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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 t

by 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

by entee 8y ago

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