- Haven, a joint healthcare upstart by Amazon, JPMorgan, and Berkshire Hathaway, disbanded in February.
- Dr. Atul Gawande, a famed surgeon-writer, was its CEO until May 2020.
- In his first detailed interview since, Gawande explains some of Haven’s key challenges.
- Visit the Business section of Insider for more stories.
But Ariadne, a center for health systems innovation, lacked two ingredients that Gawande felt were necessary for changing the healthcare system. It couldn’t afford to change technology, and it couldn’t change the way healthcare is paid for, Gawande told the UCSF School of Medicine in a February interview.
So when three massive companies came knocking, expressing a desire to change healthcare and promising him endless resources, he took the gig. Gawande became Haven’s CEO in June 2018, about five months after it launched.
Haven, a joint venture set up by Amazon, JPMorgan, and Berkshire, was well positioned to disrupt the industry, or at least that’s what analysts and observers thought at the time. The companies’ combined workforces included 1.5 million low-income workers, which is the group that’s the most left out in healthcare, Gawande said.
This was his chance to change healthcare for those who made enough money to not qualify for federal benefits, but don’t make enough money to brave their $2,000 annual deductibles and therefore skip routine medical care.
“I’d been trying to wack away at those problems and didn’t have an obvious way I could do it from Ariadne Labs,” he said.
In February, Haven disbanded three years after it launched in an apparent failure to come up with a disruptive product that satisfied its different founding companies.
Gawande, a writer, surgeon, and public health leader, had already stepped down from the CEO role in May 2020, becoming chairman of Haven’s board. In a statement at the time, he said that he wanted to devote more time to addressing the coronavirus pandemic.
In an interview with UCSF’s Dr. Robert Wachter, Gawande highlighted two of the venture’s key challenges: navigating employer-funded healthcare as well as the preferences of its founders when it came to how Haven would operate.
The founders and employer-run healthcare held Haven back
One crucial decision was whether Haven would become the benefits office for all of the founding companies, Gawande said. That would have given the upstart the authority to implement the programs it was piloting.
But it became clear that each company needed or wanted its independence on that front.
“Once that became clear, then Haven threatens to become a very expensive think tank,” he said.
The other issue was the US healthcare system itself.
Employers insure roughly half of all Americans and spend $880 billion on healthcare each year. With employees taking different jobs every couple of years, companies aren’t motivated to invest in employees’ long-term health, Gawande said.
“A job based system only cares about the costs this year,” he said. “That’s why we have fights over whether we’ll pay for hepatitis C treatments that cost $50,000 and up, but avert a million dollars in costs in the course of your life.”
Getting to a point where healthcare costs are looked at over an entire person’s lifetimes would require major healthcare reform. Only the government has the power to move the US healthcare system as a whole out of the hands of companies, per Gawande.
Haven’s work could live on
Gawande said he was hard-pressed to call Haven a failure, though.
It made an insurance plan that deployed to almost 150,000 people with no coinsurance, so just copays, and no deductibles, he said. The plan provided 60 kinds of medications at no cost to members and provided low-cost mental health and primary care services. It was also popular with the workers, he said, despite the founding companies’ secrecy requirements.
Ideas like that could live on, similar to how the Clinton administration’s work on healthcare reform was baked into the Affordable Care Act a decade later, Gawande said.
When Haven disbanded, it said in a statement that the employees would largely be absorbed by Amazon, JPMorgan, and Berkshire Hathaway, so it’s possible that they’re still carving out individual ideas.
Gawande is back to writing for The New Yorker and helped found CIC Health, a Cambridge-based organization that’s providing coronavirus testing and vaccines.