What shutting down Amazon’s national care delivery service means about its health care ambition

Amazon announced it will shut down Amazon Care—its primary care service sold to employer health plans—by the end of the year. There’s one thing that Amazon’s decision will surely mean: It will continue to be fashionable to mock Amazon.

People may look at this, compare it to Amazon’s Haven misadventure, and say that everyone (including Advisory Board) who speculated that Amazon could succeed in health care is either naïve or delusional.

But there’s more to it.

In looking at what Amazon reportedly said about the challenges facing Amazon Care, we believe that the acquisition of One Medical is the clearest signal yet that Amazon intends to succeed at health care.

The problems with Amazon Care

Amazon Care appears to have struggled to understand the nuances and demands of care delivery, as detailed recently in the Washington Post. Clearly, the tension between expectations for growth and quality were real. This raised questions for us: Was Amazon going to truly “iterate” on its health care capabilities? When it came to care delivery, would Amazon get better, or would it do enough to get by?

Amazon concedes that its product was not comprehensive enough for its employer partners. It’s unclear whether that means it simply wasn’t saving them money, even if employees were using it. At the same time, we wonder how hard it was to persuade employees to embrace Amazon-branded health care or to attract employees to a product centered on virtual and home-based care—or some combination of the two.

Remember: Everyone had to try out telehealth in 2020 because, in many cases, they had no choice. There isn’t any similarly powerful and pervasive force pushing anyone to virtual-first care today. People tend to like virtual visits, but that doesn’t mean that they want to receive all adequately satisfy users or keep care from fragmenting with its mosaic of services, channels, and providers.

What shutting down Amazon Care suggests about Amazon’s health care ambition

Amazon’s willingness to jettison its homegrown but underperforming health care business suggests three things.

  1. One Medical is the centerpiece of Amazon’s health care strategy, not simply one component among many. When viewed this way, the details of the acquisition make more sense than they did four weeks ago. Knowing that a virtual and home-based model wasn’t attractive for employers, we can understand more clearly why Amazon wanted a partner with both in-person and digital health capabilities. Knowing that its own product was struggling, we can see why it was willing to pay a huge premium for One Medical.
  2. Amazon is iterating on its health care capabilities, but it is iterating at an enormous scale. “Fail fast” is axiomatic in technology. It’s usually applied to minimum viable products—applications and services that are quickly built, delivered, and assessed for their ability to meet customer demands and gain traction in the market. Products that don’t meet those demands are replaced as quickly as possible. Obviously, Amazon Care was not a minimum viable product. It was rolled out three years ago, and it offered telehealth services in all 50 states and in-home services in seven markets. But when you look at the pivot Amazon seems to be making from virtual and home-based care with Amazon Care to in-person and virtual with One Medical, it’s hard not to reach for the “fail fast” comparison.
  3. Amazon is a different kind of competitor in health care. We can’t think of another organization that would spend years building out a care delivery enterprise, roll it out in 50 states, and then simply shut it down. We also can’t think of another organization whose alternative care delivery plan is to spend nearly $4 billion on another company. It’s not just the scale and the money—it’s the willingness to throw around those assets that makes Amazon a potentially potent competitor.

There are still enormous execution challenges for Amazon and One Medical. Massive disruption of the industry is not a given, no matter how much money is spent or how many companies are bought and/or fail.

It seems likely that the impact of Amazon on the market will be centered, at least for the immediate future, on the same direct-to-consumer approach that One Medical has taken and at which Amazon is expert in its other lines of business.

That does not mean Amazon can be dismissed as a dilettante or a dabbler in health care. Its mere presence in the market already seems to have sparked a bidding war for Signify Health. Amazon’s continued iteration of its approach to health care demands ongoing attention.

Houston Methodist reports flu levels not usually seen until December

Houston Methodist is reporting an early increase in flu cases, with numbers hitting levels not usually seen until the end of the year.

The hospital recorded 100 cases of influenza A and B in the week ending Sept. 21. A week prior, this figure hit 226. 

“We experienced an early uptick in mid-September, which relaxed some last week, but still these are the sorts of numbers we usually see in December, not now,” Wesley Long, MD, PhD, a pathologist and medical director of diagnostic microbiology at Houston Methodist, tweeted Sept. 26.

Texas is the only state in the U.S. — outside of Washington, D.C. — that already has a moderately high rate of flu cases, according to the CDC’s latest weekly flu report published Sept. 23.

The early rise in cases comes amid warnings that this season’s flu season may be severe.

Senator has questions for Providence CEO on billing practices

U.S. Senator Patty Murray of Washington is seeking answers from Renton, Wash.-based Providence’s CEO following a Sept. 24 New York Times report detailing the system’s alleged debt collection practices. 

“According to recent reports, over the past several years, Providence has increasingly extracted payments from low-income patients, even when patients qualified for free or discounted care,” Ms. Murray said in a Sept. 28 letter to CEO Rod Hochman. “The reports allege several disturbing practices, including high-pressure billing conversations at hospital beds when patients are vulnerable, the use of extraordinary collection actions by debt collectors, and patients eligible for free or discounted care being billed for outstanding balances. As a result, patients have gone without food or heat, have seen their credit scores plummet, and have been afraid to seek out further medical care due to the cost—all as a result of practices that potentially violate both state and federal laws.”

Ms. Murray said in the letter she is seeking answers on how many patients Providence has served in recent years who qualified for free or discounted care and how many it referred to debt collection services. She is also seeking information about the system’s billing and debt collection policies, and how much it paid consulting firm McKinsey & Co. for a program designed to increase its revenue. She is seeking answers by Oct. 12. 

Washington state’s attorney general filed a lawsuit against Providence in February, alleging that 14 of its hospitals engaged in aggressive tactics to collect payment, failed to ensure discounts for eligible low-income patients, and steered poor patients to debt collectors. 

A Providence spokesperson expressed discontent and disagreement with the attorney general’s charges in a statement shared with Becker’s.

“The Providence family of organizations is extremely disappointed that the Office of the Washington State Attorney General has chosen to file inaccurate and unfair charges against us regarding our charity care and financial assistance practices,” the spokesperson said. “Serving every person who comes to us, regardless of ability to pay, is a central tenet of our mission as a not-for-profit organization. We take this responsibility seriously.”

The 18 health systems Walmart sends its employees to for care in 2022

In an effort to rein in healthcare costs for its employees, Walmart sends them directly to health systems that demonstrate high-quality care outcomes, otherwise known as Centers of Excellence.

Through the COE program, Walmart will cover the travel and treatment costs for employees seeking a range of services, but only with providers the company is contracted with. Walmart then reimburses with bundled payments negotiated with the providers.

To determine which providers get access to its 1.6 million employees, Walmart starts by examining health systems. Lisa Woods, vice president of physical and emotional well-being at Walmart, and her team analyze public data, distribute requests for information and conduct detailed on-site visits.

Below are the 18 health systems or campuses to which Walmart will refer patients for defined episodes of care in 2022. (See how COE participants have evolved since 2019 or 2021.)

Cardiac

Cleveland Clinic 

Geisinger Medical Center (Danville, Pa.)

Virginia Mason Medical Center (Seattle)

Weight loss surgery

Emory University Hospital (Atlanta)

Geisinger Medical Center (Danville, Pa.)

Intermountain Healthcare (Salt Lake City)

Northeast Baptist Hospital (San Antonio)

Northwest Medical Center (Springdale, Ark.)

Ochsner Medical Center (New Orleans)

Scripps Mercy Hospital (San Diego)

University Hospital (Cleveland)

Spine surgery

Emory University Hospital (Atlanta)

Geisinger Medical Center (Danville, Pa.)

Carolina NeuroSurgery & Spine Associates (Charlotte, N.C.)

Mercy Hospital Springfield (Mo.)

Mayo Clinic Arizona (Phoenix)

Mayo Clinic Florida (Jacksonville)

Mayo Clinic Minnesota (Rochester)

Memorial Hermann-Texas Medical Center (Houston)

Ochsner Medical Center (New Orleans)

Virginia Mason Medical Center (Seattle)

Breast, lung, colorectal, prostate

or blood cancer

Mayo Clinic Arizona (Phoenix)

Mayo Clinic Florida (Jacksonville)

Mayo Clinic Minnesota (Rochester)

Hip and knee replacements

Emory University Hospital (Atlanta)

Geisinger Medical Center (Danville, Pa.)

Johns Hopkins Bayview Medical Center (Baltimore)

Kaiser Permanente Irvine (Calif.) Medical Center

Mayo Clinic Florida (Jacksonville)

Mayo Clinic Minnesota (Rochester)

Mercy Hospital Springfield (Mo.)

Northeast Baptist Hospital (San Antonio)

Ochsner Medical Center (New Orleans)

Scripps Mercy Hospital (San Diego)

University Hospital (Cleveland)

Virginia Mason Medical Center (Seattle)

Organ and tissue transplants

(except cornea and intestinal)

Mayo Clinic Arizona (Phoenix)

Mayo Clinic Florida (Jacksonville)

Mayo Clinic Minnesota (Rochester)

Is a ‘white-collar’ recession coming?

The jobs of young professionals in several white-collar industries are particularly vulnerable as companies scale back hiring plans, pull job listings and lay off workers. 

Sixty-five percent of employers see a recession coming and many are taking steps to prepare, according to a survey by Principal Financial Group. If there is a recession, white-collar industries are likely the most vulnerable, said William Lee, PhD, chief economist at the Milken Institute, according to Bloomberg

“The entry-level white-collar guy is going to have to watch out. That’s going to be the surprise in this downturn,” Dr. Lee said, according to Newsweek

A Challenger, Gray and Christmas survey revealed companies are preparing for a recession by reducing business travel, laying off staff and implementing hiring freezes.

Many industries, including technology, banking and business services, have staffing numbers that are far above pre-pandemic levels, and the layoffs have already begun, according to Bloomberg. Social media platform Snap, Netflix and Re/Max Holdings are a few of the companies that have recently announced staff reductions. 

Read the full Bloomberg article here

Read the full Newsweek article here.