The new healthcare venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase announced June 20, 2018, that Harvard professor and well-known author Atul Gawande would be the company’s CEO. The idea for the new company is to innovate by cutting costs from the healthcare system, starting with the more than one million employees of the three companies behind the venture.

Previous efforts to contain healthcare spending—from managed care to high-deductible health plans to alternative payment models—shared the goal of eliminating unnecessary and overly expensive services. But these practices are very hard to change, since they’re based on physicians’ clinical judgment and patient preferences.

The new joint venture may find it is easier to start with a different question entirely: Can we reduce spending by 15 to 20 percent just by cutting out unnecessary middlemen?

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