Health

Atul Gawande's Aim For Health Care: 'Make It Simpler To Do The Right Thing'


Dr. Atul Gawande, the surgeon-writer-researcher chosen to lead a joint health venture by three prominent employers who hope to bring down health costs, says his biggest goal is to help professionals "make it simpler to do the right thing" in delivering care to patients.

Gawande elaborated a bit on what that means at the Aspen Ideas Festival this week, just days after being named chief executive of a health care partnership unveiled earlier this year by Amazon, Berkshire Hathaway and JPMorgan Chase. The new enterprise will oversee health coverage for about 1.2 million employees of the companies and their families. Gawande said he will focus on the same behaviors by doctors and hospitals that he studies at his Boston-based think tank, Ariadne Labs.

One of the biggest problems in health care is that "doing the right thing is incredibly complicated," he told the Aspen gathering, and one of the biggest sources of waste in the system is that patients are given "the wrong care in the wrong way at the wrong time."

Gawande said he hopes to find specific ways to make health care more efficient and the solutions exportable.

"The opportunities are as long as my arm," he said. "So all we have to do in this new venture is pick a few of them and try to bat them out of the park."

For example, he said, even in countries where everyone is covered by insurance, only about half of those with high blood pressure have it controlled. In the U.S. that percentage is closer to 40 percent. And while Americans spend "tons more money" to treat low back pain, he said, "the level of disability and pain has changed not at all."

Gawande, 52, was purposely vague about his new job — which he will add to his long list of activities, including teaching at Harvard and operating on patients at a university-affiliated hospital in Boston, writing for The New Yorker and serving as chairman of Ariadne Labs.

"We are going to come up with a name — it's one of my first jobs," he joked to interviewer Judy Woodruff of PBS NewsHour during a Saturday session. On Monday, at another session, he told The New York Times' David Leonhardt that he "had no idea" how many employees would eventually come to work for the organization, although it will be a stand-alone, not-for-profit entity. He declined a separate interview.

Though short on details, Gawande talked at length in both appearances about his approach to the new initiative.

"The largest concept here is I get to have a million patients that I as a doctor get to add to my responsibility," he said Saturday. "And my job to them is to figure out ways that we are going to drive better outcomes, better satisfaction with care and better cost efficiency with new models that can be incubated for all."

That is essentially what Ariadne already does — tests ways to make care more effective and efficient, and spreads those practices in the U.S. and abroad.

As an example, he talked about his mother's recent knee replacement. A total of 66 health workers saw her in the hospital — he counted — and often provided conflicting advice about whether she should be up or in bed or exactly what she should be doing.

"And you just want to say, 'Is anybody in charge?' " he said. "That's the broken system." The system is moving "from individual delivery of stuff ... to team delivery of outcomes. And that's a radically different place." He wants to help make that transition more effective.

Gawande said his research has also shown that "the right care" can't just be dictated. He developed a now-famous surgical checklist that was later mandated for doctors in Canada. But he pointed out in his discussion Saturday that the requirement showed no reduction in surgery-related mortality. Yet in Scotland, where the implementation was more gradual and more data-driven, he said, "in the first three years we saw a more than 25 percent reduction in deaths."

Gawande said that although he is going to work for companies that provide insurance to their workers, "employer-based care is broken," with the vast majority of new jobs lacking health insurance.

And even those workers who are offered job-based health insurance are increasingly priced out of care. Some people he grew up with in Ohio, he said Monday, "are paying half their income in taxes and health care premiums and going bankrupt because of health care costs."

When workers have deductibles that are multiples larger than their bank accounts, they stop treating their chronic conditions. "And it has enormous harm for the future," he said.

Still, Gawande was optimistic about the possibilities of making health care both better and less expensive. "It's feasible to do these things," he said Monday. "But it's not sexy."


Julie Rovner is chief Washington correspondent for Kaiser Health News, a nonprofit news service, which is an editorially independent program of the Kaiser Family Foundation and not affiliated with Kaiser Permanente.

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