Atul Gawande is a brilliant person with interesting ideas on how to make healthcare more humane and robust. This is still probably a terrible choice of CEO.
To my knowledge he has never run a large organization or dealt directly with the complex backend of the healthcare system. The was healthcare is delivered and paid for is full of independent, semi monopolistic players that have often conflicting incentives. Oh and lets not forget that we have 50 states and 50 different sets of regulations.
Unless the plan is to create a brand new completely vertically integrated system, you’re gonna have to deal with the existing infrastructure, and I’d be much more confident in success if the person leading that effort had experience there. Having worked with many physicians and insurance companies, I can say from experience those skill sets are not the same.
Even if the idea is to be vertically integrated, someone like the CEO of the Mayo Clinic or Kaiser would have been a better choice.
I’d say hire that person as the COO. This will be a big organization. I think the person at the top needs to have a strong ideals about the direction of the organization
I know appeal to authority is obviously a bad way to support an argument, but I would imagine one thing the most senior people at Amazon, Berkshire Hathaway and JPM are fairly decent @ is picking management talent. So if all 3 sides agreed on a pick I would imaging there was pretty compelling case.
Considering how f...ed up the American health system is on all levels I am fine with giving an outsider a chance. Gawande appears to be a reasonable guy and a good communicator. Even if he fails, nothing is lost because the system can't get worse.
from my experience, getting these senior insiders to lead a newco would just result in more incremental innovation. Most of them came up in and benefited from the current broken system and are either too conservative to embrace drastic change or don't want to rock the boat.
I don't think something like Kaiser could be easily rebuilt from scratch, but I don't know too much about the Mayo Clinic except for its reputation for clinical excellence and their active investments in innovation. Have they implemented new models to meaningfully lower cost of care?
I also imagine Atul gawande has enough experience with the existing system to know what ideas have a chance of working vs running into a brick wall of conflicting incentives. He can hire somebody to lead negotiations with insurance companies and providers, etc
>Atul Gawande is a brilliant person with interesting ideas on how to make healthcare more humane and robust
No, he’s not.
No offense to him, but he’s a -popularizer-. He takes various bits the HC quality improvement folks have been talking about / doing for years and writes (very articulate, engaging) articles that make it accessible to the wider community, including the wider medical community that normally isn’t in on those discussions. He also has a habit of relating it in a fairly shallow/one dimensional way, compared to the real deb-
Malcolm Gladwell. He’s Malcolm Gladwell, but for healthcare.
Fair point but Atul strikes to me as a problem solver kind of person. He has obviously got the intellect and precedent in that area. What I also think is this is _the_ job that will benefit greatly from a guy who has a fresh outlook not sullied by existing ways of doing things.
As another person said below, they could easily hire a COO to deal with existing aspects of the system and still have the overall direction in the hands of someone like Atul.
For months the word from the rumor mill has been they have been struggling to find someone willing to take the job.
The ill defined mission of the organization along with perceived potential conflicts in priorities among the 3 companies has made candidates hesistent.
He's certainly a mismatch for the likes of Amazon and I'll bet won't have a long tenure. Reading about their worker healthcare ("AmCare"), one pictures a rusty tin of stained bandages. And a permanent mark on one's employee record if the tin is opened.
"Unless the plan is to create a brand new completely vertically integrated system"
Judging by the companies involved, this is most likely the plan. Whatever they create will like cause the existing system change to it and not the other way around.
This is the equivalent of promoting your best developer into management. Atul is a smart hard working guy. I’m sure he’ll work hard and do ok, but on the face of it he’s a silly choice.
I can thoroughly recommend reading Atul Gawande's "Checklist Manifesto". The premise, on the face of it, is mundane, but the stories that back up the claims are thoroughly enjoyable to read. http://atulgawande.com/book/the-checklist-manifesto/
Thanks for bringing this up! The name of the CEO didn't ring any bells for me until your comment. I've read the book and loved it; I second the recommendation.
This is the type of topic where I feel that HN community tends to not provide valuable insight as it's outside of the community's collective expertise. How many individuals here have hired SVP+ level employees and how would that compare to the collective experience of Bezos, Buffet, and Dimon?
Bezos, Buffet, and Dimon are unfortunately not available today to discuss this topic in the HN forum so you're stuck debating the pros and cons with us [fellow?] peasants, sorry.
When I read the checklist manifesto I thought it was going to change my life. It didn't because I didn't put it into effect.
Then I thought it would be great if software did the work for me, including communal checklists that people can share with me. (Got a new car, here is a checklist template. Got a new house? Here is the checklist template? Is it an investment property, use this checklist. Oh, that is good for Florida, but in Texas, use this one.)
I found some software that is sort of close but nothing quite there.
Edit: Atul Gawande wrote the book so it is sort of tangentially related. I could make it more relevant by explaining how his checklists make him a general purpose leader or something, but I can't bring myself to do it.
If you want to learn a little more about how Atul Gawande looks at the healthcare system read Being Mortal. IMHO it's more relevant than Checklist Manifesto, esp. wrt what Amazon could do here: https://www.amazon.com/Being-Mortal-Medicine-What-Matters/dp...
While Checklist Manifesto is about operational efficiency and quality, Being Mortal is about asking if we're doing the right things in the first place.
Literally just listened to his podcast he did with Freakonomics Radio yesterday. Definitely a great mind.
For all of you developers/operations folks out there, I recommend reading his book The Checklist Manifesto. Every team can learn so much from that book about their everyday practices. We read it at our company book club, and began taking checklists and documentation much more seriously which I attribute too much better productivity, operations and less siloed dev.
I was just about to mention that podcast episode! He clearly has a good, realistic grasp of what can be done to improve healthcare outside of the political mudpit. I was skeptical when this company was announced, but I am now extremely optimistic.
BWH culture is crumbling so I won't blame him for seeking other opportunities. However, this is an odd/weak selection where I believe Amazon-Berkshire-Chase will regret. Toby Crosgrove, former Cleveland Clinic CEO, would have been a well-qualified candidate and better choice. He has over 10+ years of leading a highly complex AMC and elevating the organization into the top 3 hospitals in the country for many consecutive years. This man can get things done via transformative, sustainable, and systematic changes.
Alternatively, the CEO of Iora Health would have been a good choice too. Let's pause and compare performaces and outcome of between Cleveland Clinic under Crosgrove and Iora Health under their leader, and Adrianes lab under Atul. The result is clear. Atul doesn't have the experience only the Harvard brand. Being a CEO is different from being a professor, surgeon, philosopher, or executive director at the Adrianes Lab. In those roles and physician-led environment where MDs are treated like kings, the medical directors can put in 5-10% of their time with the expertise of administrators, interns, staffs and get away with having the breadth but little depth and claiming to be a SME. Atul seems like a good storyteller and highly intelligent physician, but he is absolutely an individual contributor. Frankly, Boston is full of highly intelligent and innovative people like Atul; the CEO of this venture should have more experience or at least specializes in one of the three verticals. Atul would have been a better executive advisor.
Concerns:
- He stated not wanting to give up his privileges of practicing at BWH and professorship at Harvard meaning he can't be fully committed to leading this new organization. This is not an academic medical center environment where a physician can have multiple administrative titles and not put in the hours and work.
- Atul's fame is credited to his publication, but also from the prestige of Harvard's affiliations. He knows this and is trying to strategic about not giving that up, but I would hope he realize that truly effective leaders know they can't do everything. Most of those innovator physicians stretch themselves too thin and get their hands into too many pots, making them ineffective. If he's serious, then he needs to commit and prioritize.
IMO, extreme network/lip service must have been invloved in his pursuit or the new venture and company is only buying his fame, reputation, and brand for marketing purposes.
This is the kind of healthcare CEO most health tech startups should have -- someone who lives and breathes the system, intimately knows it's flaws but still has the vision and desire to change it. That is the rare and valuable skill in healthcare -- even more rare than engineering or operations skill
Rushika Fernandopulle, the healthcare CEO I most admire, fits this profile
I love Gawande; he's an amazing author and very thoughtful, systematic physician. That being said, to my knowledge he has never actually run anything before or operated on the back end of healthcare, so it seems like sort of a strange choice for an org this size and of this type.
Additionally, his (publicly stated) thinking seems to primarily revolve around systematizing routine practice to reliably increase outcomes for the majority of patients (ie what he espouses in Checklist Manifesto). While this is certainly important, routine patients are not responsible for most health care spend, edge case patients are. A tiny minority of very sick people account for a majority of health care spend, so I would argue that cost recovery should center around creative management of these patients rather than more systematic management of routine care, and the org should really be led by someone whose thinking centers on that.
It's interesting reading the comments here. People with no background (I assume) in healthcare describe the guy as "brilliant" and "the perfect choice".
People with years of experience in healthcare question think he's a poor pick and just a famous name.
It's amazing what a good public relations strategy can do for someone!
Most accurate observation and comment on this topic! With 10+ years of healthcare experience including Brigham and Women's hospital many years ago, he's a good writer, storyteller, but truly is just a famous name that Amazon-Chase-Berkshire venture wants. Without the Harvard brand, his work, while good, wouldn't be that highly praised and worshipped. There are better visionary physicians out there.
My main takeaway is: being a good storyteller or facilitator on innovation does not make you any more innovative without the experience to support it. However, it can significantly elevate your personal brand beyond your qualificiations and apparently lure wealthy people to invest in you.
Atul gawande is based there and the Boston area is actually ahead of the Bay Area in terms of biotech startup scene and similar if not better in terms of healthcare services
Tyler Cowen's conversation with Mr Gawande[1] was well worth the time. I don't know enough about him or the new company's plans to speculate on how this will all work out (although: neither does anyone else in this thread), but he's clearly a highly intelligent and thoughtful person with deep domain expertise. I certainly wouldn't bet against.
This gives me hope for the US health care system. Gawande’s ‘Being Mortal’ really helped me understand what was happening when my dad was dying. Highly recommend it
He's written a lot for the New Yorker is very intelligent and thoughtful. No idea how he'll adjust to being an executive of a corporation, but I think that is a risk worth taking. It sends a message that they will be patient-first and strongly evidence-based.
I've read most of Atul Gawande's books about the medical industry (Better, Complications, and The Checklist Manifesto) and I found the three of them extremely relevant to my career as a computer scientist. The latter book is by far his most famous, but IMHO the other two are much better.
This is a bold choice by Amazon, but it seems like a good idea even if it's just for name recognition.
I don't know how to fix this title, but it reads at a glance as either: Atul Gawande is going to be the CEO of Amazon, or that "Amazon" is the name of a Berkshire healthcare company.
EDIT: Thanks to the mods for the title fix, this is much better.
He seems like a very smart guy and an excellent communicator - I wonder if he'll be able to step up and make this role work. I will be rooting for him because the industry needs some players with deep pockets to step in and innovate.
On a side note I find it funny in a sort of inside baseball way that his description of an operation that he does, that he describes in detail and holds up as an example, drives my surgeon wife up the wall because it is not great (she does a lot more of them).
Curious, what are the n-order effects of large corporations reducing the cost of providing health insurance for their employees? My wages won't go up (probably), their profits will go up but I'm sure many other things happen in the middle. How will this affect taxes at the fed, state, local level? Will one level see an increase/decrease in taxes collected? etc.
[+] [-] entee|7 years ago|reply
To my knowledge he has never run a large organization or dealt directly with the complex backend of the healthcare system. The was healthcare is delivered and paid for is full of independent, semi monopolistic players that have often conflicting incentives. Oh and lets not forget that we have 50 states and 50 different sets of regulations.
Unless the plan is to create a brand new completely vertically integrated system, you’re gonna have to deal with the existing infrastructure, and I’d be much more confident in success if the person leading that effort had experience there. Having worked with many physicians and insurance companies, I can say from experience those skill sets are not the same.
Even if the idea is to be vertically integrated, someone like the CEO of the Mayo Clinic or Kaiser would have been a better choice.
[+] [-] baus|7 years ago|reply
[+] [-] qaq|7 years ago|reply
[+] [-] maxxxxx|7 years ago|reply
[+] [-] aaavl2821|7 years ago|reply
I don't think something like Kaiser could be easily rebuilt from scratch, but I don't know too much about the Mayo Clinic except for its reputation for clinical excellence and their active investments in innovation. Have they implemented new models to meaningfully lower cost of care?
I also imagine Atul gawande has enough experience with the existing system to know what ideas have a chance of working vs running into a brick wall of conflicting incentives. He can hire somebody to lead negotiations with insurance companies and providers, etc
[+] [-] arkades|7 years ago|reply
No, he’s not.
No offense to him, but he’s a -popularizer-. He takes various bits the HC quality improvement folks have been talking about / doing for years and writes (very articulate, engaging) articles that make it accessible to the wider community, including the wider medical community that normally isn’t in on those discussions. He also has a habit of relating it in a fairly shallow/one dimensional way, compared to the real deb-
Malcolm Gladwell. He’s Malcolm Gladwell, but for healthcare.
[+] [-] blinkingled|7 years ago|reply
As another person said below, they could easily hire a COO to deal with existing aspects of the system and still have the overall direction in the hands of someone like Atul.
[+] [-] tssva|7 years ago|reply
The ill defined mission of the organization along with perceived potential conflicts in priorities among the 3 companies has made candidates hesistent.
[+] [-] pinewurst|7 years ago|reply
[+] [-] debt|7 years ago|reply
Judging by the companies involved, this is most likely the plan. Whatever they create will like cause the existing system change to it and not the other way around.
[+] [-] ryanmarsh|7 years ago|reply
This is the equivalent of promoting your best developer into management. Atul is a smart hard working guy. I’m sure he’ll work hard and do ok, but on the face of it he’s a silly choice.
[+] [-] glenscott1|7 years ago|reply
[+] [-] Tomte|7 years ago|reply
https://www.newyorker.com/magazine/2007/12/10/the-checklist
[+] [-] TeMPOraL|7 years ago|reply
[+] [-] JoshTko|7 years ago|reply
[+] [-] creaghpatr|7 years ago|reply
[+] [-] projectramo|7 years ago|reply
Then I thought it would be great if software did the work for me, including communal checklists that people can share with me. (Got a new car, here is a checklist template. Got a new house? Here is the checklist template? Is it an investment property, use this checklist. Oh, that is good for Florida, but in Texas, use this one.)
I found some software that is sort of close but nothing quite there.
Edit: Atul Gawande wrote the book so it is sort of tangentially related. I could make it more relevant by explaining how his checklists make him a general purpose leader or something, but I can't bring myself to do it.
[+] [-] anitil|7 years ago|reply
Of course, there's the usual issue of managing the 'chattiness' of the app, but I use it instead of a calendar.
[+] [-] acangiano|7 years ago|reply
[+] [-] miketery|7 years ago|reply
[+] [-] JacobDotVI|7 years ago|reply
While Checklist Manifesto is about operational efficiency and quality, Being Mortal is about asking if we're doing the right things in the first place.
[+] [-] collinf|7 years ago|reply
For all of you developers/operations folks out there, I recommend reading his book The Checklist Manifesto. Every team can learn so much from that book about their everyday practices. We read it at our company book club, and began taking checklists and documentation much more seriously which I attribute too much better productivity, operations and less siloed dev.
[+] [-] schnevets|7 years ago|reply
http://freakonomics.com/podcast/atul-gawande/
[+] [-] tbg7504|7 years ago|reply
Concerns: - He stated not wanting to give up his privileges of practicing at BWH and professorship at Harvard meaning he can't be fully committed to leading this new organization. This is not an academic medical center environment where a physician can have multiple administrative titles and not put in the hours and work. - Atul's fame is credited to his publication, but also from the prestige of Harvard's affiliations. He knows this and is trying to strategic about not giving that up, but I would hope he realize that truly effective leaders know they can't do everything. Most of those innovator physicians stretch themselves too thin and get their hands into too many pots, making them ineffective. If he's serious, then he needs to commit and prioritize.
IMO, extreme network/lip service must have been invloved in his pursuit or the new venture and company is only buying his fame, reputation, and brand for marketing purposes.
[+] [-] xxpor|7 years ago|reply
[+] [-] aaavl2821|7 years ago|reply
Rushika Fernandopulle, the healthcare CEO I most admire, fits this profile
[+] [-] Thriptic|7 years ago|reply
Additionally, his (publicly stated) thinking seems to primarily revolve around systematizing routine practice to reliably increase outcomes for the majority of patients (ie what he espouses in Checklist Manifesto). While this is certainly important, routine patients are not responsible for most health care spend, edge case patients are. A tiny minority of very sick people account for a majority of health care spend, so I would argue that cost recovery should center around creative management of these patients rather than more systematic management of routine care, and the org should really be led by someone whose thinking centers on that.
[+] [-] tonyedgecombe|7 years ago|reply
[+] [-] refurb|7 years ago|reply
People with years of experience in healthcare question think he's a poor pick and just a famous name.
It's amazing what a good public relations strategy can do for someone!
[+] [-] karl11|7 years ago|reply
[+] [-] tbg7504|7 years ago|reply
My main takeaway is: being a good storyteller or facilitator on innovation does not make you any more innovative without the experience to support it. However, it can significantly elevate your personal brand beyond your qualificiations and apparently lure wealthy people to invest in you.
[+] [-] sp332|7 years ago|reply
Just wondering if there's a big regulatory benefit to being in Massachusetts.
[+] [-] aaavl2821|7 years ago|reply
[+] [-] Thriptic|7 years ago|reply
[+] [-] nelsonic|7 years ago|reply
[+] [-] jaredhansen|7 years ago|reply
[1] https://medium.com/conversations-with-tyler/atul-gawande-che...
[+] [-] baus|7 years ago|reply
[+] [-] tootie|7 years ago|reply
https://www.newyorker.com/contributors/atul-gawande
[+] [-] mFixman|7 years ago|reply
This is a bold choice by Amazon, but it seems like a good idea even if it's just for name recognition.
[+] [-] ocdtrekkie|7 years ago|reply
EDIT: Thanks to the mods for the title fix, this is much better.
[+] [-] conorh|7 years ago|reply
On a side note I find it funny in a sort of inside baseball way that his description of an operation that he does, that he describes in detail and holds up as an example, drives my surgeon wife up the wall because it is not great (she does a lot more of them).
[+] [-] unknown|7 years ago|reply
[deleted]
[+] [-] yanslookup|7 years ago|reply