The Future of Health Care

Haven: Much ado about nothing

A serial blog by Charles J. Shanley, M.D., and David Ellis, M.S.

Haven was a health care joint venture between Amazon, J.P. Morgan-Chase and Berkshire-Hathaway that began in January 2018 and disbanded in January 2021.

Over its brief, three-year life, few details about the venture were forthcoming. The intense secrecy portended something extraordinary, and Amazon’s participation suggested something radically innovative and disruptive. It wasn’t.

Although the Haven experiment failed in prospect, it remains a harbinger of radical disruption on the horizon in health care delivery.

The former Haven partners are known for being profitable, not altruistic. Haven spokesperson Brooke Thurston admitted a primary motivation of Haven was “to improve employee satisfaction and reduce health care costs for Amazon, J.P. Morgan and Berkshire’s one million U.S. employees [and] pilot new ways to make primary care easier to access, insurance benefits simpler to understand and easier to use, and prescription drugs more affordable.”^[i]

Haven’s goal was to create simpler, high-quality health care at lower cost with a focus on technology-based solutions. While this sounds more like a vision than a business plan, in point of fact, technology had already created the context for simpler, high-quality health care. Haven folded primarily because it failed to convert its vision and goals into actionable strategy, but that did not stop the three partners from executing projects “separately with their own employees, obviating the need for the joint venture.”^[ii]  

Prior to the COVID-19 pandemic, health care delivery was already quietly shifting away from traditional hospital/clinic-based systems of care to a future state dominated by an increasingly sophisticated telehealth ecosystem. As “traditional” institutions of health care – providers, government and private payers, pharmacies, health plans, pharma/biotechs and device manufacturers – rushed to innovate disruptive strategies and operating models during the pandemic, the paradigm shift accelerated. In a heightened context of creative disruption, Haven was rendered irrelevant by dramatic changes in the marketplace, especially among consumers, demanding a transformation in care delivery.

It is worth noting that the private sector is by no means the only source of creative disruption in health care delivery. Technology-enabled mobile health services, such as those pioneered by Dr. Phil Levy and Wayne Health to meet the complex needs of vulnerable communities in Detroit, have been embraced and facilitated through private and public sector support. Initially launched as a mobile COVID testing effort, the program has expanded to include vaccination, HIV testing, cardiometabolic risk factor and blood pressure screenings with referrals to social, behavioral and preventive health services, as well as to primary and complex specialty care. These neighborhood and community-based services are available to people driving or walking and do not require appointments or prescriptions.  The mobile future of ambulatory health care is here, now.

Though it took a pandemic to make it happen, the approximately 150-year-old status quo of state medical licensing was disrupted early last year by states issuing temporary declarations recognizing out-of-state medical licenses, and by CMS’s temporary waiver of a Medicare requirement that a clinician be licensed in the state where the patient is located. Furthermore, 28 states and Guam have signed on to the Interstate Medical Licensure Compact, founded in 2017 to expedite interstate licensure.^[iii]

But the private sector remains the most formidable vector for disruption. In our next Future of Health Care blog, we will examine what Google, Amazon, IBM, Microsoft, and in particular Apple, are up to. In the meantime, we welcome your comments. Thank you for following our blog series.

 

^[i] KHN Morning Briefing. “Just 3 Years After Making Huge Splash In Health Care, Haven Goes Kaput” January 5, 2021. Accessed at https://khn.org/morning-breakout/just-3-years-after-making-huge-splash-in-health-care-haven-goes-kaput/

^[ii] CNBC https://www.cnbc.com/2021/01/04/haven-the-amazon-berkshire-jpmorgan-venture-to-disrupt-healthcare-is-disbanding-after-3-years.html

^[iii] Mehrotra, Ateev, Alok Nimgaonkar, and Barak Richman (2021). “Telemedicine and Medical Licensure — Potential Paths for Reform.” NEJM, February 20. DOI: 10.1056/NEJMp2031608