Can Atul Gawande Fix Healthcare? Maybe.

A physician and journalist probably isn't who you thought business titans Bezos, Buffet, and Dimon would choose to lead their effort to disrupt healthcare, but Atul Gawande still might make a big impact.

The selection of Atul Gawande, MD, to be the CEO of Amazon's joint venture with JP Morgan Chase and Berkshire Hathaway is at once surprising and groundbreaking.

We should all be heartened that someone willing to try bold ideas is getting the chance to hack away at healthcare's problems and push forward the Institute for Healthcare Improvement's so-called triple aim: improving the patient experience, the health of populations, and the per-capita cost of care.

In announcing the effort at the end of January, the three tycoons promised no less from the company than "simplified, high-quality and transparent healthcare at a reasonable cost."

But can an East Coast healthcare celebrity work hard enough—and be ruthless enough—to tear down and rebuild a broken industry while continuing to write for The New Yorker and serving as chairman of Ariadne Labs, the health system innovation center for which he is currently executive director? That's what it might take to achieve the bold mandate his bosses have set forward.

These business titans have led us to believe their new, unnamed joint venture will be nothing less than transformative. Back in January, Warren Buffet called healthcare a "hungry tapeworm on the American economy." But as I wrote then, many have tried and failed to bring healthcare's unsustainable inflation rate and quality problems to heel.

Winners and Losers

If this venture is successful, and it will be a long time before we know, the winners will be American corporations and patients. The healthcare-industrial complex, if you will, will be the losers.

Ken Turner, vice president of operational effectiveness at University Hospitals Health System in Cleveland, whose clinical leaders have taken $25 million in costs out of the health system over the past six years, is taking the threat seriously.

Turner breaks it down:

• Physicians: "Medical staffs should be most concerned," he says. "[This venture] will find ways to deliver more care without them, through automation, technology, and nurse practitioners."
   
• Health Plans: "Look at the rate of medical inflation," says Turner. "It's unsustainable and health plans will have to figure out how they provide those products at a price people are willing to pay."
   
• Healthcare IT: This industry subsegment has a made a mint on setting up health systems with proprietary systems that require expensive and frequent upgrades, and that aren't interoperable across sites of care or health system to health system. Amazon may do the same thing to them that it's done to retailers.
   
• Pharma: Specifically, what Turner calls "pharmakinetics," the science of making sure evidence shows that drugs are both effective and cost-effective for specific conditions. "We have folks who have knowledge about what therapies are effective and we already use them to coach our physicians," he says. "Amazon will totally transform this."

What It Means

Gawande is an analytical scientist who also happens to be arguably the best healthcare writer of his generation. No national healthcare figure understands the underlying problems in healthcare with his blend of perspective and compassion.

• Many expected a disruptor. They expected a deconstructive business revolutionary who would use the megapower of three international industry giants to rip away at the wasteful underpinnings of the industry. We didn't quite get that here, but perhaps the Bezos-Gawande partnership will have that effect.
   
• What IS IT? Another institute, cross-industry collaborative, or white paper factory? If it is a non-profit enterprise, what, exactly, does it have at stake? Things are still pretty murky. No one knows what this company will actually do.
   
• One thing's clear: There will be no equivocating when it comes to healthcare's affordability and quality problems. Gawande has become famous by exposing healthcare's many failings.