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Before last month, David W. Smith was a midlevel executive at the sprawling health services company Optum. He’d never met the company’s CEO, according to a sworn affidavit, or cracked into a senior leadership team that includes about 200 people. He was basically a strategy consultant.

But on Dec. 11, he became an existential threat. He took a job working for a nascent competitor, the health venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase & Co and helmed by Dr. Atul Gawande.

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