry outsider to set up a conventional insurance system or haggle with doctors and hospitals over prices. Dr. Gawande was selected to fundamentally change how healthcare is structured, paid for and provided. He was hired to disrupt the industry, to make traditional health plans obsolete, and to create a bold new future for American healthcare.
A Siemens AG Axiom Sireskop SD x-ray machine sits in an exam room at Perry Memorial Hospital in Princeton, Illinois, U.S., on Friday, Sept. 1, 2017. Almost eight months after PresidentDonald Trumptook office and promised to immediately repeal Obamacare, Republican senators are instead developing a small package of changes to help the health law rather than end it. Photographer: Daniel Acker/Bloomberg

Tackling medical waste

When Gawande was appointed to his current position, he told Bloomberg he plans to target three kinds of waste in the healthcare system: administrative costs, high prices and improper healthcare usage.

“One source of waste is our very high administrative costs,” he said during a conversation with journalist Judy Woodruff at the Spotlight Health event. “There are a lot of middlemen in the system, and there have to be solutions that simplify that, take some of the middlemen out of the system.”

Healthcare as an engine

Gawande has been vocal about his ideas to improve health care and lower costs. He has advocated more integration in healthcare, saying in a 2012 TED Talk that the ones getting the best results at the lowest costs have found ways to get all the different pieces to come together into a whole.

"There's a famous thought experiment that touches exactly on this that said, what if you built a car from the very best car parts? Well it would lead you to put in Porsche brakes, a Ferrari engine, a Volvo body, a BMW chassis. And you put it all together and what do you get? A very expensive pile of junk that does not go anywhere. And that is what medicine can feel like sometimes. It's not a system."

The cost of care

At the annual meeting of America’s Health Insurance Plans, Gawande said that drug costs are an impediment to recovery.

“We are screaming right now about pharmaceutical costs ... and that is just 10%” of total U.S. healthcare spending, Gawande said, noting how patients faced with a $200 drug co-pay see that as standing between them and their health.
Healthcare Challenges 4-3-=18.png

Healthcare is too complex in America

The high cost of healthcare is also having an impact on doctors and hospitals in how they do their job, he wrote in a 2015 New Yorker article based on his 2009 book, “The Cost Conundrum.”

But, whichever way we go (and this being America, we’ll no doubt try to do some hodgepodge of it all), we cannot let the complexities blind us to the core concern. The one thing the medical profession is not rewarded for is providing better, higher-value care. We are financially rewarded either for doing more stuff or for securing monopoly power. In a fee-for-service payment system — a system of paying doctors and hospitals by pill and procedure — we are actually penalized for making the effort to organize and deliver care with the best service, quality, and efficiency we can. That’s why both public and private insurers are rolling out reforms like “bundled payments” (paying a package price for certain conditions) and “accountable care” (sharing savings doctors and hospitals produce from more efficient care) — they want to replace our system of paying for stuff with one that pays for outcomes.