Nine days ago, in a column for this newsletter (“Who Will Lead the JPMorgan-Berkshire-Amazon Health Venture? A Better Question: Who Should Lead?”), I wrote:

“I’m hoping that they’ve picked a pusher—um, as in envelope pusher. There is simply no point in setting up this enterprise unless the new leader is (a) determined as all heck to shake up the companies’ healthcare incentive system and (b) absolutely committed to integrating long-horizon prevention services, robust wellness coverage, and new consumer-focused technology into the plan(s).”

Well, that they did. Gawande, a surgeon and writer, has utterly pushed the envelope on so many issues of modern medicine—from how we spend our healthcare dollars to how we die. As Gawande wrote, indelibly, in Being Mortal, it’s no longer clear, in our Fix-It Ralph healthcare system, what dying even means anymore:

“In the past few decades, medical science has rendered obsolete centuries of experience, tradition, and language about our mortality and created a new difficulty for mankind: how to die.”

Gawande has also helped explain better than anyone, perhaps, why we spend so much for our care—and how recklessly unhinged from necessity those cost drivers often are, as I wrote about in a post in February 2017. Gawande’s famous piece for The New Yorker, “The Cost Conundrum: What a Texas town can teach us about healthcare,” remains the foremost dissection of how the fee-for-service paradigm, and its misguided set of incentives, has driven us astray.

Gawande won’t officially begin shaping this new entity—and, I would presume, more clearly defining its mission—until July 9, when he formally assumes the CEO role. But based on only a reading of his public writings, and the experiences he has shared, I would guess that he’ll focus on three key areas:

First, I imagine that he and his team will embark on a thoughtful, data-rich analysis of what’s really driving health and wellbeing in the triumvirate’s combined workforces, from the daily medicines they take to how they eat and commute to work, to the social determinants that silently shape their lives. Some may pooh-pooh more study, but understanding at a granular level what’s actually keeping employees healthy—and what isn’t—is essential if the right actions are to be taken.

Second, they’ll do the same kind of analysis on what’s driving cost—not just for the three companies but also for their employees, from copays to the carfare spent getting to the doctor and hiring a last-minute babysitter. (I would recommend they study outcome and expense separately, even if the data gathering is done at the same time—more on why I think so in a separate column.)

And third, though perhaps most importantly, I believe Gawande will try to vigorously reframe the conversation at the three companies about what good health and wellbeing truly mean—moving the discussion from one centered on mechanistic repairs to one about human vibrancy and potential. This isn’t a soft-and-gooey “New Age” talking point. This is the heart of the matter—and it’s this reframing that has the power to ultimately create a new model of workplace health.

Surgeons are trained to sew and reset broken bones and ligaments, unclog the body’s plumbing, fix leaky valves and gaskets, and often replace certain parts when they’re threadbare or broken. By nature, it’s a profession for mechanically minded craftsmen and artisans. But Atul Gawande is one of the special few who sees the whole in the parts. If he can bring that mind’s eye to the new healthcare venture, this corporate experiment might lead to a true path for reform.

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