Amazon, Berkshire Hathaway, JPMorgan Chase shutting down health care venture

David M. Duong, MD, MPH

There were initiatives in the United States by other corporations, such as Walmart, with goals similar to Haven, before Haven launched.

Even so, myself and others were extremely excited by Haven’s creation in 2018. We saw that three titans of industry — Amazon, Berkshire Hathaway and JPMorgan Chase — that penetrate almost every single facet of our lives were going to leverage their collective power to disrupt and potentially change the health care industry. As proof of Haven’s potential impact, immediately after the announcement of its creation, stock of insurance companies UnitedHealth Group and Anthem went down.

Haven’s closing speaks volumes to the complexity of the U.S. health care system and how difficult health care is to disrupt in this country. If those three companies approximately combined $7.5 billion per year in health care spending with over 1.2 million employees cannot change health care, then who can?

The closure of Haven speaks to the important role of government in health care. We have made the argument as a country that we need to let the market regulate health care to promote quality and innovation; however, countless studies, economic analysis, the experience in other developed countries have proven this to be wrong. Health care is not like other service industries. The government needs to have a bigger and more dominant role in the health care space.

Haven did experiment with some models of health care payment and delivery, including incentivizing people for healthy behavior choices and incentivizing providers to keep people healthy. These models are not new, as we see the replacement of volume-based, fee-for-service reimbursement with capitation models by organizations such as Kaiser Permanente and Intermountain. However, the majority of health care systems have no real incentive to keep people out of the hospital as our health care system still rewards (eg, pays) based on “sick care,” not “health care.”

A true health care model will place more value on primary health care and preventive care, which we know are essential to keeping populations healthy. Because employees of Amazon, Berkshire Hathaway and JPMorgan Chase were spread throughout the country, they did not dominate one market, and therefore, could not negotiate with health care providers and systems to lower health care prices and adequately promote the model of keeping populations healthy rather than merely paying for sick-care services.

The Affordable Care Act was a step in the positive direction, and it is my hope that the Biden-Harris administration can continue to improve upon the ACA, expanding Medicare Advantage plans to people aged younger than 65 years and the creation of the “public-option” so that individuals can obtain their own insurance, and employers could offer Medicare Advantage plans at government-established rates. This would hopefully wean us from the fee-for-service system to a system that truly promotes health.

Ann Greiner

It is disappointing that Haven is disbanding, since employers are an important lever for health care reform. But since Haven was so mum about its activities, it is difficult to know why it threw in the towel.

We knew that Haven prioritized primary care, so that sent an important signal to the market. It seems that Amazon is going to continue an effort on the primary care reform front, starting with its employees. The Primary Care Collaborative would be interested in working with them as they move forward.