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Published January 12, 2021

Seeking a Safe Haven — A timely lesson from the collapse of the Amazon-Berkshire Hathaway-JPMorgan venture

Haven, a three-year odyssey to find the solution to runaway healthcare costs, has ended without reaching its destination. In January 2018, Jeff Bezos, Warren Buffett, and Jamie Dimon promised that together they would change the way healthcare works. Now, in January 2021, they are retreating to their separate corners “to address the specific needs of their own employee populations.”

Early on, Haven set three broad, lofty goals:

  • Create better health outcomes and satisfaction for employees
  • Improve primary care access, simplify insurance benefits, and make drugs more affordable
  • Leverage data and technology to drive better incentives and lower costs

While some speculated Haven would leverage its founders’ scale to develop an insurance plan capable of serving the entire nation’s employers and consumers, and others expected Haven to build a nationwide risk-based clinically integrated network, Haven never shared any details regarding its strategy.

We suspect there were few if any details to share, and Haven suffered the time-tested “terminal diagnoses” of previously touted game-changers: cloudy direction from the top, a lack of unified objectives, competing cultures, and the failure to build momentum through early victories.

The lesson from Haven’s demise is the same one repeated over and over in the last two decades: to pursue healthcare transformation, one must commit to a specific path forward. Not just a direction–like better access or affordabilitybut a path–a defined route to improve access or affordability. And that path cannot be a straight uphill climb, or one will lose any momentum one had at the beginning of the journey.

As the transition to value-based care has lurched forward (and sometimes backward), many must-have’s have been marketed to health systems. Billions have been spent in the name of harnessing data to manage populations, consolidation has been prescribed as the cure for exposure to downside risk, and complex corporate structures have been erected to support ACOs and other provider networks.

But securing such tools–data analytics, scale, and structure–should not be confused with doing the work to position your health system for new care models. Absent commitment to a specific path and some idea how you’re going to traverse it, investments in these tools will bear limited returns. In fact, these shiny pennies risk diverting your attention from the road ahead.

We are convinced that to survive and thrive under new care models in the post-pandemic world, health systems should commit to a path leading to the maximization of primary care capabilities. This is much broader than securing an adequate number of primary care physicians, although that is certainly a prerequisite. “Primary care” in this context refers to the means by which your organization engages with the population it intends to serve.

This includes highly efficient primary care practices, with provider compensation based on panel size and performance measures as opposed to wRVU productivity-only compensation methodologies. Beyond primary care practices, the maximization of primary care must also encompass your organization’s range of virtual services (e.g., telehealth, telephonic check-ins, remote monitoring), urgent care, care management and patient monitoring programs, outreach clinics (e.g., schools, community centers), screenings for social determinants of health, wellness fairs, and other outreach activities.

Unlike other value-based investments, many of these specific primary care initiatives can be funded–at least in part–through existing fee-for-service reimbursement mechanisms. Health systems, however, should not limit their primary care investments to those that can immediately “cash flow,” instead of appreciating the long-term value in positioning the organization for new care models.

The PYA team now is working with health systems making the investments to build achievable, resilient strategies to maximize primary care capabilities. These strategies have multiple components–e.g., implementing new compensation models, using technology to expand access to services, forging new community partnerships to address social determinants of health–with each component contributing to a shared vision of meaningful, long-term engagement with the communities served by those systems.

In these highly uncertain times, health systems that commit to the vision of meeting their population’s comprehensive primary care needs and executing on a strategic plan to achieve this vision will find the safe haven being sought by Haven–and be well-positioned for what the future will bring.

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