It’s no secret that American businesses and American citizens are frustrated with the current state of the national healthcare system. Just weeks into 2018, three of the largest companies the United States made an announcement that garnered plenty of strong reactions-- Amazon, Berkshire Hathaway, and JPMorgan Chase revealed their plans to team up, eliminating their reliance on national healthcare by creating an independent healthcare company to serve their United States employees. Months later, the corporate behemoths sent shock waves through the industry again when they announced that surgeon, patient advocate and innovator Atul Gawande would be the company’s first CEO.

While these decisions are unprecedented, they aren’t necessarily surprising. Don’t believe us? Keep reading because we’ll be breaking down:

• What the Amazon/Berkshire/Chase (ABC) partnership reveals about healthcare in the United States
• Why Atul Gawande is the perfect person to take on the immense challenge of disrupting the healthcare industry
• How tools and strategies for gathering patient feedback in real time can improve the care you provide your patients

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Healthcare Is an Enormous Challenge for American Employers

If you’re like many Americans, you probably rely on your employer for your health insurance. In fact, according to 2017 study by the Henry J. Kaiser Family Foundation, more than 150 million Americans get their health insurance via employers. That makes managing healthcare complexity an immensely important task for American employers-- one that affects nearly half of the country’s population.

Healthcare costs have risen steadily over the last two decades, and that trend doesn’t show any sign of changing. In the past, companies have worked together to seek out ways to offset rising prices. These are just a few of the strategies we’ve seen before:

• Working with health systems directly
• Offering telemedicine benefits
• Restructuring deductible employee health plans
  

While some of these strategies have resulted in significant savings, none of them have truly lessened the overall burden of rising healthcare costs. Why? At its heart, healthcare is a locally-based industry, which means that decisions made by individual doctors or hospitals can have a huge impact. Companies have little control over local decisions regarding price or quality of care, which ultimately makes it difficult for them to effectively manage employee health coverage.

The partnership between Amazon, Berkshire Hathaway, and JPMorgan Chase reveals that this struggle continues to place an increasing amount of pressure on American employers. None of the companies has any extensive experience working with health benefits or managing medical professionals. Amazon is an online retailer. Berkshire Hathaway is a holding company, and JPMorgan Chase is a bank. How can these non-medical companies add any real value to the conversation surrounding American healthcare?

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The (Potential) Benefits of Taking a New Perspective

A Culture of Disruption

If you ever found yourself sitting on the bench outside of the principal’s office in elementary school, it’s likely you were, in some form or another, charged with the offense of being disruptive. The idea of disruption has long since carried with it a negative connotation, conjuring up images of ne’er do wells and trouble-makers, but today it’s not all that bad. In fact, some of the world’s most innovative companies-- names like Apple and Google come to mind-- pride themselves on being disruptors. That is, they anticipate and embrace change, and they are unafraid to experiment.

In many industries-- including those in which Amazon, Berkshire Hathaway, and JPMorgan Chase made their names-- disruption is just a part of the game. However, disruption hasn’t historically found much of a market in the healthcare industry. According to an analysis by The New York Times, the classic model of disruption is for the disruptive companie to break into a market with an exciting, lower-value but also lower-cost product than those offered by market incumbents. Consumers may accept cheaper cars and MP3 players, but they generally don’t want to sacrifice high-quality healthcare for a more economical option.

That being said, the basic premise of disruption is predicting and responding to the needs of consumers-- or in the case of healthcare, the needs of patients-- before those needs create friction. Within the healthcare community, this is a concept that has been gaining momentum for decades, which may make now the perfect moment for a disruptive partnership such as the ABC partnership to have a real and lasting impact on how the healthcare industry operates.

Patient-Centered Healthcare and Consumerism

It’s not difficult to guess whose desires drive changes and trends in the age of consumerism-- it’s the consumer. In the field of technology, we see this trend expressed in an increased focus on user-experience and user-centered product design. In medicine, this concept translates to patient-centered healthcare.

Patient-centered healthcare has its roots in the late 1960s. It was in 1969 that the American Academy of Pediatrics (AAP) first introduced the phrase “medical home” as a way of describing accessible, family-centered, coordinated, comprehensive, continuous, compassionate, culturally effective primary care facilities. From there, the idea of patient-centeredness only grew in popularity. By the mid 2000-aughts, the Patient-Centered Primary Care Collaborative (PCPCC) was formed to support the idea that evaluations of medical care should place more emphasis on the patient experience. In 2010, provisions designed to improve primary care and medical homes using patient-centered strategies were even popping up in key pieces of legislation.

From a high-level perspective, this movement within the medical community towards increased patient-centeredness makes a lot of sense. Medicine has always focused on improving patient quality of life, so it makes sense that placing more emphasis on patient feedback helps care facilities better serve this goal.

Who is Atul Gawande?

The man chosen by the Amazon, Berkshire, and Chase to lead their foray into the world of healthcare is, much like the companies themselves, perhaps not the most obvious choice for the job. Atul Gawande was born in New York City in 1956 to a urologist and a pediatrician. He studied political science and biology as an undergraduate student at Stanford and later achieved a master’s degree in philosophy, politics, and economics from Balliol College in Oxford. He earned a medical degree from Harvard.

Atul Gawande dabbled in public health policy during Bill Clinton’s campaign. He has written several essays for popular publications such as Slate and The New Yorker. He is a surgeon. He has no direct experience with health insurance or management, but in the words of Gawande himself: “I have devoted my public health career to building scalable solutions for better healthcare delivery. Now I have the backing of these remarkable organizations to pursue this mission with even greater impact. This work will take time, but it must be done. The system is broken, and better is possible.”

Gawande is now tasked with the immense challenge figuring out ways to drive better patient outcomes, better satisfaction with care, and better cost efficiency with new models that can be incubated for all. In the words of Atul Gawande himself: “That is a tall fricking order.”

Luckily, with the support of the ABC partnership, resources won’t prevent Gawande from achieving these goals. The real challenge lies in understanding human behavior, developing innovative solutions, and achieving scale. The hope is that Gawande will bring a new perspective to healthcare field, disrupting old strategies to make way for solutions that truly emphasize what patients need from their healthcare and helping companies provide it in a more economically-sustainable fashion.

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Finding Scalable Solutions for Better Healthcare Delivery in Your Own Hospital

Collecting Data is the First Step

Before you can find ways to effectively disrupt healthcare in your hospital and make care more patient centered overall, you first have to pinpoint where your organization can improve. Data collection should always be the first step in strategy change, and this situation is no different. When it comes to collecting data about the patient experience, you have a few options, and they all have their pros and cons.

The Importance of Real-Time Recording

Think back to your college days. You’re sitting in a lecture hall, filled with people, trying to take down all of the information your professor is whisking through. Students raise their hands, contributing other thoughts and ideas or perhaps asking questions it would be helpful to record in your notes. Does the thought of trying to keep those detailed notes make you glad those days are behind you?

Capturing information in realtime can be difficult, but if your goal is to disrupt old strategies to uncover new, more effective ones, it’s absolutely necessary. You need a method of data collection that strikes a balance between efficiency and detail. We have reviewed a few popular strategies for gathering information about the patient experience:

• Patient experience surveys
• Patient interviews
• Patient Shadowing

A Review of Strategies and Tools for Implementing Patient-Centered Care

Patient Experience Surveys

Patient experience surveys involve carefully designing questions for patients to complete independently that will help you understand how a patient experienced care in your facility. One of the biggest advantages of this method is that it is easily repeatable-- the same questions are recycled for every patient, making it a time-effective way to gather a lot of data. However, patient experiences are as diverse as patients and their maladies, which means that you may miss out on valuable information because your survey simply doesn’t address it. Surveys must also be administered after care has already been provided, which means some details may get lost between the care occurring and the patient remembering the care to fill out your survey.

Grade: C

Patient Interviews

Similar to patient experience surveys, patient interviews involve designing a series of questions that will be presented to patients. However, in this case the questions are delivered by an interviewer, which leaves more room for discussion and open-ended or nuanced responses. Unfortunately, interviews too are conducted after patient care has already been administered, so again some key details may be overlooked. It is also sometimes the case that patients who have had an average care experience will neglect to bring up what they perceive as minor problems or inconveniences when speaking to a representative for the hospital, in an attempt to “be nice.”

Grade: B

Patient Shadowing

Unlike patient experience surveys and patient interviews, patient shadowing involves having trained shadowers-- often medical students or technicians-- following a care experience in real time, making their own observations and recording direct feedback from the patient and/or the patient’s family. This method runs into the problem of finding a way of effectively capturing information at the same pace that care occurs. It can be next to impossible to accomplish using the pen and paper method, but today there are a variety of digital tools that simplify the patient shadowing experience. GoShadow is a smartphone app that allows you to take rapidfire notes and time multiple different care events simultaneously. It also supports categorizing notes and attaching photographs to notes, making it a quick and easy way to record a complete picture of the care experience.

Grade: A

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The formation of Amazon, Berkshire, and Chase’s ABC Healthcare partnership and the selection of Atul Gawande as the company’s CEO reflects a need for real change within the healthcare industry. ABC Healthcare and Atul Gawande certainly appear to be capable of disrupting healthcare on a large scale, but you can seek out areas for improvement in your own hospital by collecting patient experience data and seeking out scalable solutions within your own organization.

Has your hospital or practice implemented patient-centered care strategies? How did it go? Let us know in the comments section below!