4 ms·

Your point seems true regarding that particular article, though I dont think that is sufficient to demonstrate that he doesnt understand the system. As a surge

Your point seems true regarding that particular article, though I dont think that is sufficient to demonstrate that he doesnt understand the system. As a surgeon, I'm sure he knows the barriers to adoption of such a tool, and being the head of a large buying consortium for health insurance (Amazon / berk / jpm) could give him the market power to "wag the dog" and push payers to implement such policies. But i agree that the checklist manifesto is prob not the best / most practical way to reduce spend I'd point to another article, his "cost conundrum" article actually was a pretty insightful piece that I think gets at the core of one of the main drivers of high HC spend: local monopolies [1] Another article of his, the "hot spotters" [2], was very influential among providers, administrators and even VCs as well. However, I dont think he's right that addressing frequent fliers is the solution -- you see the same cost concentration among a few patients in all countries, and even across time, so it doesnt appear that that phenomenon is the cause of the US' unique expensiveness i dont know of many other people who have ideas that demonstrate the same combination of independent thinking, reach / visibility and understanding of the system as atul gawande (i actually dont think there are many great ideas to improve healthcare, most dont even diagnose the problems accurately). some of his ideas will be wrong, but he has new and solid hypotheses, and being able to test those and learn is a great way to make progress [1] https://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum https://www.newyorker.com/magazine/2009/06/01/the-cost-conun... [2] https://www.newyorker.com/magazine/2011/01/24/the-hot-spotters https://www.newyorker.com/magazine/2011/01/24/the-hot-spotte...

entee 8y ago
Your point is an excellent positive case for his appointment :). I fully agree with you on monopolies and hot spotters. The monopolies are a pernicious issue that's incredibly hard to solve, and targeting hot spotters is not likely to be the silver bullet people hope it will be. I hope he succeeds given his perspective, I'm just skeptical that he can given the scale and structure of the problem. In particular the monopolies issue seems utterly intractable. Maybe some combination of remote care and creating vertically integrated treatment centers can help? I don't know, healthcare is really hard. I just hope this isn't a flash/vision over nitty gritty execution appointment.
- aaavl2821 8y ago
  I agree that lack of ops / execution experience is a potential concern, but for me the characteristics that make me most positive are 1) ability to connect with a wide audience of physicians and 2) courage: a willingness to fight the "powers that be" and try things that probably won't work, as long as you get enough shots on goal to do something that does (not sure how courageous he is but his willingness to put himself out there in ways that most docs dont do is encouraging). Rushika Fernandopoulle at Iora has these qualities and they seem to make up for his lack of healthcare ops experience (though I dont know that his model is sustainable / scalable enough) I think these are important because my hypothesis is that the way to tackle the monopoly issue is by reversing the trend of hospital consolidation and purchasing of independent providers, and putting more power in the hands of physicians rather than health systems or payers. But to do that you need to make being an independent physician feasible again, and to learn how to do that you need to connect with a lot of physicians and then be in a position to create services and products to help them become independent (probably by getting payers to pay independent docs more / reducing auth and other burdens; maybe this company has the heft to do so). I don't know that Atul Gawande's the perfect person for that, but I know that anyone who has run a hospital or payer is probably not right

entee 8y ago

Your point is an excellent positive case for his appointment :). I fully agree with you on monopolies and hot spotters. The monopolies are a pernicious issue that's incredibly hard to solve, and targeting hot spotters is not likely to be the silver bullet people hope it will be. I hope he succeeds given his perspective, I'm just skeptical that he can given the scale and structure of the problem. In particular the monopolies issue seems utterly intractable. Maybe some combination of remote care and creating vertically integrated treatment centers can help? I don't know, healthcare is really hard. I just hope this isn't a flash/vision over nitty gritty execution appointment.

aaavl2821 8y ago
I agree that lack of ops / execution experience is a potential concern, but for me the characteristics that make me most positive are 1) ability to connect with a wide audience of physicians and 2) courage: a willingness to fight the "powers that be" and try things that probably won't work, as long as you get enough shots on goal to do something that does (not sure how courageous he is but his willingness to put himself out there in ways that most docs dont do is encouraging). Rushika Fernandopoulle at Iora has these qualities and they seem to make up for his lack of healthcare ops experience (though I dont know that his model is sustainable / scalable enough) I think these are important because my hypothesis is that the way to tackle the monopoly issue is by reversing the trend of hospital consolidation and purchasing of independent providers, and putting more power in the hands of physicians rather than health systems or payers. But to do that you need to make being an independent physician feasible again, and to learn how to do that you need to connect with a lot of physicians and then be in a position to create services and products to help them become independent (probably by getting payers to pay independent docs more / reducing auth and other burdens; maybe this company has the heft to do so). I don't know that Atul Gawande's the perfect person for that, but I know that anyone who has run a hospital or payer is probably not right