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Tim Stewart

Haven: From Manhattan Project to Side Project

An empty, unrenovated warehouse

What to make of Haven’s demise?

The partnership of Amazon, JPMorgan Chase and Berkshire Hathaway was launched in 2018 to credulous fawning, despite the announcement being utterly devoid of anything.

Turns out, all the money in the world can’t buy a clear vision for success in healthcare. The industry is immune to half-hearted, drive-by attempts at big change, no matter your brand. It’s all or nothing, and without total buy-in from leadership (and deep pocketed backers), you end up where Haven did: What could have been a Manhattan Project turning out to be a side project.

It’s as easy today to mock Haven’s failure as it was to be skeptical at its creation – so we won’t judge if you do some mocking, because it’s fun. And fun can be hard to come by these days.

But once we’re done laughing and enjoying some self-righteous “told-you-so’s”, we face the same reality this industry has faced for decades: Who’s going to get healthcare costs under control?

We’re 11 years out from the passage of the ACA, which was successful in expanding coverage and unsuccessful in reining in costs. The cool kid “disruptors” have been narrowly focused on disrupting the wheelbarrows of healthcare money long enough to scoop some up for themselves, not on changing the market dynamics in a way that pays off for patients.

Big employers may yet unlock the vault with instructions for bending the cost curve, and it would still be dumb to bet against the world’s richest person and Amazon Care. But as costs continue to rise and many patients are forced to rely on having the best GoFundMe story in order to pay for their medical expenses, demands for substantive change will only increase.

This line, from one of the many Haven postmortems, stands out: “Healthcare providers and insurers have significant market leverage, and that’s difficult to overcome in trying to control costs,” said Kaiser Family Foundation’s Larry Levitt. To put another way: Providers and insurers are the reason healthcare costs are high.

For the moment, and as we have detailed throughout the last year, healthcare providers enjoy a considerable amount of trust, along with favorability ratings that we haven’t seen this century. Hospitals and health systems should view that positivity as ephemeral, a byproduct of the heroism displayed by frontline clinicians throughout the pandemic. As insurers continue, uh, let’s call it throwing their weight around, providers can leverage the current landscape to draw sharp contrasts with them – keeping in mind that the public goodwill might not extend indefinitely.

As we move through 2021 and the pandemic begins to recede, other elements are likely to come into sharper focus and scrutiny, including issues like price transparency and hospital consolidation. Now is the time to lead on these issues. You may not like the price transparency rule (ok, I know you don’t), because of the context it lacks. If that’s the case, then get to work providing that context. Get out ahead of the regulators and your consumers. Maybe you have a great partnership opportunity on the horizon – now is the time to start building a comprehensive story beyond “uh, scale?” for why it is great for the people you serve.

If the “incumbents” in healthcare aren’t going to change, and even the biggest disruptors can’t shake up care delivery in a meaningful (read: cheaper) way, then it is only a matter of time (and polling trends) before a broad coalition across this country views greater federal involvement in the delivery of healthcare as their only hope. If that bothers you, you’ve got time to change course. But not much.

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How will Health Systems Deal with a COVID-19 Vaccine?

Woman lifting her shirt sleeve while a man inserts a medical shot into her arm

As opponents build their case, providers risk reputational damage if they don’t take a point of view.

Early in the COVID-19 era, sometime after Bargaining and Depression, Acceptance began to set in.

With it came the grim realization that we wouldn’t fully leave this era until there was a widely available and reliable COVID-19 vaccine. And we were told that cavalry wouldn’t be rolling in until early 2021 at the absolute soonest. Now here we are, months later, still in suspended animation and confronting another major question:

What if there’s a reliable vaccine, and people refuse to get it?

Our recent national consumer survey shows that just 53 percent of Americans are extremely or very likely to get a COVID-19 vaccine. Now, there’s a lot we don’t know about an eventual vaccine. But we do know two things:

  1. The public overwhelmingly expects and trusts healthcare providers to actively talk about healthcare issues, which includes educating about the coronavirus and encouraging people to take specific actions to protect public health.
  2. The looming war on vaccines will make the masking battles look like tickle fights.

Six months ago, no one cared about the idea of wearing a mask. The idea that it could become a major political signifier would have seemed absurd, even for these absurd times. But as we saw, the issue quickly took on major cultural importance for months before we settled into our current détente. Some of the political air has left the balloon. Most people have accepted their masked fate, while the holdouts remain largely unpersuadable.

There are several significant differences between masking and vaccines, with the most obvious being that one is gently draped in front of your body and the other goes directly into it (via needle, no less…shout out to my fellow trypanophobiacs!). There’s also the fact that suspicion about vaccines has steadily risen over the last several years, long before COVID-19 swept the land. Some groups, particularly marginalized groups with unpleasant histories of medical trials in this country, have every right to be wary. Then there are the Jenny McCarthys of the world, whose rationales are less reasonable but even more, uh, viral.

So, are we telling you that you have to mandate vaccines for all your employees and aggressively promote the vaccine’s efficacy to the public? We are not.

However, as the trusted voice on healthcare in your community, healthcare leaders have an opportunity and a responsibility to educate the public, starting with the people who work within your organization.

Of the 47 percent of the public (and 40% of healthcare employees) who are hesitant about taking the hypothetical vaccine, the overwhelming majority are either worried about the potential side effects or worried about getting infected from the vaccine. These are very reasonable concerns about what is likely to be the most quickly developed vaccine in history. They are also an opportunity for health systems to leverage the trust the public has invested in them in a way that answers the public health concerns they seek.

Broad education on vaccines must start now, while clarifying that specific instruction on what to expect from a COVID-19 vaccine will come later, when we have the appropriate information. Don’t take for granted that everyone understands how vaccines work. Hypothetically, there could be a communications consultant who’s worked in healthcare for years but is just learning today how they actually work. Hypothetically.

Both now and later, explain how your organization will evaluate any vaccine. Make it clear that you won’t just be pulling syringes off an unmarked van and administering them to patients. (You’re not going to be doing that, right?) By explaining the process, we can begin to socialize the idea that any vaccine that comes our way will be thoroughly reviewed for safety and efficacy – “Operation Warp Speed” notwithstanding.

This is a major challenge, and it’s one that many health systems would prefer to avoid. It is an instantly political issue which will be further politicized and weaponized in our dismal national discourse. While it may not feel like it, the far greater reputational risk lies in health systems not doing everything they can to get responsible, timely and accurate information out to the public. As we continue to confront the greatest public health crisis this generation has seen, shrinking from the moment is a guaranteed way to lose the trust you’ve built.

What is your plan? You don’t have an option to sit this out, so you best start preparing one now.

Review the full survey results

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