ASPEN, 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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  • I have enjoyed reading all of your enlightening posts, thank you. Having worked in a variety of health care specialties as a nurse for over 37 years I have witnessed clients being discharged much less prepared to care for themselves and family members. When I first became a nurse in 1981 patients were kept in the hospital because the health care team decided they were not “quite ready” to be discharged. Now discharge is dictated by the insurance company with minimal medical input. Although discharge planning should start the day of admission it typically begins the day of discharge. Upon learning that Amazon, Berkshire Hathaway and JP Morgan were collaboratively hiring Dr. Atul Gawande to “dive deep” into how we can improve the health care system. The fact that the selection was a physician is so refreshing. There is currently a disconnect between patient care and the health care team. I foresee this team (yet to be named, but Centsible Health Reform (CHR) is my recommendation) initially performing a gap analysis to determine where the effort needs to be placed to create the greatest positive impact in health care. Is the solution having an interpreter at every physician/patient intervention for both language and health literacy? Should all health care providers be fluent in a second language? Do we need to focus on our elderly population and make sure they are each assigned a patient advocate that is readily assessible during all transitions of care; during their hospital stay, after discharge and attend all MD visits with them and assure they fully understand and can implement the HCP’s plan of care at home? I applaud Jeff Bezos, Warren Buffet and Jamie Dimon for hiring a Medical Captain that now has the difficult task of assembling the crew and then determining where to direct the initial sail. It will be very fascinating to observe how this initiative progresses.

  • CNBC reports that Amazon plans to launch and run primary care clinics of its own for its own employees.

    One has to wait for confirmation.

    First, this is not primary care. Primary care is unconflicted and relational advocacy for one’s patients. Being an employee of the patient’s employer presents an inherent conflict of interest. This relates to both the interest of the patient and to his privacy.

    Second, owning such a clinic would be using the clinic as a de facto profit center.

    The concept of primary care has declined in this country as hospitals and HMOs and corporations have bought up physician practices. Physicians are thus meant to serve the interests of the hospitals and provide in hospital referrals.

    http://www.cnbc.com/2018/08/09/amazon-plans-primary-care-clinics-employees.html

  • I guess you people really don’t get it. Bezos has had a problem lately with injured warehouse workers. Just like every other employer in America, and all of the major minimum wage employers, this cuts into profits. Amazon has used the same tactic employed access America, postpone, deny delay, for their injured workers.
    Many states have Medicaid but they also have higher taxes, so Amazon wold never locate there. If injured workers “luck out” and get Medicaid eventually, the tax payers can pay for the injuries later on. Since a percentage of these unemployed, injured workers, have musculo skeletal injuries, they had to create a counter narrative. They redefined these injured workers as either “Mentally Ill” or Drug Addicted. The so called opiate epidemic has been a great cover to avoid paying for injured workers. They transferred the costs to all of us. This is the business model. They get the profit and the taxpayers subsidize it all. At the same time they demonize the sick, the low income and the economically disadvantaged.

    They need Dr. Guwande to put a nice face on all of it. Of course their upper echelon employees will have the best healthcare available. The rest will be blamed for getting injured, while the media gushes over how innovative they are. At Davos they listened to lectures by experts who repeated how innovative they are while blaming income inequality and despair on “Mindset.”
    Bezos doesn’t want to invest any money in making his shipping facilities safer, the employees are disposable and deniable. There is a “Wellness Coach” or well paid Psychologist available to tell them that.

    • Mavis Johnson raises excellent points.

      Warren Buffett came out during a recent PBS interview on the News Hour for single payer insurance. So, we do not know what to expect from this new entity.

      Dr. Gawande has done some excellent work within hospitals. He has also written eloquently about the doctor patient relationship. He has not written much on health policy. It is not at all clear what he hopes to accomplish working with his new employers and task.

      Hopefully, it will not be a form of patrimonial benevolence or capitalism.

      Some writings of Dr. Gawande demonstrated poor understanding of what ails medicine globally in this country. He is a highly successful and respected doctor at an elite hospital. He has not seen how the real world of medicine works.

      It is possible that JP Morgan, Amazon, and Berkshire Hathaway want to divest themselves of health care delivery and may even support what Americans like to call single payer.

      We have to wait and see.

      Certainly, Dr. Gawande’s performance may make or break his reputation.

  • When naming a business it is crucial that it describes its focus, thus I have created the perfect name. I am also interested in when the recruitment team will be created.

    Centsible Health Reform (CHR)

  • Is he the head of the NIH or CDC under tRump?? THAT would be an impossible job for a committed earnest physician…

  • Rick; Do you happen to know if Dr. Guwande will be using a recruitment firm to begin to assemble his team? Is there any way to find out?
    Thank you.

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