Healthcare has the power to transform lives. But who has the power to transform healthcare? The answer seems to be large employers, who are increasingly frustrated with the challenge of providing their employees with affordable, high quality care. The problem isn’t new. During World War II, the industrialist and shipbuilder Henry Kaiser transformed healthcare for workers in his West Coast shipyards by creating what became the Kaiser Permanente health plan. This week, Amazon, Berkshire Hathaway, and JPMorgan Chase announced their intent to pursue a similar objective for their employees through the formation of an independent company “free from profit-making incentives and constraints.”
These three companies bring a fascinating variety of perspectives to the challenge of healthcare. Amazon disrupts other businesses and does so quickly and creatively. Berkshire Hathaway invests for the long term, prudently managing capital and cash flow. JPMorgan Chase helps businesses and governments through financial crises and has done so for over 200 years. We don’t know exactly how these companies will seek to transform healthcare, and there is no reason to think their solution will be the next Kaiser Permanente. But we believe there are five areas where they are likely to focus their efforts.
1. The Internet of Health
Twenty-plus years ago, Amazon began as an online bookseller. Today that part of the business has developed into the creative collection and use of data to drive consumer purchasing across an immense range of products and services. How might they apply similar techniques for the benefit of healthcare consumers?
Amazon’s success in building a dominant cloud computing business may prove valuable in achieving their goals of increased transparency and simplicity. While many clinicians have adopted electronic medical records, a lack of standardization and incentives to share data has made it difficult to unlock the potential of that data to feed innovative analytics. Amazon has a history of finding ways to break tangled infrastructure problems down into manageable pieces with clear interfaces—in other words, to create simplicity out of complexity and make it easy for systems to talk to each other.
The data collection process might also include information gathered from social media activity, online purchasing, and wearable devices or smartphones– just recently Apple announced it was bringing health records to the iPhone. The application of predictive modeling methods to this data could then provide the ability to monitor individuals’ health status and risk factors in real time, leading to early warnings of acute medical events or suggested actions to manage heath risk and cost. For instance, does your fitness tracker show a higher than usual heart rate after your weekly jog? Have you been buying an unusual amount of ibuprofen? You might receive a notification to stop by the employee health center at your earliest convenience for a free physical exam.
2. Online shopping for healthcare
The lack of competition and pricing transparency among healthcare providers contributes significantly to the high cost of healthcare. What if the same technology that powers Amazon’s online marketplace were used to create a nationwide transparent cost network of hospitals, physicians, and pharmacies? Imagine an online marketplace where providers and pharmacies compete for patients by leveraging cutting-edge technology to update their fees in real time while making it easy for patients to see and compare value across the providers that deliver the care they need. Patients and third-party sources could provide satisfaction and quality rankings to further inform decision-making. The transparent cost network would facilitate innovative benefit designs and consumerism in healthcare where patients could get full coverage for the highest-value providers but would need to pay more for higher-cost providers. This solution would also significantly reduce the administrative costs associated with contracting with providers and paying claims.
3. Pharma of the future
Pharmacy spending represents a meaningful portion of total healthcare costs, and no area has been more intensely scrutinized in recent years. Large employers and employer coalitions have tried for some time to leverage their purchasing volumes to negotiate lower drug prices, and it is unlikely that the mere aggregation of three large companies would result in material further savings beyond what has already been achieved by large national pharmacy benefit managers and other successful coalitions. A more fundamental transformation of the drug purchasing process would be required. How might this occur?
Berkshire Hathaway and JPMorgan Chase may take a back seat in the media when compared with Amazon, but they’re a part of the equation for a reason. As financiers, they might develop creative value-based contracting solutions to provide pharmaceutical manufacturers with a more predictable profit stream over the life cycle of a specific drug—from the immense investment in research and development, to the high returns of a specialty drug under patent protection, to the much lower margins available once the drug becomes generic—all in exchange for improved pricing while the drug is under patent. The data management and predictive analytics capabilities of Amazon could help improve medication adherence, identify personalized medicine opportunities, and monitor medical outcomes. This information is of immense value that could help bend the cost curve and be returned to drug manufacturers and other entities in the pharmacy supply chain, perhaps in exchange for favorable pricing terms or to hold manufacturers financially accountable for clinical outcomes.
4. Claims could be a thing of the past
Both providers and payers expend massive resources on submitting and paying insurance claims. The CFO of a prestigious hospital system once anecdotally said he has more billing clerks than hospital beds. While that may not be the norm, the healthcare system generates on average more than 10 claims for every person every year. On the receiving end, health insurers employ massive infrastructure to process those claims, a system that has changed little since the 1980s. But claims do serve a purpose: in addition to providing records for invoicing and payment, claims represent the primary data collection process for insurers. What if there was another way to collect the information the health insurer needs while significantly enhancing the richness of that data at the same time?
The answer is simple: the electronic medical record. Today, most physicians and all hospitals collect information about every patient encounter in an electronic medical record; claims are a relic from a time when medical information was maintained on paper records in color-coded file folders. Direct access to medical record systems by insurance companies could eliminate the claims process while enhancing the data available for healthcare analytics.
5. We become better patients
Amazon, Berkshire Hathaway, and JPMorgan Chase employees are part of a pilot program to test all kinds of healthcare system strategies. One foundation of successful start-up firms is the concept of A/B testing—a controlled comparison of two groups—to rapidly learn what strategies affect consumer behavior leading to desired outcomes.
The industry to date has used a variety of instruments to influence consumer behavior, such as high-deductible health plans and wellness programs, but such efforts aren’t typically tailored to an individual’s personal profile. Machine-learning technology could be employed to incentivize consumers to be more efficient patients. In the same way artificial intelligence can learn which movies to recommend or which products are appealing, value-based insurance design can identify the best incentives to make sure diabetic patients monitor their blood sugar levels and take insulin as needed, thereby improving outcomes and reducing healthcare costs.
Chance of success?
Transformation is by no means certain. While the announcement of this partnership brought excitement to many within the industry, there are still many details to be ironed out and much uncertainty around what issues the group will tackle first. Many would-be disruptors have found healthcare’s problems less tractable than they expected, and solutions that worked in other sectors will need to be custom-tailored to have a chance of being successful. Healthcare is personal in ways unlike any other industry, and the stakes of getting it right are literally life-and-death. Assessing previous attempts at healthcare disruption, partnering with forward-looking healthcare experts, and staying focused on the end-user will allow this new organization to learn from past mistakes and further its goal of transforming and improving the healthcare marketplace.