Hubris Overdose

The last item I wrote in this space was in October. The continuing onslaught of COVID-19 seemed to me to make all other subjects in healthcare of lesser importance. While the onslaught continues and arguably has worsened, the advent of effective vaccines brings hope that there will soon be better times. As a result, other subjects in healthcare are beginning to be revived and discussed.

This week two developments in the non-clinical area of healthcare which I believe are related caught my attention. One development was in the private sector and the other was a bit of political legerdemain in the public sector.

In March 2019 in this space I addressed the subject of “hubris” by outside private sector experts who really did not understand healthcare:

There is a place for story telling in organizations.  At NorthBay Healthcare we used stories to reinforce our culture.  Stories work best if there is substance to back them up.  Otherwise, the recipients of stories can get cynical.

I thought about stories the past week when “Haven” was grandly announced.  This is the improbable name of the nonprofit organization formed by the CEOs of Amazon, J.P. Morgan and Berkshire Hathaway. What was Haven’s name supposed to convey?

“Haven” to me sounds more like a name better suited for a church or homeless shelter but I am sure the branding experts at these three companies spent hours and many dollars to come up with it.  I could have done it for free for them.

More to the point, was this another ego stroking effort by three prominent CEOs? Was that the story?

The mission of Haven per their website is as follows:

“Our mission is to transform health care to create better outcomes and overall experience, as well as lower costs for you and your family.”

That’s their public story and they are sticking to it.  Notice as usual, the initial emphasis in the mission statement is on quality.  It is only in the last clause they stick in “lower costs” as also part of their mission.

Haven’s CEO, Dr. Atul Gawande, made it clear that the cost of health care was a driving force in creating Haven.  In a memo he said the following:

“Haven was formed by the leaders of Amazon, Berkshire Hathaway, and J.P. Morgan because they have been frustrated by the quality, service and high costs that their employees and families have experienced in the U.S. health system.”

I feel the same way about the cost of my Amazon Prime membership which keeps going up.  And don’t get me started about J. P. Morgan which holds my home mortgage. I hope every month they will lower my interest rate but alas I hope in vain.

I think I will start an organization to address this issue of the costs of super large corporations. I’ll call it “Craven”. No one will mistake that for a church.

More seriously, one can be encouraged by the fact that Dr. Gawande is involved in this latest venture by do-gooding, profit maximizing, publicity seeking CEOs. He has written several compelling books about health care quality.  He also is a very good speaker on this subject.  Whether his leadership will be sufficient to make a difference remains to be seen.

There have been no shortage of other organizations with a similar focus formed by business organizations.  Usually, after a year or two, they wither away as the sponsoring organizations lose interest or focus or change CEOs.

Management guru Peter Drucker once said hospitals were  “the most complex human organization ever devised”.

Given Drucker’s opinion, it is obvious that an internet peddler of goods, a bank which caters to the wealthy and a company which collects other companies are perfectly suitable to revolutionize healthcare including hospitals. You just have to develop an app.

Peter Drucker in his writings recognize that a service industry like healthcare is inherently more complicated than other endeavors like selling and loaning. That does not mean healthcare should be exempt from examination of its practices. That’s happening everyday in healthcare.

I don’t believe the issues of cost and quality are really amendable to a top down approach as seems to be the way organizations like Haven view things.  Even with a star as its leader, Haven seems a reach. Perhaps a better name for Haven would be “Hubris”. That may be the real story here.

This week Haven went down in flames as it issued this press release:

In the past three years, Haven explored a wide range of healthcare solutions, as well as piloted new ways to make primary care easier to access, insurance benefits simpler to understand and easier to use, and prescription drugs more affordable.

Moving forward, Amazon,Berkshire Hathway, and JPMorgan Chase & Co. will leverage these insights and continue to collaborate informally to design programs tailored to address the specific needs of their own employee populations.

Haven will end its independent operations at the end of February 2021.

What gibberish! They got bored and moved on to other virtue signaling activities. Healthcare is harder than the day job these company moguls have. Patients just did not understand what these guys were trying to do nor did they care. Haven devoted a whole two (!) years trying to change healthcare and basically accomplished nothing. Time to move on to something more exciting.

As I indicated two years ago, a top down approach to changing the behavior of patients was doomed to fail. These weird collaborations always fail. Moguls and academic quality experts let their hubris overcome common sense. I am trying to avoid my own brand of hubris but I cannot resist giving myself a pat on the back here on the beach for predicting this result. Feels good.

In a similar vein, a new law has gone into effect which will compel hospitals to disclose prices they have negotiated with health plans. This is supposed to help patients make informed decisions about where they seek care. That is a ridiculous expectation and reveals an abysmal ignorance on the part of Congressional members and their 24 year old legislative assistants. Maybe they should hire older legislative assistants.

Patients’ decisions are not affected by what reimbursement is contained in an agreement between their local hospital and doctor and their health plan. Patients trust their doctors to make decisions that are in the patient’s best interest, not the health plan’s.

Health plans are commodities, middle men who adjudicate claims and yearn to be loved. Health plans would like to be more but no one feels cuddly about Blue Cross and their ilk. It would be like embracing a shark.

Moguls, academicians, pundits and politicians need to get real. They all should be in treatment for hubris overdose. Hopefully they will check the price before seeking treatment.