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General Category => Berkshire Hathaway => Topic started by: petec on January 30, 2018, 04:39:42 AM

Title: BRK/JPM/AMZN healthcare tie up
Post by: petec on January 30, 2018, 04:39:42 AM
https://www.businesswire.com/news/home/20180130005676/en/Amazon-Berkshire-Hathaway-JPMorgan-Chase-partner-U.S.

Will be interesting to see how this develops.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: rogermunibond on January 30, 2018, 04:54:11 AM
WOW. Buffett and Munger have always stated that healthcare is too bug a problem to crack, when asked at the annual meeting, and then Munger talks about chairing a community hospital as a form of penance for his extreme good fortune.

Someone from Amazon must have brought the blueprint for something exceptional
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Liberty on January 30, 2018, 05:58:12 AM
I think Amazon probably brought forward the idea but even them didn't have the critical mass of employees to make this make sense, so they went to BRK and JPM.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: John Hjorth on January 30, 2018, 10:08:28 AM
ValueWalk [2018.01.30]: Berkshire Healthcare Business May Never "Reach Its Potential" (http://www.valuewalk.com/2018/01/berkshire-healthcare-jpmorgan-amazon/?utm_source=dlvr.it&utm_medium=twitter).
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on January 30, 2018, 12:05:23 PM
This is great news.

What analysts describe as a relative disadvantage (new player with a yet undefined vision) may be one of its greatest entrepreneurial strengths.

The idea of starting with a cash flow negative pilot project makes sense before a scalable model is deployed.

Healthcare is based on science but its delivery is far from scientific. Just comparing regional variations would meet the definition of haphazard. A lot of what is considered “complex” could be simplified with the introduction of efficiency and discipline.

The timing is excellent as true “reform” will likely take precedence over idleness factors.

It appears that there is great potential to increase quality and satisfaction (patient, provider, insurer) AND to decrease cost. If that is achievable, the “profit” can be shared.

Creative destruction at work. Bring it on.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Voodooking on January 30, 2018, 02:37:22 PM
I know that Warren has a LOT of respect for Bezos, and both him and Charlie hold him in high regard. I'm sure Warren said that Bezos was the best businessman of his generation, or the last two decades, or some other sort of high praise like that.

It will be interesting to see what comes of it. Living in the UK with our free National Health Service, it paints a huge contrast to healthcare in the USA. I love the US, but healthcare for the less fortunate isn't one of its strong points.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: longinvestor on January 30, 2018, 03:00:25 PM
Great to see this. After all, Berkshire is a heavily American business, the17% healthcare inflation is the"tapeworm" Buffett talks about.

My wife is a healthcare worker for30 years and even seen from her perspective, the healthcare system is coming apart.   
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: rb on January 30, 2018, 03:29:21 PM
I think it's brilliant and that it's gonna work. In addition while they claim it's non-profit, they're gonna make a whole bunch of money off of it.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: John Hjorth on January 30, 2018, 03:49:50 PM
I have to agree with longinvestor & rb here,

What's the basis for this platform with regard to headcount?

Berkshire: 367,671 [Berkshire Annual Report 2016, p. 116, - add to that at least the employees at Flying J]
Amazon: ? [I don't know, and I don't bother to look it up - please fill in.]
JP Morgan Chase & Co.: ? [I don't know, and I don't bother to look it up - please fill in.]

- - - o 0 o - - -

It's a lot.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: rb on January 30, 2018, 04:07:31 PM
Between the three of them they'll probably have 1 million policies covering 2-2.5 million people. It's a lot.

Now for the what ifs. What if other companies join? Off the top of my head Wells Fargo, Coca-Cola (with it's bottlers), and American Express. If Wells joins all the majour banks will have to join as well. We're talking about a lot of people here.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on January 30, 2018, 04:18:11 PM
Interesting to note that Mr. Buffett and Mr. Munger have been unusually vocal concerning the financing aspect of healthcare and seem to back a single-payer system.

But the internal focus will initially be on the health benefit cost per employee aspect in a way perhaps that is related to how 3G capital would look at every step along the way to cut cost. The bottom line would include the value that the employee would perceive as the end result in terms of health benefits. Friction expected along the way but a potential win-win.

And then, the model could be expanded, whoever pays the bill at the end of the line.


Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: EliG on January 30, 2018, 04:26:33 PM
What's the basis for this platform with regard to headcount?

Berkshire: 367,671 [Berkshire Annual Report 2016, p. 116, - add to that at least the employees at Flying J]
Amazon: ? [I don't know, and I don't bother to look it up - please fill in.]
JP Morgan Chase & Co.: ? [I don't know, and I don't bother to look it up - please fill in.]

Amazon: 541,900
http://money.cnn.com/2017/10/26/technology/business/amazon-earnings/index.html

JPM: 240,000
https://www.jpmorganchase.com/corporate/About-JPMC/about-us.htm

Combined: 1,150,000
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: HJ on January 30, 2018, 06:09:28 PM
The demographic of this 2MM people and their health profile is probably very desirable too.  What works within this small group may not work for the population at large.  Will they be covering retirees?  How do they draw the line of who qualifies, and what is covered, and how are they covered, etc., etc.  There's no doubt this will be great for these three companies.  How does it impact the overall healthcare system in the US?  We'll find out. 
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on January 31, 2018, 07:19:17 AM
"How does it impact the overall healthcare system in the US?  We'll find out."  We will indeed.

The intent is long term but the short term focus will be on the cost/quality curve for their own employees. Private firms have had the option of outsourcing the health care benefit management. The decision is becoming more costly and it appears more and more to be a poor value proposition.

For those interested in comparing their own premiums with averages, here's an interesting link:
  https://www.kff.org/interactive/premiums-and-worker-contributions/#/

The "premium" is the total cost and you can adjust the graph for single/family status and can "compare" with employee contribution which is a fraction of total cost.
Interesting to note that the total cost, even if the trend has somewhat improved comparing to the 1980's-90's period, continues to grow at relatively high rates.
Also interesting to remember that rising health costs have been only one of the few items keeping CPI above zero in our (still) largely disinflationary world.

The "big three" announcement has been met with some doubts: "The new company will have to align itself with main industry players". Helpful to remember that many previous attempts have failed but, lately, many similar endeavors are coming to life. Intel has made some regional progress on this front. Also, in 2016, many self-insured employers (including American Express, BNSF, Coca-Cola, Verizon...) have formed the Health Transformation Alliance. The essence of these initiatives, at this point, is to "cooperate" and gain scale/leverage. So far, these groups show some promise but have not been able (so far) to address the fundamental cost drivers of unnecessary care and avoidable complications.

In a way, health care is a puzzle of components that are essentially commoditized. The way the incentives are set up, at this point, prevents competition and the associated downward pressure on prices as ill-defined collusion forces make prices "sticky". Also, over the years the third-party "shield" (on a net basis, obviously not the case if you have to deal with higher deductibles and higher co-payments) has become larger, delaying the impetus for significant reform as many participants tend to think that there is a free lunch somehow. The new "project" spearheaded by Amazon likely will target the whole supply chain.

Some analysts have mentioned that the fear of healthcare disruption will have to be reconciled with today's reality. The treatment of a tapeworm infection rests on the necessity to evacuate it. But first, you have to put it to sleep.

Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DooDiligence on February 01, 2018, 04:03:51 AM
Amazon seems like a nice elephant.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on February 01, 2018, 02:11:12 PM
"Amazon seems like a nice elephant."
I'm not sure what you mean? Are you referring to the elephant acquisitions that Mr. Buffett talks about?

If that's the case, maybe there is something to learn.

My understanding is that Mr. Buffett always carries his loaded elephant gun but is known to have said that he enjoyed shooting fish in a barrel.
He does not seem to use an enterprise value to revenue ratio as a selection criteria.

In many ways, what Amazon has accomplished in the last 20 years is nothing short of extraordinary. I submit though that it is priced now for more of the same.

Here is a link that I read earlier today that is superficial and sensational in nature but that nonetheless helps to put things in perspective:
https://thefelderreport.com/2018/01/31/amazon-adds-a-mcdonalds-in-market-cap-in-the-month-of-january/

Funny because there may be some interesting parallels between Jeff Bezos and Ray Kroc.





Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DooDiligence on February 02, 2018, 06:15:04 AM
"Amazon seems like a nice elephant."
I'm not sure what you mean? Are you referring to the elephant acquisitions that Mr. Buffett talks about?

If that's the case, maybe there is something to learn.

My understanding is that Mr. Buffett always carries his loaded elephant gun but is known to have said that he enjoyed shooting fish in a barrel.
He does not seem to use an enterprise value to revenue ratio as a selection criteria.

In many ways, what Amazon has accomplished in the last 20 years is nothing short of extraordinary. I submit though that it is priced now for more of the same.

Here is a link that I read earlier today that is superficial and sensational in nature but that nonetheless helps to put things in perspective:
https://thefelderreport.com/2018/01/31/amazon-adds-a-mcdonalds-in-market-cap-in-the-month-of-january/

Funny because there may be some interesting parallels between Jeff Bezos and Ray Kroc.

Yes, and I meant it half jokingly.

I was imagining WEB & JB sitting down in Gorat's, with Bezos pitching him the healthcare idea, and Buffett saying "you know what, you'd have a lot more time to crush this idea, if you didn't have to do SEC filings & analyst calls."

The joking half was, of course, due to the the seemingly crazy valuation, and the huge leverage they'd probably have to take on to swallow Amazon.

Everyone here knows that I'm not a balance sheet ninja, and instead, am a story guy (this will undoubtedly bite me some day.)

I just love the concept of how BRK has freed up so many execs to run their businesses & re-allocate divs to capex (I know, no divs to re-allocate at Amazon, just having fun riffing on an idea here.)

---

I don't know much about Kroc, other than what was included in the movie "the Founder."
I'd guess that innovative processes and a relentless drive would be the main things the two men share in common.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: rkbabang on February 02, 2018, 06:35:18 AM
"Amazon seems like a nice elephant."
I'm not sure what you mean? Are you referring to the elephant acquisitions that Mr. Buffett talks about?

If that's the case, maybe there is something to learn.

My understanding is that Mr. Buffett always carries his loaded elephant gun but is known to have said that he enjoyed shooting fish in a barrel.
He does not seem to use an enterprise value to revenue ratio as a selection criteria.

In many ways, what Amazon has accomplished in the last 20 years is nothing short of extraordinary. I submit though that it is priced now for more of the same.

Here is a link that I read earlier today that is superficial and sensational in nature but that nonetheless helps to put things in perspective:
https://thefelderreport.com/2018/01/31/amazon-adds-a-mcdonalds-in-market-cap-in-the-month-of-january/

Funny because there may be some interesting parallels between Jeff Bezos and Ray Kroc.

Yes, and I meant it half jokingly.

I was imagining WEB & JB sitting down in Gorat's, with Bezos pitching him the healthcare idea, and Buffett saying "you know what, you'd have a lot more time to crush this idea, if you didn't have to do SEC filings & analyst calls."

The joking half was, of course, due to the the seemingly crazy valuation, and the huge leverage they'd probably have to take on to swallow Amazon.

Everyone here knows that I'm not a balance sheet ninja, and instead, am a story guy (this will undoubtedly bite me some day.)

I just love the concept of how BRK has freed up so many execs to run their businesses & re-allocate divs to capex (I know, no divs to re-allocate at Amazon, just having fun riffing on an idea here.)

---

I don't know much about Kroc, other than what was included in the movie "the Founder."
I'd guess that innovative processes and a relentless drive would be the main things the two men share in common.

Invert.  With Amazon growing so fast it will soon be able to swallow BRK.  WEB can retire and with Bezos at the helm all of Berkshire's cash can be used to grow Amazon instead of being allocated to buying companies.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DooDiligence on February 02, 2018, 06:44:52 AM
"Amazon seems like a nice elephant."
I'm not sure what you mean? Are you referring to the elephant acquisitions that Mr. Buffett talks about?

If that's the case, maybe there is something to learn.

My understanding is that Mr. Buffett always carries his loaded elephant gun but is known to have said that he enjoyed shooting fish in a barrel.
He does not seem to use an enterprise value to revenue ratio as a selection criteria.

In many ways, what Amazon has accomplished in the last 20 years is nothing short of extraordinary. I submit though that it is priced now for more of the same.

Here is a link that I read earlier today that is superficial and sensational in nature but that nonetheless helps to put things in perspective:
https://thefelderreport.com/2018/01/31/amazon-adds-a-mcdonalds-in-market-cap-in-the-month-of-january/

Funny because there may be some interesting parallels between Jeff Bezos and Ray Kroc.

Yes, and I meant it half jokingly.

I was imagining WEB & JB sitting down in Gorat's, with Bezos pitching him the healthcare idea, and Buffett saying "you know what, you'd have a lot more time to crush this idea, if you didn't have to do SEC filings & analyst calls."

The joking half was, of course, due to the the seemingly crazy valuation, and the huge leverage they'd probably have to take on to swallow Amazon.

Everyone here knows that I'm not a balance sheet ninja, and instead, am a story guy (this will undoubtedly bite me some day.)

I just love the concept of how BRK has freed up so many execs to run their businesses & re-allocate divs to capex (I know, no divs to re-allocate at Amazon, just having fun riffing on an idea here.)

---

I don't know much about Kroc, other than what was included in the movie "the Founder."
I'd guess that innovative processes and a relentless drive would be the main things the two men share in common.

Invert.  With Amazon growing so fast it will soon be able to swallow BRK.  WEB can retire and with Bezos at the helm all of Berkshire's cash can be used to grow Amazon instead of being allocated to buying companies.

Bam!
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: John Hjorth on February 02, 2018, 06:51:51 AM
... I don't know much about Kroc, other than what was included in the movie "the Founder."
I'd guess that innovative processes and a relentless drive would be the main things the two men share in common. ...

To me, a pretty accurate - and short - description from you about what these two men have in common, DooDiligence.

Thank you to villainx and Cigarbutt for bringing this up about Mr. Buffett's thoughts about compensation for the next Berkshire CEO. That has skipped my attention.

Cigarbutt, somehow, I like the concept of shooting fish in a barrel with an elephant gun!
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on February 02, 2018, 07:07:53 AM
One of the things I admire most about Mr. Buffett is his unique ability to act rationally, whatever the circumstances.
On the question of spotting opportunities, making "stupid" mistakes and buying stocks after significant price appreciation: "We've done it before".
Now, he is sitting on a pile and as far as I know, he hasn't pulled the trigger.
It is fair to say that BH would not bet against Amazon but they also would not invest in it at this point.
I think that represents a reasonable position.
https://www.cnbc.com/2017/05/08/warren-buffetts-one-word-answer-for-why-he-hasnt-purchased-amazon-shares.html
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: John Hjorth on February 02, 2018, 07:29:17 AM
Berkshire Website Announcement [2018.01.30] (http://berkshirehathaway.com/news/jan3018.pdf).

After reading it carefully, I speculate, that is an idea shared between [Mr. Dimon and Mr. Combs] and Mr. Bezos, without having any idea about who initiated the contact.

Somehow one get the feeling from the announcement, that Mr. Buffett must have said to Mr. Combs something like "It's "your idea" [in the meaning : "It's your idea" or "You came to me with the idea"], so you do it.".
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: tol1 on February 08, 2018, 06:17:00 AM
Does anyone consider a part of the US healthcare value chain to be unaffected by the tie-up? From pharma, PBMs, wholesalers, retailers - I just cannot see anyone not being squeezed.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: John Hjorth on February 08, 2018, 07:41:18 AM
Somehow I personally consider this initiative an employer-owned PBM, that will be running on some kind of non-profit basis.

Attached is a part of note 1 from Novo Nordisk Annual report 2017 released yesterday. It's ludicrous. Gross sales af DKK 216 B, net sales of DKK 112 B, US rebates etc. alone of DKK 100 B.

Novo Nordisk diabetes US market share 39 percent. Very rough calculation of total potential savings [with a lot of short cuts with regard to not taking NVO product mix etc. into consideration], here assuming without diabetes pharmas earnings affected: Savings potential for diabetes alone ~ DKK 100B / 39 percent minus J/V internal operation costs ~ DKK 256 B minus J/V internal operation costs ~ USD 43 B minus J/V internal operation costs.

What US politics haven't been able to fix so far, will eventually be fixed by Corporate America.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DooDiligence on February 09, 2018, 06:05:46 AM
Does anyone consider a part of the US healthcare value chain to be unaffected by the tie-up? From pharma, PBMs, wholesalers, retailers - I just cannot see anyone not being squeezed.

DVA, you can't do dialysis online.

But then again, they're getting squeezed by Uncle Sam.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on February 09, 2018, 07:26:42 AM
On the potential squeeze and potential transformation, we appear to be very early in the game.
There will be certainly pressure on the suppliers but demand will have a strong tendency to go up.

Potential winners may the ones able to position themselves to achieve satisfactory rates of regulated returns and gain market share. DVA seems to be a good example.

Simply getting to move at the speed of an elephant may be a comparative advantage to slow moving dinosaurs.
The "customer" cost/value proposition can be improved.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: longinvestor on February 09, 2018, 01:11:12 PM
https://www.forbes.com/sites/brucejapsen/2018/02/08/cvs-health-ceo-on-amazon-berkshire-threat-weve-got-this/#be65822276ae

A partner or a fox in the hen-house?
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on February 10, 2018, 05:08:14 AM
A partner or a fox?

If your thesis lies on the assumption of more of the same, the CEO’s assessment is reasonable. I would say that this status quo reasoning reinforces a false sense of security, an ideology of cautionary principles and stationary states.

If your thesis lies on a coming disruption with many small, unknown and bold players waiting to deploy their ideas, given the opportunity, then the big-three announcement may signal that the door is opening.

It may be reasonable to think that Amazon will set up some kind of technology-based transparent marketplace for the providers and the “consumers”. Something like a consolidated middleman.

A relevant example is what happened with the transportation logistics revolution that occurred since the early 80’s, although few people realize it was a revolution and it is often a neglected factor in the economic growth of the last few decades. Transportation logistics specialized in maximizing efficiency at all levels: from the order, to temporary storage, to the coordination of carriers, transfers, warehousing and delivery. Most transportation firms (asset-heavy) have an in-house logistics hub but this side of the business has been somewhat overtaken by asset-lite specialized entities (CH Robinson, Expeditors, etc) who became sophisticated brokers (middlemen). Transportation is not healthcare but nobody would go back in time in the transportation industry. Transportation costs are way down and these specialized brokers have been very profitable investments.

My humble take on the article and on the position of the “industry” is that if they want to partner with the big-three project, I see it more as a Trojan horse situation. The crafty Odysseus was able to bring the horse right in the middle of the city of Troy. Not a technology expert but I understand that a “Trojan” is used in the techno area as a trick or strategy that creates a context where the “virus” is spontaneously loaded into a protected or secured bastion and then fashioned to induce the host to willingly activate and use it.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on February 10, 2018, 02:14:41 PM
"Somehow I personally consider this initiative an employer-owned PBM, that will be running on some kind of non-profit basis.

Attached is a part of note 1 from Novo Nordisk Annual report 2017 released yesterday. It's ludicrous...

What US politics haven't been able to fix so far, will eventually be fixed by Corporate America."

John,

Your last post was a source of reflection and research.

This post lies halfway between this thread and Novo Nordisk (more on that later).

Concerning your non-profit basis comment, some say that this has been a key long-term characteristic of Amazon :). Notwithstanding the "profit" part, because of Amazon, I keep receiving on my doorstep, delivered rapidly and reliably, affordable specialized equipment that comes from far away places. Somehow, I get connected with sellers and delivery people who otherwise would have been outside of my reach.

I started looking at Novo Nordisk. If I understand you well, you seem to imply that the rebates etc are rising and affecting NVO's profitability in the context of a challenging pricing environment. Politely submitted, in my present limited understanding, it seems that the "value" of an american diabetic patient remains still relatively higher than other patients in general (ie Europe) even if pricing there is felt to be more "publicly" regulated. It seems also that the rebates and others are not passed on to the end user (the one who needs the product).

Concerning your "fix" comment, It seems that what a lot of the present players are saying is: "if it ain't broken, don't fix it".

This cost containment issue has been around for a long time and pharmas such as Novo Nordisk have always managed to preserve (and even increase) their profitability so this is nothing new perhaps. To help assess the cost pressure trends, here's a link related to a hot off the press report. If short on time, read the executive summary, the conclusion and the other Bloomberg link which gets the flavor of the report.

https://www.whitehouse.gov/wp-content/uploads/2017/11/CEA-Rx-White-Paper-Final2.pdf
https://www.bloomberg.com/news/articles/2018-02-09/drugmakers-dodge-another-bullet-in-trump-s-drug-pricing-report

Government reports are, by nature, political (we don't want to get into that, don't we?) so issues may not assumed head on and the plan may change but, for what it's worth, my opinion is that 1-we may reach a point (soon?) when significantly more pressure will be applied on the profit margins 2-pharmas will need to "prove" the value of their products and 3-now there is an added component aimed at the reduction of "free-riding abroad".

I understand that Novo Nordisk has a focus on diabetes (and obesity). Long term, diabetes industry dynamics may be changed by revolutionary new products (who knows when but the discovery of insulin itself is instructive in terms of the difficulty to identify where threats will come from and when) and pricing pressures may increase. However, the diabetes "market" will likely increase (a lot). Thinking of morbidity and mortality, did you know that, despite what the healines say, the global percentage of people dying violently has gone down tremendously in the last century and now, relatively, more people die from direct complications of diabetes (which is mostly a preventable disease, at least type 2)? Sugar (excess) is dangerous. One would think that preventive measures may eventually decrease demand for diabetic meds but, if history is any guide, when tobacco products were determined to be deadly products, tobacco companies were on the eve of long term stellar returns.

Sometimes I wonder about the usefulness of these general discussions so, when I read more about Novo Nordisk and if I become bright enough, I may try to contribute to that specific thread.

Final words related to your "political" comments and a way to go back to the essence of this thread. Health care costs have gone up ++ and, in many ways, this is not sustainable (tapeworm argument). Two links below using essentially the same data and coming to vastly different conclusions. The first link suggests that governments are too intrusive. The second link (Baumol's disease) suggests that the high prices we pay for health care may be in correlation to our relative affluence.
http://www.aei.org/publication/chart-of-the-day-century-price-changes-1997-to-2017/
https://www.vox.com/new-money/2017/5/4/15547364/baumol-cost-disease-explained
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: dwy000 on February 14, 2018, 03:54:41 PM
I was at a startup conference last week and the head of a new healthcare insurer was commenting on the announcement.  Take the source for what you will....but he raised a couple of good points.

He first questioned whether this would actually turn into anything meaningful.  Apparently the average Amazon employee stays there less than 2 years.  As the market shifts from fee-for-service to value-based-care that makes it a very difficult population to structure and price for long term coverage given you have 50% turnover in the underlying every year.  Also tough to apply pre-emptive health services that many insurers are focusing on.

The other point was that this is hugely beneficial for Amazon but he thought probably negative for everyone else.  The vast majority of Amazon's employees are under 40 years old.  This is the most desirable target group for insurers because they use very little healthcare and end us subsidizing the chronic care and older patients that account for over 80% of healthcare costs.  By pulling it's "cheap to insure" population out of the broader insurance environment and self insuring, Amazon is both saving cost for itself and increasing cost for the rest of the insured population. 

I have to assume JPM and Berkshire employee bases have much broader age ranges and less turnover but it was an interesting observation.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Jurgis on February 14, 2018, 04:36:39 PM
I thought other tech companies also self-insure on the money basis, but still contract with healthcare companies (United/Aetna/Cigna/etc.) for actual handling/benefits/accounting/etc. So that would be no different from Amazon and would have the same two points.

Amazon/JPM/Berkshire project IMO is interesting only if it does more than above: does not contract with healthcare companies for service?

But perhaps tech self-insure is something that comes and goes. I can't quote how many companies do this year to year.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on February 15, 2018, 04:59:19 AM
Good points.

Employee turnover appears to be high at Amazon but I'm not sure about the age profile.
Amazon is apparently even encouraging workers to quit with a 5000$ "offer".
https://www.theatlantic.com/business/archive/2018/02/amazon-offer-pay-quit/553202/?utm_source=feed
"Officially called “The Offer,” this proposition is, according to Amazon, a way to encourage unhappy employees to move on."
The jobs are physically demanding and many stay on the job for the health insurance coverage.

Concerning self-insured firms and the captive market, a practical experience (read from the scientific journal USA Today):
"As the founder and CEO of a mid-sized company that employs 180 people in the United States, I know this well. In 2018, we will pay $2.8 million to insure our workers and their families. Year after year, we have wrestled with the costs of our health care plans. And despite trying every trick in the book, our per-employee costs have tripled over the past 14 years. A family plan in 2018 will cost us $27,000, which is higher than the annual salary of one-third of all working Americans. To put it another way, we are paying $13.50 per hour per employee just to cover the health care benefit. It’s a model that’s completely unsustainable, and needs to change."

Employers, self-insured or not, (and the government) want to pay less.
Patients are not satisfied with the value proposition.
Providers are looking for more efficient processes and technology.
Insurers (who now connect all these actors) don't see ingredients for meaningful change.

Still early in the game and a lot of resistance expected but a potential for change.
Example:
https://www.apple.com/newsroom/2018/01/apple-announces-effortless-solution-bringing-health-records-to-iPhone/
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on February 27, 2018, 01:35:57 PM
For those who follow this "venture", here are some potentially useful links:
https://25iq.com/2018/02/23/what-might-the-amazon-berkshire-and-jp-morgan-health-care-joint-venture-actually-do/
https://www.wsj.com/articles/hidden-profits-in-the-prescription-drug-supply-chain-1519484401?mod=pls_whats_news_us_business_f
http://fortune.com/2018/02/27/apple-health-clinics-ac-wellness-employees-amazon-warren-buffett/

Not clearly investable yet but Medicare Advantage type scenarios and bundled payments may become subjects of interest.

Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DeepSouth on February 28, 2018, 02:05:34 PM
I was at a startup conference last week and the head of a new healthcare insurer was commenting on the announcement.  Take the source for what you will....but he raised a couple of good points.

He first questioned whether this would actually turn into anything meaningful.  Apparently the average Amazon employee stays there less than 2 years.  As the market shifts from fee-for-service to value-based-care that makes it a very difficult population to structure and price for long term coverage given you have 50% turnover in the underlying every year.  Also tough to apply pre-emptive health services that many insurers are focusing on.

The other point was that this is hugely beneficial for Amazon but he thought probably negative for everyone else.  The vast majority of Amazon's employees are under 40 years old.  This is the most desirable target group for insurers because they use very little healthcare and end us subsidizing the chronic care and older patients that account for over 80% of healthcare costs.  By pulling it's "cheap to insure" population out of the broader insurance environment and self insuring, Amazon is both saving cost for itself and increasing cost for the rest of the insured population. 

I have to assume JPM and Berkshire employee bases have much broader age ranges and less turnover but it was an interesting observation.

Amazon is not paying a blended average American rate for their employees. They are paying for insurance based on the risk of their employee pool.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on March 01, 2018, 06:51:22 AM
For those who wonder if less is more in healthcare:
http://www.nejm.org/doi/full/10.1056/NEJMms1713248#t=article
https://www.medscape.com/viewarticle/891091?src=WNL_infoc_180301_MSCPEDIT_ONC&uac=15207AZ&impID=1569981&faf=1

Relevant because the outcome of this debate will impact some players more than others.

The two articles are written by respected authors who, despite conflicting views, elevate the debate and help to find the way.
Perhaps not inappropriate in an era where people have never been more inundated by data (of unequal quality) often leading to the triumph of ignorance.
Need humble guiding lights in order to "see" the data-driven answers and filter out the hype-driven and purely profit-driven promises.
At the risk of raising the ire of zealots, I'll disclose that I subscribe to a sensible less is more approach but remain open to other ideas as there are no perfect answers in this difficult "market".

For those interested, an important contributor to the the field is Atul Gawande who got praise from Mr. Charlie Munger after "The Cost Conundrum" article.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Dynamic on June 21, 2018, 04:57:08 AM
https://www.businesswire.com/news/home/20180620005747/en/Amazon-Berkshire-Hathaway-JPMorgan-Chase-appoint-Dr. (https://www.businesswire.com/news/home/20180620005747/en/Amazon-Berkshire-Hathaway-JPMorgan-Chase-appoint-Dr.)

Amazon, Berkshire Hathaway and JPMorgan Chase appoint Dr. Atul Gawande as Chief Executive Officer of their newly-formed company to address U.S. employee healthcare

The new company to operate independently and be based in Boston

If you're interested he has 2012 TED talk and presented the 2014 Reith Lectures on BBC Radio 4, both of which seem to revolve around fixing healthcare systems, and both of which should still be available to listen to.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: CorpRaider on June 21, 2018, 05:57:00 AM
For any who haven't read his books, especially the Checklist Manifesto, get on it.  What an incredible polymath!
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Dynamic on June 21, 2018, 05:58:39 AM
I remember that from his Reith lecture and various other podcasts from a few years ago. Amazingly smart idea.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: sleepydragon on June 21, 2018, 06:45:39 AM

wow, I wonder if Buffett or Bezo was reading this

For those who wonder if less is more in healthcare:
http://www.nejm.org/doi/full/10.1056/NEJMms1713248#t=article
https://www.medscape.com/viewarticle/891091?src=WNL_infoc_180301_MSCPEDIT_ONC&uac=15207AZ&impID=1569981&faf=1

Relevant because the outcome of this debate will impact some players more than others.

The two articles are written by respected authors who, despite conflicting views, elevate the debate and help to find the way.
Perhaps not inappropriate in an era where people have never been more inundated by data (of unequal quality) often leading to the triumph of ignorance.
Need humble guiding lights in order to "see" the data-driven answers and filter out the hype-driven and purely profit-driven promises.
At the risk of raising the ire of zealots, I'll disclose that I subscribe to a sensible less is more approach but remain open to other ideas as there are no perfect answers in this difficult "market".

For those interested, an important contributor to the the field is Atul Gawande who got praise from Mr. Charlie Munger after "The Cost Conundrum" article.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DTEJD1997 on June 21, 2018, 06:46:46 AM
Good points.

Concerning self-insured firms and the captive market, a practical experience (read from the scientific journal USA Today):
"As the founder and CEO of a mid-sized company that employs 180 people in the United States, I know this well. In 2018, we will pay $2.8 million to insure our workers and their families. Year after year, we have wrestled with the costs of our health care plans. And despite trying every trick in the book, our per-employee costs have tripled over the past 14 years. A family plan in 2018 will cost us $27,000, which is higher than the annual salary of one-third of all working Americans. To put it another way, we are paying $13.50 per hour per employee just to cover the health care benefit. It’s a model that’s completely unsustainable, and needs to change."

A family insurance plan costs $27k per year? 

That could almost be the wage for an employee per year!  When I was working as an attorney a couple years ago, the pay rate was $21/hour.  Something has gotten seriously, seriously out of whack.  A lot of people in America (not just fast food workers & clerks) just simply can't afford to pay that...not even close.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: gfp on June 21, 2018, 06:55:03 AM
You made $21/ hour pretax as an attorney??!  Yikes!
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: sleepydragon on June 21, 2018, 07:05:24 AM
You made $21/ hour pretax as an attorney??!  Yikes!

Maybe a real estate attorney? :)
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: CorpRaider on June 21, 2018, 07:10:58 AM
He was a first year at Cravath...but he said hourly.   ;D
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DTEJD1997 on June 21, 2018, 07:16:12 AM
You made $21/ hour pretax as an attorney??!  Yikes!

Maybe a real estate attorney? :)

No, I was a "contract attorney" brought in to work on massive lawsuits.  It was preparation/sorting/analysis of documents.

At that point in time (2015), there were attorneys POUNDING down the door to get in...

A lot of attorneys did that work "for the big kash money!".  I was surprised and dismayed at that.  it was then explained to me that $21 an hour was SUBSTANTIALLY more than a lot of attorneys make in the Detroit market. 

Thankfully, I don't do that any more.  I feel bad for the people who still do.

It was boring, tedious work.  It was the best outcome a LOT of people could hope for though.

I could tell so many crazy/sad stories...
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: mbreject on June 21, 2018, 10:26:03 AM
$27k is actually pretty good for a family.

My parents paid ~$35k a year (PPO, California) before my dad got Medicare. My mom's counting the days until she's 65 lol
I think free health insurance for the unemployed is why a lot of people are unhappy about Obamacare. People like my parents saw a lot of their friends quitting their jobs to travel and getting free insurance while the people who kept their jobs had to keep paying for this crazy thing.

Also, I'm pretty sure a lot of people think insurance is cheaper than it really is, because their employer subsidizes it.

I'm very hopeful about this new company and hope they open it up to other people as well.

Good points.

Concerning self-insured firms and the captive market, a practical experience (read from the scientific journal USA Today):
"As the founder and CEO of a mid-sized company that employs 180 people in the United States, I know this well. In 2018, we will pay $2.8 million to insure our workers and their families. Year after year, we have wrestled with the costs of our health care plans. And despite trying every trick in the book, our per-employee costs have tripled over the past 14 years. A family plan in 2018 will cost us $27,000, which is higher than the annual salary of one-third of all working Americans. To put it another way, we are paying $13.50 per hour per employee just to cover the health care benefit. It’s a model that’s completely unsustainable, and needs to change."


A family insurance plan costs $27k per year? 

That could almost be the wage for an employee per year!  When I was working as an attorney a couple years ago, the pay rate was $21/hour.  Something has gotten seriously, seriously out of whack.  A lot of people in America (not just fast food workers & clerks) just simply can't afford to pay that...not even close.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on October 17, 2018, 10:28:06 AM
The venture is shaping up.
I understand that the recently posted "data scientist" position may have something to do with the adventure.
https://www.amazon.jobs/en/jobs/715945/data-scientist-healthcare-benefits

FWIW, I think there is a huge talent basin for this position.
The profile requires to be data driven, transformative and multi-disciplinary.

The #1 candidate on my list is Mr. Andrew Bartley.
https://itpeernetwork.intel.com/lean-startup-approach-predictive-clinical-analytics-healthcare-part-ii/
https://www.intel.com/content/www/us/en/healthcare-it/solutions/documents/predictive-analytics-in-healthcare.html

Was looking recently at work being done on workers injuring themselves at work and ending in the downard spiral of an opioid addiction problem. Big issue, huge costs (human and financial) and...mostly preventable. All you need is a relatively intelligent tool that would spot the risk factors early on, provide alternatives and remedial actions before it's too late. And it would cost less too.

An unrecognized concept is that the approach that the data scientist will apply is very similar to what clinicians do on the field.
They will:
-observe and collect data (listen, ask, examine and read test results)
-try to answer a question (diagnosis)
-finds way to predict what will happen based on the above two (risk factors and natural history)
-try to prescribe a solution in order to obtain a positive change in outcome

Hippocrates would be proud and advanced analytics is closer than you think.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: handycap5 on October 17, 2018, 12:39:14 PM
Hippocrates would be proud and advanced analytics is closer than you think.

Shane Parrish did a very interesting interview with Atul which I recommend.

Also, since you mentioned the Hippocratic Oath, I can't help but think of Milton Friedman's criticism of the same (search for Oath here: http://www.freerepublic.com/focus/f-news/1684832/posts). I suspect the greater opportunity and greater challenge will be changing human behavior and organizations, not mining data. But maybe the latter can aid the former.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on October 17, 2018, 06:38:45 PM
Shane Parrish did a very interesting interview with Atul which I recommend.

Also, since you mentioned the Hippocratic Oath, I can't help but think of Milton Friedman's criticism of the same (search for Oath here: http://www.freerepublic.com/focus/f-news/1684832/posts). I suspect the greater opportunity and greater challenge will be changing human behavior and organizations, not mining data. But maybe the latter can aid the former.

Thank you for the link handycap5. It was an interesting conversation and I hope that the BRK-led venture amounts to something.

Mr. Gawande is a humble leader with conviction and I guess he is not the type to underestimate the challenge.

Benjamin Friedman must himself turn in his grave if he sees the growing portion of GDP spent on healthcare and he did make a distinction between the oath and the man behind the oath. Going forward, we will need to continuously rebalance the tensions between the freedom for alternatives and the reliance on third party payments.

The foreseeable future is fuzzy, as always, but I think health outcomes, for at least a while for the tapeworm to grow, will come down to a race between growing "system" productivity and diminishing returns on "scientific" inputs. All the hype around the big data and predictive analytics is really about gradual and evolutionary application of method where science meets humanity.

Interesting to note that Mr. Gawande does not talk about increasing intricacies and opacity, he explains that we will try to "unknot the complexity". In my own humble on-the-ground experience, the most effective improvement projects were simple, automatic and "natural", irrespective of the degree of underlying complexity, insight or sophistication. The underlying design will continue to require human intelligence but the application of the design will increasingly require the assistance of artificial intelligence.

Concerning incentives and changing people, I remember an episode where I was part of a group responsible, in a self-regulating type of environment, for adjustments in payment amounts (code) for listed procedures. There was a typing mistake and a rarely performed procedure became more rewarding financially. Guess what happened after the new list was disseminated. People, medical or otherwise, respond to incentives, good and bad.

Concerning changing people and systems, nobody likes it to be told about the huge gap that exists between the assumed "performance" and actual results but Mr. Gawande sees himself as a bridge builder and Fortune favored the prepared mind. A relevant example is the integration of the thermometer into the "system". Historical example but highly enlightening. Just like the BRK-led projects to come, the iniatives may first be seen as threats but, before you know it, it's not the the people that will change the system but the system that will change the people.
https://blogs.scientificamerican.com/observations/why-doctors-reject-tools-that-make-their-jobs-easier/

I'm long human intelligence since ignorance has reached the level of ineptitude.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Jurgis on October 17, 2018, 09:24:56 PM
I'm long human intelligence since ignorance has reached the level of ineptitude.

OT.

I'd be long Elon Musk's Neuralink, since human intelligence and knowledge acquisition in particular seem to be hitting walls dealing with complex multifaceted problems.

Although I continue to be amazed by new discoveries, especially in math and physics where problems and their solutions have moved beyond being understandable by very very few.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: gfp on October 18, 2018, 07:48:56 AM
Not sure where to link this, but Warren did an event sponsored by newly acquired MLMIC, New York's largest medical malpractice insurer - where he had a public conversation with Dr. James Reed, CEO of St. Peter's Health Partners.  (if you've reached your 'free limit' for reading the article, open the link in private or incognito mode to read)

https://www.bizjournals.com/albany/news/2018/10/18/warren-buffett-health-care-st-peters-reed.html
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on October 30, 2018, 03:05:50 PM
Not sure where to link this, but Warren did an event sponsored by newly acquired MLMIC, New York's largest medical malpractice insurer - where he had a public conversation with Dr. James Reed, CEO of St. Peter's Health Partners.  (if you've reached your 'free limit' for reading the article, open the link in private or incognito mode to read)

https://www.bizjournals.com/albany/news/2018/10/18/warren-buffett-health-care-st-peters-reed.html
Thank you for the link which I just reviewed.
Also led me to the following conversation:
https://www.mlmic.com/blog/physicians/warren-buffett-on-protecting-physicians

On the expectations about the joint venture (It feels like Columbus looking for a continent... and we don't really know where we're going...expect failures) I find that it's the good 'ole way to manage expectations. It feels the same when one reads the early partnership letters concerning investment return expectations...

Atul Gawande also shares this capacity to hide the drive behind humility. But it's there.

Also interesting because, during the interview, Mr. Buffett clearly said that the cash cushion at BH was still 20B. Something I had not heard for some time and expected to be higher as insurance operations have grown somewhat in the last few years.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Gamecock-YT on November 06, 2018, 04:42:53 PM
new yorker article by the new CEO

https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: John Hjorth on November 06, 2018, 08:47:44 PM
Posted by dcollon a few days ago in the "Buffett/Berkshire - general news" topic :

Discussion about Health Care and Malpractice

https://www.valuewalk.com/2018/11/malpractice-insurance-warren-buffett/
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DooDiligence on November 07, 2018, 04:10:38 AM
Posted by dcollon a few days ago in the "Buffett/Berkshire - general news" topic :

Discussion about Health Care and Malpractice

https://www.valuewalk.com/2018/11/malpractice-insurance-warren-buffett/

What a great resource to identify physicians that they do & DON'T want in the BRK/JPM/AZN system.
Are they only operating in NY?

Seems like insurance, in general, is a great business to own, for identifying risky businesses to avoid.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on November 07, 2018, 05:44:34 AM
Posted by dcollon a few days ago in the "Buffett/Berkshire - general news" topic :

Discussion about Health Care and Malpractice

https://www.valuewalk.com/2018/11/malpractice-insurance-warren-buffett/

What a great resource to identify physicians that they do & DON'T want in the BRK/JPM/AZN system.
Are they only operating in NY?

Seems like insurance, in general, is a great business to own, for identifying risky businesses to avoid.
Even if the emphasis was on the positives and the synergies, the point you make is interesting because the stick component may be just as important as the carrot (in the UK, there is a car insurer named Carrot Insurance that rewards "good" drivers).

-comment on the presence in NY State
New York State appears to be the largest market for malpractice insurance in the US.
https://www.diederichhealthcare.com/the-standard/2018-medical-malpractice-payout-analysis/
MLMIC is AFAIK only writing business in the NY State and, in 2008, had 40% market share (in 2017, 26% and MedPro, another BRK sub, 10%). The MLMIC transaction is a classic Buffett one because the NY market has been challenged by new players, including some risk rentention groups, that have clearly shown less than ideal discipline. In this market, the typical delay for payout is about 7 years which may give an unusually long and apparent period of growth and profitability before hitting the wall (see Oceanus Insurance recent liquidating experience that happens with surplus depletion and the tide going out). When looking at the incredibly instructive cycle of reserve releases in this specific market, it seems that shit is about to hit the fan and, as usual, BRK businesses will be there to pick up the pieces and continue to build the masterpiece.

-comment on the opportunity to share knowledge with the venture
Healthcare liability insurers want to keep premiums low and the incentives behind that aim correlates well with an improved quality of care to cost ratio. They have built a huge database and tools that help to identify "deviant" outcomes. In the positive sense, they can identify groups or areas that have somehow put together a format of care giving superior results. They can also spot relative negative outcomes and are ideally placed to define strategies to improve results (constructive feedback, education but also other "unpleasant" measures).

Just in case you have time, here's an example of "cooperation" between the liability insurer and the clinical world:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2725304/

Take-home message: companies like MLMIC can identify areas of unusual costs, can help define the costs and their causes and can help define a cost effective way to improve the quality to cost ratio. Sponges left inside a cavity is an extremely rare event (about 0,01%) but when it's you, it's a 100%. This study and others have shown that there are simple and cost-effective strategies (including a systematic method and a checklist) that can reduce the risk of "forgotten" items in human cavities. With this mindset, imagine the potential for people going to the emergency room with a heart attack or even for more mundane conditions as people going to primary care for eye styes.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on November 20, 2018, 08:43:03 PM
The project is taking form with one more addition.
https://www.healthcareitnews.com/news/amazon-berkshire-jpmorgan-venture-hires-bcbs-it-exec-dana-safran-data-driven-position
https://aboutus.bluecrossma.com/affordability-quality/alternative-quality-contract-aqc
https://nam.edu/wp-content/uploads/2018/07/5.3-Safran.pdf

Her title could have been chief of incentives alignment and she could be seen as capitation with a smile.
Her task will be to try to tackle the price/value proposition.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Jurgis on December 27, 2018, 09:54:25 PM
https://qz.com/work/1481224/the-most-screwed-up-employee-perk-in-america-and-the-man-who-just-might-fix-it/ - Longish article about Gawande and BRK/JPM/AMZN healthcare effort (no details). Lots of links to other articles.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Cigarbutt on December 28, 2018, 05:11:39 AM
https://qz.com/work/1481224/the-most-screwed-up-employee-perk-in-america-and-the-man-who-just-might-fix-it/ - Longish article about Gawande and BRK/JPM/AMZN healthcare effort (no details). Lots of links to other articles.
That was an interesting summary. Thank you.
The reference to Francis Moore is quite revealing, a pioneer who, especially in early life, pushed for innovative reforms in a pro-active way, causing some painful transition issues along the way but he was a man of prodigious memory and energy, and never hesitated to overthrow dogma.
The trigger for Dr. Moore, which eventually led to memoirs titled A Miracle and a Privilege was, in 1942, when he had to deal with the arrival of 114 burn victims from the catastrophic Cocoanut Grove nightclub fire.

A reminder that "we" have gotten quite poor at handling tipping points.
But, even if forced to, we'll get there somehow.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: investmd on January 03, 2019, 04:28:10 AM
https://qz.com/work/1481224/the-most-screwed-up-employee-perk-in-america-and-the-man-who-just-might-fix-it/ - Longish article about Gawande and BRK/JPM/AMZN healthcare effort (no details). Lots of links to other articles.
Thanks for the good article. The merging of a healthcare system for Amazon, BRK & JPM is a neat experiment in US healthcare models. Purpose clearly seems to be to see if healthcare quality can be improved, whilst simultaneously cutting cost and waste. Premise is that healthcare in US is inexplicably tied to employment and that universal healthcare (like Canada, UK and much of Europe) is not an option. Thus, it's up to employers to change it. This "experiment" has a great Principle Investigator in Gawande, a good population base of 1.5 million individuals and support/resources of  3 of the strongest companies in the US. I'm excited to see where this goes.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DooDiligence on February 01, 2019, 07:39:21 AM
https://www.wsj.com/articles/new-details-on-amazon-berkshire-hathaway-jpmorgan-health-venture-emerge-in-court-battle-11548899146
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: longinvestor on February 01, 2019, 09:56:42 AM
https://www.wsj.com/articles/new-details-on-amazon-berkshire-hathaway-jpmorgan-health-venture-emerge-in-court-battle-11548899146


Must be very high $takes.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: John Hjorth on February 01, 2019, 02:18:03 PM
Attached is the 2.1 note from NVO financials YE2018, released today, for perspective of diabetes and [less] obesity.

What does that tell you? [From an investment angle: Who may be on their way under the bus here?]
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DooDiligence on February 01, 2019, 02:26:34 PM
Attached is the 2.1 note from NVO financials YE2018, released today, for perspective of diabetes and [less] obesity.

What does that tell you? [From an investment angle: Who may be on their way under the bus here?]

P B M s & other non-innovative supply chain participants.

I'm not worried about NVO

edit: I sold ABC - $625m settlement over illegal compounding. What else is management missing?
(Cash will go to ???)
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: gfp on March 06, 2019, 03:32:24 PM
https://www.havenhealthcare.com
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: Dynamic on March 07, 2019, 04:49:40 AM
https://www.havenhealthcare.com

And here's today's press release (https://www.businesswire.com/news/home/20190306005660/en/). Below are a couple of excerpts:

Quote
“We want to change the way people experience health care so that it is simpler, better, and lower cost,” explained Haven CEO Atul Gawande, MD, MPH. “We’ll start small, learn from the experience of patients, and continue to expand to meet their needs.”

Quote
“The good news is the best results are not the most complicated or expensive. The right care in the right place is often more effective and less costly than what we get today,” explained Dr. Gawande.

As Haven scales up its operations, the organization is focused on recruiting a range of talented individuals, including software engineers, data scientists, and clinicians to join its team. The company is headquartered in Boston and also has an office in New York.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: DooDiligence on March 07, 2019, 04:55:29 AM
https://www.havenhealthcare.com

And here's today's press release (https://www.businesswire.com/news/home/20190306005660/en/). Below are a couple of excerpts:

Quote
“We want to change the way people experience health care so that it is simpler, better, and lower cost,” explained Haven CEO Atul Gawande, MD, MPH. “We’ll start small, learn from the experience of patients, and continue to expand to meet their needs.”

Quote
“The good news is the best results are not the most complicated or expensive. The right care in the right place is often more effective and less costly than what we get today,” explained Dr. Gawande.

As Haven scales up its operations, the organization is focused on recruiting a range of talented individuals, including software engineers, data scientists, and clinicians to join its team. The company is headquartered in Boston and also has an office in New York.

I really like this in principle & we obviously need some altruism in healthcare (hell, everywhere for that matter.)

Just to play devils advocate though, how will patients feel about this in our "have it your way" society?

I can almost hear the neo-con spin.

"They're won't let your Grandma have her meds & are trying to kill her"

----

I do believe that initiatives like this could force players / payers to act on a value based framework.

How well it will be received initially (by many) seems obvious too.

CVS over the next 2 decades? I understand all the bearish arguments but don't see an existential threat to them.
Title: Re: BRK/JPM/AMZN healthcare tie up
Post by: John Hjorth on May 17, 2019, 07:15:27 AM
CNN Business [May 17th 2019] : Haven, the Amazon-Berkshire-JPMorgan health care company, has already lost its No. 2 executive (https://edition.cnn.com/2019/05/17/business/haven-coo-leaves/index.html?utm_source=twbusiness&utm_term=link&utm_content=2019-05-17T13%3A50%3A02&utm_medium=social).