We're Not Gonna Take It: Amazon Delivering Healthcare?



Harry Greenspun, M.D.

Chief Medical Officer, Managing Director, Health Solutions

Korn Ferry

February 13, 2018

Healthcare stories are very popular in the mainstream media because they are usually relatable, inspiring, or fascinating. A quick glance at one of my usual sites features coverage of the flu and people overcoming opioid addiction. The highlight this week in the fascinating column is “Couple finds worms in their feet after a beach vacation.” However, aside from big political stories, healthcare rarely gets to be a top story or wear a flashy “breaking news” banner.


That changed when Amazon, Berkshire Hathaway, and JPMorgan unveiled plans for a new company to lower healthcare costs for their employees. Of course, when I say unveiled, I mean they put out a four-paragraph press release. However, that was enough to propel them to the top of every major news outlet and send shockwaves through the stock market. These titans of industry, with a history of growth, innovation, and disruption, looked poised to reshape the healthcare, starting with their combined one million employees.


My first reaction was, “Wait, haven’t I seen this somewhere before?”


The strong feeling of déjà vu was shared by many my colleagues. We have seen this play out many times before, in which a large company or consortium declares healthcare broken and, by their size, reputation, capabilities, or forcefulness, says that things are going to change. If this were a musical, invariably it would start with Twisted Sister’s “We’re Not Gonna Take It.”


In the last two decades, several large-scale efforts were launched to lower costs and improve quality and service. Typically led by large employers, sometimes with a health system or payer in the mix, these initiatives would identify an obstacle or core issue to address – the misaligned incentives of fee-for-service medicine, the lack of consumer engagement, etc. Not surprisingly, with technology companies as frequent participants, technology was often cast as the either the problem or the solution. Announcements are made, meetings are held, manifestos are drafted, and the work begins in earnest.


Sadly, many of these efforts never achieved anything close to what they set out to do or were abandoned entirely. Why?


Fundamentally, not only is healthcare hard, but it often behaves quite differently from other industries (including the ones seeking to revolutionize it). Entrenched interests and misaligned incentives have proven exceedingly hard to dislodge. Even with large collective pools of employees, their influence across broad markets can be limited. Moreover, employees often have little trust that their employer is acting in their best interest. While an employer might want to lower their costs, and promote health and wellness, employees often see this as negatively. They may perceive such actions as forcing them to do things they don’t want to do (like exercise or quit smoking), restricting their access to certain doctors or therapies, or simply just doing what’s best for the company but not for them. Complicating matters further, the value received depends heavily on your point of view. Individuals may want great service while companies may want highest quality at the lowest cost. Caregivers in the middle may have complex personal and economic drivers.


Still, don’t take my skepticism and appreciation of 80’s hair metal as pessimism. Healthcare is clearly ripe for disruption and recent efforts indicate that it just might happen. Organizations such as the Health Transformation Alliance are gaining traction, reshaping the traditional employer-payer-provider-employee relationship. As details emerge from this most recent announcement, we will get a better understanding of their goals and priorities. My hope is that they want to reshape healthcare, starting with their own employees. The question remains whether they will have the leadership that can create a new healthcare culture and mindset, or if they will join the myriad of other well-intended efforts that fell short.


“We’re right, we’re free, we’ll fight, you’ll see!... Oh, we’re not gonna take it anymore!”



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