Haven Healthcare will cease operations at the end of February. In case you missed it, Haven Healthcare was the brainchild of three of the world’s most dynamic and successful companies: Amazon, Berkshire Hathaway and JP Morgan Chase. Haven launched with much fanfare on Jan. 30, 2018, with the audacious goal of revolutionizing health-care delivery. The starting point for their revolution would be the collective 1.2 million employees and dependents of their own organizations.  

Given the financial and technological prowess of the three CEO partners, the world expected big results. According to Bloomberg: “The mere prospect of Jeff Bezos, Warren Buffett, and Jamie Dimon joining forces so worried investors that the shares of established health insurers and pharmacy benefits managers tumbled on the news”. 

With all their potential, their success in this venture seemed guaranteed, so how could they have possibly failed? I think Haven’s approach was spot-on, as evidenced by their post-mortem press release: “In the past three years, Haven…piloted new ways to make primary care easier to access, insurance benefits simpler to understand and easier to use, and prescription drugs more affordable. Having a relationship with a family doctor, whether it’s online via telemedicine or in-person, can also be key to helping employees live healthier lives…” 

Geez, doesn’t that sound a little bit like me on my soap box? Every opportunity I get, I hammer the same talking points: our patients need more primary care. An engaged, easy-to-access relationship with a primary care provider will keep patients healthier, better manage chronic disease and lower costs, solving much of what’s wrong with health care today. So with their nearly unlimited access to financial and technological resources, why did Haven fail? 

My guess—there weren’t enough primary care providers to ensure their employees had the easy access to health care they were seeking.    

Haven wasn’t just managing one group of employees in a single location. They were managing 1.2 million employees and dependents, spread across three different companies in geographically diverse locations across the country. A critical factor in executing their strategy centered on a basic concept of the medical home—each employee would have easy, unfettered access to the health care system through their established relationship with a primary care provider. But all of it falls apart when there is an inadequate supply of primary care providers, thus limiting their timely (and easy) access to care. Despite their considerable resources, Haven could not conjure up more primary care providers in their multiple locations spread out across the country. 

And unfortunately, adding Amazon’s technological expertise to the primary care equation doesn’t solve the manpower issue. For technology to enhance health care, a trained human (that the patient trusts—i.e. has a relationship with) still needs to be on the receiving end of that technology. If either element is missing (the trained human or the trust) then technology fails to complement the delivery of primary care. 

The primary care shortage is multifactorial, but I think there is one key factor that needs to change. According to EducationData.org, the current student loan debt for medical students is over $240,000. And guess what? The loan debt is the same whether those students become primary care docs or go into other sub-specialties. Yet the salaries of several sub-specialties are more than twice the salaries of primary care physicians. So at the time of graduation, when students are contemplating their pile of debt, it doesn’t take a rocket scientist (or a brain surgeon) to figure out that repaying that debt would be so much easier in a higher paid sub-specialty. So, if we all agree that transforming health care rests on the shoulders of primary care, then we better figure out how to pay them what they’re worth. Maybe before they go away, the Haven brain trust could re-focus their substantial clout on helping our country solve this problem. 

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