--Frank Easley, senior vice president, health care strategist at Aon

Fed up and not going to take it

“The news that Amazon, Berkshire Hathaway and JPMorgan Chase are teaming up to launch a new health care company is, frankly, unsurprising to me. For some time now, employers of all sizes have been struggling on behalf of their employees to deal with a system completely out of alignment with their needs. Costs rise, even as covered services fall, affecting wage growth, worker well-being and business productivity. Employers are fed up with the misalignment and are actively looking to change how they sponsor employee health coverage.

“In our national practice counseling employers on the development of employee benefit programs we’ve seen a strong and growing trend of employers willing to pursue alternative methods for providing effective health and prescription drug coverage benefits to their employees – direct contracting, bundled payments, direct primary care, reference-based pricing, utilization of on-site clinics, improved pharmacy benefit arrangements and more.”

--John Greenbaum, national employee benefits practice leader at Risk Strategies Co.

"Stealth mode" engaged

“We may not get a ‘single-payer’ system, but will we get a duopoly? Its non-profit structure is noteworthy. That, and starting with their employees underscores a large and strong alignment of its interests with constituents unlike anything outside of Medicare.

“It is also noteworthy that Amazon, along with its cloud service, discussions with Cerner, massive customer base of affluent households, has also acquired wholesale pharmacy licenses in at least 12 states. (That reportedly precipitated the CVS Aetna merger.) It also is another indication that the project may already be well under way but trying to keep its actions in ‘stealth mode.’”

--Heywood Sloane and Bob Grieb, principals of Diversified Services Group Inc.

If Amazon, then Apple?

“This will likely only be the start of the companies’ proposition. Its scope could expand to partner with other employers in the U.S. market. This would provide a major competitive threat to other U.S. health care providers, which has already been confirmed by their shares dropping in value following the announcement.

“If Amazon establishes itself in the insurance market, it will not be long before other alternative providers follow suit. Apple is already a partner with Vitality in the UK, with the pair receiving press for their offer allowing Vitality customers to receive the newest Apple Watch at a discounted price. Apple has also updated its health app, enabling U.S. customers to see their medical records on their phone. This could signal a potential move into the health care space.

“Alternative providers are highly influential brands, have masses of consumer data and resources, and are known for providing exceptional customer experiences – all of which makes them a significant threat to the insurance industry.”

--Danielle Cripps, Insurance Analyst at leading data and analytics company GlobalData

The market is ready

“Amazon, JPM and BH are important voices calling out an increasingly urgent problem for employers, who together form the largest private payer in the American health care system. The incentives are misaligned, and the market is ready for improvements in member experience and cost control driven by technology.

“Employers spend more than $1.2 trillion every year insuring more than 170 million Americans. The vast majority of that—covering more than 108 million Americans and representing ~$700 billion in health care spend every year—is through a model called self-funding, when the employers directly take all the accountability (and absorb the risk) for health benefits, but only pay for the health care their employees use. These self-funded enterprises have essentially been running their own mini-insurance companies for decades.”

--Ali Diab, CEO and co-founder of Collective Health

Watching and waiting

“This announcement received a lot of press but at this point no details have been shared. ... As people live longer and the workforce evolves, addressing gaps in the U.S. health care system will be critical not just for employees and their families, but for all health care consumers.

“Of course, the focus on technology solutions continues to interest all of us. Amazon and others continue to explore approaches that improve the cost and quality of health care by leveraging technology in the consumer and provider space. We look forward to partnering with both current and new entities to help pioneer new ways to improve health. We’ve also been out in front in forming collectives that facilitate group purchasing of services – and more recently, an initiative that offers employers in a given health care market a way to collectively address quality issues with local providers. It goes without saying that we will be watching this and other new ventures closely and keeping you up to date on developments.”

--Tracy Watts, U.S. leader of health care reform at Mercer

Shift in power

“At 1.1 million employees and growing, they are already a decent-sized ‘health plan’ in themselves and could essentially operate as its own payer entity or possibly an ‘Accountable Care Organization’ for their employees.

“At a minimum it gives the companies more power to hold existing payer vendors more accountable for health and cost outcomes for their employees. It gives them a chance to deliver better health care and reduced costs and change the market dynamics in the commercial health care space. Expand this to the number of captive and loyal customers these firms collectively touch and you suddenly have the possibility of this becoming a huge disrupting development.”

--Maulik Bhagat, managing director at AArete

Industry uncertainty

“Merger mania in the health care space is indicative of industry wide uncertainty. The various stakeholders will try anything to better the system. Whether it’s CVS and Aetna, Amazon, Berkshire Hathaway and J.P. Morgan Chase, Ascension and Providence St. Joseph, they will use their scale, business savvy and technology, to drive costs out of the system — something CMS has struggled to do on its own.”

--Lyndean Brick, CEO of The Advis Group

Regulations and red tape

“Considering the regulatory burden around every aspect of health care, any new entrant in the space is at a huge disadvantage. In light of today’s announcement, the potential merger of CVS and Aetna is even more compelling, as a more coordinated approach to medical care is necessary to lower the overall health care costs for consumers.”

--Mickey Chadha, Moody vice president

Finally, something new

“This is one of the first truly new and radically interesting announcements coming out of the banking industry in some time. If you think about banks and the challenges they’re facing, it’s about relevance and, if they have consumer trust, how do they use it?”

--Kevin Travis, partner with Novantas, talking to American Banker