David M. Duong, MD, MPH
Before Haven started, there were initiatives by other companies like Walmart in the US with goals similar to Haven.
Even so, I and others were extremely excited about founding Haven in 2018. We saw that three industrial titans – Amazon, Berkshire Hathaway, and JPMorgan Chase – who permeate almost every facet of our lives, would use their collective power to disrupt and potentially transform the healthcare industry. As evidence of the potential impact of Haven, the shares of insurance companies UnitedHealth Group and Anthem fell immediately after they announced their formation.
The Haven deal speaks volumes about the complexities of the US healthcare system and how difficult it is to disrupt health care in that country. If these three companies, with more than 1.2 million employees, raise about $ 7.5 billion in healthcare spending annually, healthcare can’t change that. Who can do that then?
The closure of Haven speaks to the government’s important role in healthcare. We as a country have argued that we need to let the healthcare market regulate it in order to promote quality and innovation. However, countless studies, economic analyzes and experiences in other industrialized countries have shown that this is wrong. Healthcare is not like other service industries. Government needs to play a bigger and more dominant role in health care.
Haven experimented with a number of models for paying and delivering health services, including incentives for people to choose healthy behaviors and incentives for providers to keep people healthy. These models are not new as we see organizations like Kaiser Permanente and Intermountain replace volume-based service fee reimbursement with capitation models. However, the majority of health systems have no real incentive to keep people out of the hospital because our health system still provides rewards (e.g. payments) based on “health care” rather than “health care”.
A true health model will place more emphasis on primary health care and preventive care, which we know are essential to the health of the population. Because Amazon, Berkshire Hathaway and JPMorgan Chase employees were spread across the country, they did not dominate a market and therefore could not negotiate with health care providers and systems to lower health prices and adequately promote the model of keeping the population healthy only pay for nursing services.
The Affordable Care Act was a step in the positive direction and I hope the Biden Harris government can further improve the ACA by extending the Medicare Advantage plans to those under 65 and the “public option” so that individuals can get their own insurance and employers can offer Medicare Advantage plans at state-set rates. Hopefully this would wean us from the fee system to one that is really good for health.
David M. Duong, MD, MPH
Peer Perspective Board member of Healio Primary Care
Director, Global Primary Care and Social Change, Harvard University Center for Primary Care
Disclosure: Duong reports that he has received financial support from Novartis in the past to strengthen the health system in Vietnam.