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SPEN, Colo. — It’s hard to imagine having to endure a more exacting executive search committee than the triad of corporate chieftains atop Amazon, JPMorgan Chase, and Berkshire Hathaway.

But Dr. Atul Gawande’s selection last week by Jeff Bezos, Jamie Dimon, and Warren Buffett to run a venture with the extraordinary yet seemingly futile goal of disrupting the health care industry didn’t stem from any longstanding relationship he had with any of them. Its genesis was an article he wrote for the New Yorker nine years ago.

“That opened the door,” Gawande told STAT, providing the first explanation of how his selection came about.

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Gawande, 52, the celebrated surgeon, author, and journalist, said the closest he had come to knowing Amazon’s Bezos was a fleeting hello at a TED Talk. “But I had really never met Jeff Bezos. And I didn’t know Jamie Dimon in the least.” He did catch the eye of Berkshire Hathaway’s Buffett years ago, or, rather, Buffett’s longtime right-hand man, Charlie Munger, also a businessman and entrepreneur.

In a brief interview at the Aspen Ideas Festival Spotlight Health program — in which he also said the new job would have to be his top priority —  Gawande said he had known Munger ever since he wrote a much acclaimed article in 2009 for the New Yorker, “The Cost Conundrum.”

The piece examined why health care was vastly more expensive in some parts of the U.S. than others, despite little difference in the quality of health care and the sickness of people getting it. The piece was reported from McAllen, Texas, then the most expensive health care market in the country.

“Charlie Munger I’ve known since he told me he loved, he liked, the article I wrote,” Gawande said. He then recalled the story, well-publicized at the time, of how Munger thought the article was so socially important that he blindly mailed Gawande a $20,000 check.

Gawande, a surgeon at Brigham and Women’s Hospital in Boston, said at first he sent the money back: “He sent it back to me again and said, ‘Do with it what you want.’ And so I put it into our research fund.”

Though Gawande said the Munger relationship had paved the way for his selection as CEO of the new health care company, he went on to say of Buffett, Dimon, and Bezos, “I think each of them heard about me in different ways.”

Buffett spoke publicly about Gawande long before they met. In a CNBC interview in 2010, Buffett praised the “The Cost Conundrum,” saying, “That fellow whose written on health care recently in the New Yorker — Gawande — he had an article last summer that was absolutely magnificent.”

In some ways, the McAllen article could be seen as laying out some of the challenges the new enterprise will face as it seeks to reduce health care costs. In announcing the venture in January, Dimon said, “Our goal is to create solutions that benefit our U.S. employees, their families and, potentially, all Americans.”

Gawande told STAT that he was first approached for his advice in January. He said he did not know when the dialogue evolved from his offering his thoughts to being a prospect for the job.

“I started talking with them,” he said, “but they ended up talking to over 100 people for advice, so I don’t think I exactly know.”

Gawande has offered scant details about the yet-to-be-named organization (he jokingly referred to it as AJB after its corporate owners), though he said it is meant to come up with ways to reduce health care costs for the companies’ employees, as well solutions that could be applied across the entire country.

He said the intermediary who first contacted him was Todd Combs, an investment manager at Berkshire Hathaway in Omaha who was the emissary who quietly put the three billionaires together in the first place. Combs was said to have so impressed Dimon that he was named to the board of JPMorgan Chase.

No matter how efficient Gawande is with his time, his CEO role will test even his ability to multitask. Asked how much time he would devote to it when he officially begins July 9, Gawande said, “It’ll have to be 100 percent.”

But he is not giving up his positions at Harvard or Brigham and Women’s or his work as a surgeon, and plans to continue writing. He said he will transition from being executive director to chairman of Ariadne Labs in Boston, which works on solving problems in health systems around the world.

“I still have my patients and surgery booked through the summer and have my work,” he said.

Asked if most of his time will be spent in the new role, he said, “This is going to become the number one priority.”

If it were possible for Gawande to be even more of a celebrity in the worlds of health and medicine, the announcement last week has inevitably made him more in demand. He was crowded by well-wishers at appearances here Saturday and Sunday, with some thrusting his books at him for autographs.

Several leaders in health and medicine said in interviews here that while Gawande’s mission is daunting, they thought he was a prudent choice.

“He’s excited. He’s nervous. And he’s also incredibly humble,” said Seth Berkley, CEO of Gavi, the Vaccine Alliance, who met privately with Gawande in Aspen this weekend. “He’s incredibly smart and he has a great shot at being able to do this.”

Berkley said Gawande will, of course, be under great pressure from Dimon, Bezos, and Buffett. “Some of these leaders he’s working with don’t have a reputation for patience, and he knows that. He understands the risks given the oversized personalities.”

Rip Ballou, vice president and head of GSK Global Vaccines, said he was impressed after hearing Gawande speak here, saying, “He left me feeling that there are actual people thinking how do we get out of this quagmire.”

Ballou said that the billionaires who will be Gawande’s new bosses reminded him of when he worked for Bill Gates. “People who have achieved the kind of success these people have achieved — it’s not by accident,” he said. “I would expect them not to leave him to his own devices. I wouldn’t be surprised if those three bosses become very well-educated” in health care and put forward their own ideas.

“I was very encouraged to hear that all three of his bosses said, ‘You have time — you don’t have to figure it out by next year,'” Ballou added.

Indeed, during a panel here Saturday, when he was questioned by PBS journalist Judy Woodruff, Gawande took care not to overpromise — and repeatedly noted that he hadn’t started yet. He said he understood the daunting challenge of taking on health care intermediaries such as insurers and pharmacy benefit managers.

Dr. Atul Gawande speaking at an Aspen Ideas Festival panel on Sunday. Rick Berke/STAT

“It is amazing to me that I would get to partner with people like Jeff Bezos, Warren Buffett, and Jamie Dimon — amazing people who have committed themselves to the long term,” he told the crowd. “But the largest concept here is that I get to have a million patients that I as a doctor get to add to my responsibility, and my job for them is to figure out ways that we’re going to drive better outcomes, better satisfaction with care, and better cost efficiency with new models that can be incubated for all. That is a tall fricking order. But what they’re saying to me is that resources won’t be the problem. Human behavior will be. And achieving scale will be.”

Gawande emphasized the nonprofit nature of the organization and made clear that he does not see himself under the thumb of Amazon, JPMorgan Chase, or Berkshire Hathaway bureaucracies — something people who know him said was important to establish before he accepted the job.

“Number 1: It is an independent entity; it is not part of those companies. Number 2: It is nonprofit; there are no dollars that go back to those companies. That’s really important.”

Asked about the range of employees at the companies, Gawande said, “This is ordinary America. They are across the entire country. So I get to have and have to worry about and learn about the life and needs of — what’s the largest employment group at Amazon? Fulfillment center workers, most of them people who probably are only there a year or so.

“So these are people who have very unstable health care … and how do you solve problems for that range of people?”

Berkshire Hathaway includes many old-line companies, he noted, “often union, Midwestern, Southern — it’s Burlington Northern Railways, with union railway workers, it is Acme Brick, it is Dairy Queen. They make stuff. And then you get to JPMorgan Chase, where their largest employment group are bank tellers.”

Sounding much like a politician, Gawande told people here that he intends to embark on a “listening tour.” His first decision: coming up with a name that’s less of a mouthful than the Amazon-Berkshire-JPMorgan health venture.

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  • Tremendous effort to reform and broken healthcare industry fraught with waste through inefficiencies, too much variability, unsafe practices, and less than sufficient outcomes. During my 35 years of anesthesia practice I’ve been worried about the health of our society. I dread ever being a patient. I have always been very passionate about our healthcare system, or lack of system. We have as many systems as organizations providing healthcare. I would love to be instrumental in leading healthcare in a new direction, a sustainable high quality and affordable direction. I have heard Atul speak and he is inspirational.

  • I would like to offer my suggestion for an appropriate title for the Entity which Dr. Gawande is so well qualified to head: ” ABC Health”. Referring of course to the companies themselves, Amazon, Berkshire,Chase. And implying the search for a new beginning and simplicity.

    • It is not at all clear what Dr. Gawande is going to head. He also has no administrative experience.

      His checklist work is brilliant and simple. I heard it discussed in the 1980s at the Harvard School of Public Health in the Health Policy and Management Program by no less than Donald Berwick. But it took someone with Dr. Gawande’s soft personality to make it happen.

      It is not clear what the mission statement of this organization is going to be!!!???

  • This is a fantastic opportunity for Gawande but worry he does not yet have the range of background experience to handle this efficiently. As a 7 year ( three hospitals) Army hospital commander who then and now practiced(s)the complete demands of orthopedic surgery ( office. Clinic. Inpatients. Surgey and call) simultaneously see the challenges he faces as one who must care intensely for the individual patient and family yet musf make the entire system work for all within a budget while completing the ever present Army mission. Almost a schizophrenic task(s) which can best be negotiated by training, education and experience based on a solid value system. 703 444-5000. Good luck and God Speed. Dr G.

  • Dr.Gawande is an excellent doctor and writer and a popular in demand speaker. Dr. Bohdann O’s comment below is very appropriate.
    Dr. Gawande’s association with the 3 Amigos is just an Ego trip for all of them and will make them richer and may reduce a little insurance company profits.
    But the health of the average American gets only worse as they Refuse to take personal responsibility for their health and the Obesity curse gets horrific day by day and the consequences will break any health care system. It is no brainer. Other nations like Holland and China who practice and encourage preventive health care and keep health care costs lower are examples to be emulated. God only can help America.

  • As a graduate of the health policy and management program at Harvard, I can appreciate why Dr. Gawande (a graduate of the same program) would want to take on this job.

    Dr. Gawande is remarkably well tempered and talented.

    His checklist approach to surgery and to medicine will save more lives and do more good in the long run than any Nobel Prize earning research.

    Reforming American medicine is a totally different matter.

    Gawande’s article, the Cost Conundrum, was in my opinion one of his weakest pieces. Most of his writing is excellent if not superb.

    Cost Conundrum is about Hidalgo County Texas. It is on the Mexican border, is named after the Mexican priest who helped start the Mexican Revolution against Spain.

    It is one of the very poorest counties in the United States. It does not even have a community college. Its health care delivery undoubtedly needs reform, reorganization, national health insurance, and better population focused medicine.

    Health care costs are remarkably high at Harvard and it is unfair for someone who works at Harvard to travel to Hidalgo County and criticize it for its poor performance and high cost in health care delivery.

    I somehow doubt that Hidalgo County is on the radar screen of Amazon, JP Morgan, or Berkshire Hathaway. Yet, the future of our health care system depends upon the reform of places like Hidalgo County.

    It is fundamentally impossible to reform American medicine and health care delivery working within the private sector. I wonder whether Amazon, JP Morgan, and Berkshire Hathaway consume anywhere near one percent of our health care expenditures.

    We desperately need a national debate on how to develop a national consensus on what we want out of health care. We also need a vision on how to make our population healthier. Health care delivery does not make you healthier. It works to correct or repair the damage we have done to ourselves through our lifestyles or to mitigate the misfortune of bad genes, unfortunate accidents. That is not taking place for fear of setting social goals or bringing about rationality to our system. Social goals and rationality in our system would reduce profits and spending within health care.

    Only global budgeting with universal social objectives is likely to make a difference. But that is not on the agenda in this country at this time.

    • Very well written Dr Oryshkevich. I am a not a trained business type doctor. In fact I have never really truly managed an office. I am a generalist trained in family practice at a military hospital who spent most of my career doing emergency medicine in the rural upper midwest with a two year stent as a hospitalist in a midsized community hospital (excellent training in end of life care and how very few physicians will approach the issue with families because it is too time consuming and emotionally draining) and also a rather unique experience as a rural family physician in Canada along the US border (what an eye opener). Intermingled with all this is a brief encounter with the VA, a two month locum as an FP in winter in Alaska north of the Arctic Circle, and volunteering in hospitals in Africa, Papua New Guinea, and Iraq. I am now working in a clinic in one of the most dangerous cities in the US with a majority of patients African American. I have reached the point where I just can’t see Americans having an adult conversation about health care. It seems everyone knows we need to do something but like everything else politically they want someone else to give something up, not themselves. I had fascinating conversations with Canadians who would politely ask me to explain the actual thought processes that go on in the American mind about why ‘we’ think that their system is so ‘evil’. Anyhow, I don’t think we will change until the system actually collapses. Thank you for your eloquent analysis.

    • You are smarter than the 4 of them! Well said. Those so enamored by either the wealth of an individual or the idealism of someone’s writing are placing false hope on the merits of each…One’s IQ doesn’t go up by winning the lottery. Likewise just because your are intelligent doesn’t mean you can sing opera.

  • Gawande most certainly gives this project the air of respectability. I remain doubtful about the true intentions of people like Bezos, and the other billionaire Tech “Geniuses.” One Fact that is left out of all of these healthcare discussion is that we are already paying to the tune of @10 K a year per American, for this bloated and ineffective system.
    The pursuit of profit while the media portrays an alternate reality about healthcare, has many people confused. The demonization of “Government Healthcare,” by the profiteers, investors and now the Agencies themselves is non stop. This is what happens when Capitalism runs amok. The US has large health disparities, and the outcomes are hidden. Health Industry Lobbyists told CMS that collecting certain data is “Government Overreach.” The well worn trope about choice is really a myth, that needs to be dispelled.

    Gawande might be one of the good guys, but the forces at work here, are very devious. Letting Americans suffer for profitability has been a good model for the Industries involved. They re-framed all of that to blame the patients, the family and anyone that speaks up is now “Mentally Ill.” Dissatisfaction with ones healthcare is a diagnosis, thanks to the American Psychological Association, just one more way they sided with profit over people.

    • I am an American physician who is Canadian trained. I spent six years at the McGill Faculty of Medicine at the other MGH, not the Mass General Hospital.

      I returned from Canada to the HSPH as a WK Kellogg Foundation Fellow. American medicine exists in an alternative reality as Dr. Craig Holland pointed out.

      I also have the same Health Policy and Management degree from Harvard Dr. Gawande has.

      Private systems in the USA will always subvert discussions of health care reform for their own benefit.

      Harvard Medical School is a private medical school with its own interests and mission in mind. The Harvard School of Public Health is a private school of public health. Its health policy and management program educates professionals to run private hospitals and enable them to work in the black. We have the most expensive hospitals in the world.

      Dr. Gawande is very bright and sincere, but he is also soft spoken and tolerant. I doubt he can transcend his medical roots and discipline the behemoth.

  • I was Gawande-hooked since reading “Being Mortal” last year as I cared for my brother (who had since passed on) through his end-of-life journey by way of prostate cancer; I continue to download every article in the internet by and about Dr. Gawande and am so happy to learn about his new engagement as CEO for an innovative healthcare initiative. I plan to adapt his ideas in my advocacy for end-of-life care in rural Philippines.

  • A note to all who write, speak and share your ideas because you have expertise in an area you are passionate about. I thought this was interesting how Atul Gawande was taped for the job of CEO of the new health care model of Amazon-Berkshire-JPMorgan health venture. The article shows you never know when someone will read something you wrote or listen to you speak and tap you for an important job or use the information to change their lives. The moral of the story is don’t underestimate your potential. Best of Luck Dr. Gawande. On your listening tour, I would love to introduce you to the leadership of the Case Management Society of America, the professional organization for those working in the area of case management. We would love to help you work through how you develop the mission/vision of this new venture.

    • The first step is a “listening tour”.
      This conjours memories of a similar “listening tour” that was undertaken in the 1990s by the First Lady at that time. Let’s hope this “listening tour” has a different outcome, or history may repeat itself.

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