Dr. Atul Gawande, the famed surgeon-writer-researcher chosen to lead a joint health venture by three prominent employers to bring down health costs, said his biggest goal is to help professionals 鈥渕ake it simpler to do the right thing鈥 in delivering care to patients.
His comments at the came just days after chief executive of a health care partnership unveiled earlier this year by Amazon, Berkshire Hathaway and JP Morgan Chase & Co. The new enterprise will oversee health coverage for about 1.2 million employees of the companies and their families. Gawande said he will focus on the same behaviors by doctors and hospitals that he studies at his Boston-based think tank Ariadne Labs.
One of the biggest problems in health care is that 鈥渄oing the right thing is incredibly complicated鈥 and that one of the biggest sources of waste in the system is that patients are given 鈥渢he wrong care in the wrong way at the wrong time,鈥 he said
He said he hopes to find specific ways to make health care more efficient and the solutions exportable.
鈥淭he opportunities are as long as my arm,鈥 he said. 鈥淪o all we have to do in this new venture is pick a few of them and try to bat them out of the park.鈥
For example, he said, even in countries where everyone is covered by insurance only about half of those with high blood pressure have it controlled. In the U.S. that percentage is closer to 40 percent. And while Americans spend 鈥渢ons more money鈥 to treat low back pain, he said, 鈥渢he level of disability and pain has changed not at all.鈥
Gawande, 52, was purposely vague about his new job 鈥 which he will add to his long list of activities, including teaching at Harvard and operating on patients at a university-affiliated hospital in Boston, writing for The New Yorker and serving as chairman of .
鈥淲e are going to come up with a name, it鈥檚 one of my first jobs,鈥 he joked to interviewer Judy Woodruff of 鈥淧BS NewsHour鈥 during a session at Aspen on Saturday. On Monday, at another session, he told The New York Times鈥 David Leonhardt that he 鈥渉ad no idea鈥 how many employees would eventually come to work for the organization, although it will be a stand-alone, not-for-profit entity. He declined a separate interview.
But Gawande did talk at length in both appearances about his approach to the new initiative.
鈥淭he largest concept here is I get to have a million patients that I as a doctor get to add to my responsibility,鈥 he said Saturday. 鈥淎nd my job to them is to figure out ways that we are going to drive better outcomes, better satisfaction with care and better cost efficiency with new models that can be incubated for all.鈥
That is essentially what Ariadne already does 鈥 tests ways to make care more effective and efficient and spreading those practices in the U.S. and abroad.
As an example, he talked about his mother鈥檚 recent knee replacement. A total of 66 health workers saw her in the hospital 鈥 he counted 鈥 and often provided conflicting advice about whether she should be up or in bed or exactly what she should be doing.
鈥淎nd you just want to say, 鈥業s anybody in charge?鈥欌 he said. 鈥淭hat鈥檚 the broken system.鈥 The system is moving 鈥渇rom individual delivery of stuff 鈥 to team delivery of outcomes. And that鈥檚 a radically different place.鈥 He wants to help make that transition more effective.
Gawande said his research has also shown that 鈥渢he right care鈥 can鈥檛 just be dictated. He developed a now-famous that was later mandated for doctors in Canada. But he pointed out in his discussion Saturday that the requirement showed no reduction in surgery-related mortality. Yet in Scotland, where the implementation was more gradual and more data-driven, he said, 鈥渋n the first three years we saw a more than 25 percent reduction in deaths.鈥
Gawande said that although he is going to work for companies that provide insurance to their workers, 鈥渆mployer-based care is broken,鈥 with the vast majority of new jobs lackinghealth insurance.
And even those workers who are offered job-based health insurance are increasingly priced out of care. Some people he grew up with in Ohio, he said Monday, 鈥渁re paying half their income in taxes and health care premiums and going bankrupt because of health care costs.鈥
When workers have deductibles that are multiples larger than their bank accounts, they stop treating their chronic conditions. 鈥淎nd it has enormous harm for the future,鈥 he said.
Still, he was optimistic about the possibilities of making health care both better and less expensive.
鈥淚t鈥檚 feasible to do these things,鈥 he said Monday. 鈥淏ut it鈥檚 not sexy.鈥
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