Viral Healthcare

Productivity may decline. Resistance can grow. Unexpected problems emerge. Sometimes performance even gets worse before it gets better. But when does normal implementation friction become evidence that something is actually wrong? In this reflection on Part 3 of the Haven Healthcare series, Dr. Bruce Spurlock explores one of the hardest challenges in leading change: separating noise from signal. Looking back at Haven’s leadership turnover, competing initiatives, and other warning signs, Bruce asks what healthcare leaders can learn about recognizing trouble before hindsight makes it obvious. The key may be deciding what failure looks like before implementation begins—using pre-mortems, milestones, measures, and predefined tripwires to challenge assumptions before sunk costs make changing direction even harder. Viral Healthcare — Real change lasts. Theater doesn’t. 

Then the warning lights started appearing. A senior executive departed. Employee turnover followed. A promising pilot struggled with engagement. Amazon began developing healthcare initiatives of its own. Eventually, CEO Atul Gawande stepped away. But none of those events, on its own, necessarily meant Haven was failing. In Part 3 of the Haven Healthcare series, Dr. Bruce Spurlock examines one of the hardest challenges leaders face during implementation: how do you distinguish normal turbulence from a meaningful warning signal? Rather than judging Haven with hindsight, Bruce follows the evidence as it accumulated and explores how tools like pre-mortems, leading indicators, milestones and predefined “trip wires” can help leaders recognize when persistence is warranted—and when it may be time to adapt, narrow or stop. Because innovation rarely comes with one unmistakable moment when someone tells you the strategy isn't working. More often, leaders receive pieces of evidence and have to decide when those pieces have become a pattern. Topics / Keywords Haven Healthcare, healthcare innovation, healthcare leadership, implementation science, change management, pre-mortem, leading indicators, healthcare strategy, Amazon healthcare, Berkshire Hathaway, JPMorgan Chase, Atul Gawande, sunk cost fallacy, organizational change, healthcare transformation  

Where would you start?In this reflection on Part 2 of the Haven Healthcare series, Dr. Bruce Spurlock looks at the choices Haven made once it moved from ambition to implementation. In Ohio, the organization experimented with benefit design and easier navigation. In Seattle, it explored technology-enabled access to primary care. Different populations, different approaches, and—most importantly—something that could finally be measured.Bruce explores a fundamental challenge of healthcare innovation: eventually, leaders have to stop designing the perfect strategy and put a foot down somewhere. That first decision creates consequences, produces information, and gives an organization the opportunity to learn.The question isn’t whether your first decision will be perfect. It’s whether you have built a process that allows you to recognize what is working and adopt, adapt, or abandon as you learn.Show NotesIn this reflection:Why unlimited resources don't eliminate implementation riskHaven's experiments in Ohio and SeattleSimplifying benefit design and healthcare navigationUsing technology to improve access to primary careWhy changing physicians can become a major adoption barrierThe value of segmenting populations before scalingWhy a pre-mortem can reveal problems before implementation beginsTurning implementation into something measurableKnowing when to adopt, adapt, or abandonMaking decisions without the benefit of hindsightWhy every implementation decision creates consequencesThe question every healthcare leader eventually faces: Where do we start?

What happens if Haven Healthcare actually succeeds?Employees get healthier. Prescription drug spending falls. Primary care becomes easier to access. Unnecessary emergency department visits and hospital stays decline. Amazon, Berkshire Hathaway, and JPMorgan Chase spend less on healthcare.It sounds like success. But in healthcare, lower spending for one organization often means lost revenue for another.In Part 2 of the four-part Haven Healthcare series, Bruce Spurlock moves beyond Haven's ambitious launch and into the realities of implementation. Haven wasn't entering a blank healthcare system. It was entering an enormous network of hospitals, physicians, insurers, pharmacy benefit managers, pharmaceutical companies, brokers, technology companies, employers, and patients, all operating with different incentives and definitions of value.Bruce explores the uncomfortable economics behind healthcare transformation and then follows Haven as its broad mission begins turning into actual experiments. New health plan designs are tested. Primary care models are explored. Technology becomes part of the strategy. Employees begin interacting with these ideas in the real world, sometimes differently than expected.And another challenge begins to emerge.While Haven was developing new approaches, its founding companies remained capable of pursuing their own healthcare strategies. Amazon Care, for example, was developing alongside Haven's work, raising a much larger question about alignment, independence, governance, and who ultimately controlled the strategy.None of these developments meant Haven was failing. But together, they were beginning to form a pattern.In Part 3, Bruce asks: When does a setback become a warning?

Imagine being given more resources than you could reasonably expect, a long-term time horizon, access to more than a million employees, and a mandate to rethink healthcare.Would you take the job?In this reflection on Part 1 of the Haven Healthcare series, Bruce Spurlock goes back to 2018 and deliberately removes what we know today. Amazon, Berkshire Hathaway, and JPMorgan Chase had come together around an enormous ambition: find a better way to deliver and pay for healthcare.Atul Gawande was brought in to lead the effort, giving Haven an accomplished physician, writer, and healthcare thinker who had spent years examining how healthcare systems work and why they fail.From where the leaders stood at the time, the opportunity was extraordinary.But once you accept the opportunity, a much harder question appears: Where do you start?Do you redesign the entire system? Focus on one population? Choose one healthcare problem? Start small and learn? Or use the unusual scale and resources you've been given to attempt something much bigger?Bruce reflects on the decisions facing Haven's leaders without using the benefit of hindsight and sets up Part 2 of the series, where the story moves from ambition to implementation.

On January 4, 2021, one of the most closely watched experiments in American healthcare came to an end. Haven Healthcare, created by Amazon, Berkshire Hathaway, and JPMorgan Chase, was shutting down less than three years after its launch.Its CEO had already stepped down. Its COO had left before him. The remaining employees would be absorbed back into the companies that created it.So what happened?In Part 1 of this four-part Viral Healthcare series, Bruce Spurlock deliberately avoids starting with that question. Once we know how a story ends, hindsight makes it easy to identify all the reasons failure seems inevitable. Instead, Bruce takes us back to January 2018 and asks what Haven looked like to the people making decisions at the time.Three enormously successful companies. More than a million employees. Extraordinary access to capital, technology, data, purchasing power, and talent. A healthcare system almost everyone agreed needed improvement. Then, six months later, the venture selected physician, researcher, author, and healthcare thinker Dr. Atul Gawande as its leader.On paper, it was difficult not to believe Haven had a real chance.But underneath the excitement was a much harder question: What exactly were they trying to fix?Bruce explores the difference between a compelling purpose and an implementable aim, the complexity of trying to disrupt an interconnected healthcare system, the challenge of governing an independent organization with three powerful owners, and the decisions Haven's leaders faced before anyone knew how the story would end.And he leaves us with the decision Haven itself had to make: Do you use extraordinary resources to rethink healthcare broadly, or narrow the problem to one population, one market, and one measurable outcome, prove it works, and then spread?In Part 2: Who loses if Haven Healthcare wins?

If you're committed to improving health outcomes, how far beyond the traditional healthcare system should you be willing to look? In this Episode 25 Reflection, Bruce Spurlock builds on his conversation with Rich Rasmussen, President and CEO of the Oklahoma Hospital Association, and explores what healthcare leaders can learn from the development of the Oklahoma Healthy Oklahoma Profile, or OK HOP. Transportation, food access, broadband, preventive services, virtual care, and other factors outside the hospital can have an enormous impact on health. The challenge is that healthcare organizations cannot address every need at once. Bruce discusses why leaders need to identify the highest-leverage opportunities in individual communities, prioritize limited resources, and collaborate across the public and private sectors rather than treating healthcare as a collection of separate "swim lanes." The larger lesson is about thinking differently. Improving health requires understanding the entire system surrounding the people and communities we serve, then determining where focused action can have the greatest impact. 

Hospitals collect enormous amounts of data. But how much of that data actually helps improve the health of the communities they serve? In Episode 25 of Viral Healthcare, Bruce Spurlock sits down with Rich Rasmussen, President and CEO of the Oklahoma Hospital Association, to explore OK HOP and a different approach to improving health across Oklahoma. OK HOP brings together data from hospitals and sources outside the traditional healthcare system to identify gaps affecting health at the community level. Transportation, broadband access, food availability, healthcare access, chronic disease, and other factors can all influence whether patients ultimately achieve better outcomes. Bruce and Rich discuss why hospitals, particularly in rural communities, often serve as much more than places to receive medical care. They are anchor organizations, employers, public health resources, and essential parts of the local safety net. The conversation also explores how Oklahoma is bringing hospitals, health plans, government agencies, transportation leaders, chambers of commerce, philanthropy, and other stakeholders together around shared priorities and measurable outcomes. The lesson extends well beyond Oklahoma. We already collect much of the data needed to understand where communities are struggling. The opportunity is to connect it, prioritize it, and use it to decide where action can make the greatest difference. In this episode: How OK HOP turns healthcare and community data into actionable priorities  Why rural hospitals are critical anchors in their communities  How transportation and broadband access affect health outcomes  Why better healthcare requires looking beyond the walls of the hospital  How hospitals, payers, government, and community organizations can collaborate  Why local proof of concept can help successful interventions spread  How other states could replicate Oklahoma's approach