Amazon Comes to Health Care

Amazon’s strength lies in three areas: cloud computing services, transactions, those B2B or healthcare business to insurance payments(B2I), and logistics. How do these core competencies pair up in providing Amazon Care? 

The cloud

Perhaps in your recent visit to the doctor, you noticed an additional figure in the room, rapidly typing away on a computer. For the lucky few physicians, these scribes take on the burden of entering data into your electronic health record. For the rest of the physicians, nurse practitioners, and physician assistants, the data must be entered in some distracted way, alternating pretending to look and hear the patient while madly filling inboxes. Not to worry, Alexa is coming to the rescue.

Voice recognition, Siri, Alexa, or Hey Google have advanced to the point where they can take our verbal utterings as a command to document. This will be helpful in those pre - and post-operative checklists where we make sure we are doing the right operation, on the right person, on the right side. Voice-controlled documentation should save a minute or two of nursing documentation and actually works.

The smoke and mirrors come with the next possibility of the digital assistant: to listen to the conversation between patient and physician (with full consent, of course) and find clinical “nuggets” that the clinician may have missed. If our recent experience with the ability of artificially intelligent systems to find “nuggets” in clinical records is any measure of ability, these “second pair of ears” will be hard of hearing, if not completely deaf. But smoke and mirrors are frequently what Big Tech sells and Big Health-System buys, such as the collaborations between IBM’s Watson and MD Anderson. [1]

On the plus side, Amazon’s cloud services are less vulnerable to data breaches; the last was in 2018. Others since then have been blamed not on the cloud “platform” but the service using the cloud. (Does that seem to echo Facebook, Meta?) More importantly, the cloud can provide data backup for health systems that are all vulnerable to ransomware attacks. Recovery of patient data and the continuing function of hospital systems is a significant concern, and the expertise of Amazon might well make a difference here.

Telephones And Telehealth

By now, we have all come to realize that while physicians are more connected than ever, given the ubiquity of cell phones, they have succeeded in building a much greater communication divide from those pesky patients. Amazon has much to offer in those telephone chains, the ones that begin with the warning to call 911 if this is an actual emergency and then follow with the lie that “your call is important to us.” Those same digital assistants will transfer your words into text messages to sit in those various boxes waiting for attention.

COVID-19 accelerated the move to telehealth – the digital version of the house call. With Amazon Web Services (AWS), Amazon is uniquely able to provide a safe, secure, and redundant telehealth platform. But the contribution by Amazon is the platform; it will be up to others to provide the interface between you and your physician. Once again, we can anticipate that the same large healthcare software providers like EPIC and Cerner, will provide the interface. After all, they provide one in the medical office already, and it is far easier to integrate programs from the same company. That is a process called lock-in, “an arrangement according to which a person or company is obliged to deal only with a specific company.”

Amazon’s strength in transactions, those previously mentioned B2I services, may not improve payments. These payment systems are already highly computerized and efficient. The hassles in payments are built into the design – they are a feature, not a bug. Those payment hassles, like the requirement to pre-certify certain treatments or follow a specific path of medication escalation (“step-therapy”), are put there by insurers to contain costs. Amazon’s transactional capabilities are more a liability when used to delay.

Amazon Pharmacy – “People who bought a statin often also buy a diuretic.”

Here, at last, is a healthcare product that Amazon is uniquely tailored to provide. They have the inventory management and logistics to deliver medications quickly. Now, most health insurers have a similar program, especially for medications used chronically, where you can order them ahead of time. Those health insurers also have an advantage because they have the patient’s medical records and cover part or all of the medication cost. One- to two-hour delivery of medications when needed acutely, say for a sore throat, might be a logistic advantage for Amazon. But the neighborhood pharmacy, CVS, Walgreens, and Walmart all offer in-person urgent care, and their pharmacy will be able to provide the medications at the time of the visit.

Perhaps Amazon’s buying power will bring drug prices down; perhaps their corporate treasury is large enough to absorb some of the middle-men who raise drug prices or engage in a price war long enough to break them.

Amazon has shown some creativity in turning internal products into external ones. Amazon Dx provides at-home test kits for Covid-19, with results within 24 hours. But once again, while promising, it falls short, despite the breathless cheering of its supporters. A positive COVID test should make you stay at home; if you become more ill, you need to be seen by a physician. Perhaps other at-home tests say for a sore throat would be helpful, but then, you would need a prescription for antibiotics. Those brick-and-mortar urgent care centers, especially in the neighborhood pharmacy, can already provide those services. The service that Amazon really wanted to provide was healthcare to its employees, and for that, they got together with two other ”titans of healthcare,” JP Morgan and Berkshire Hathaway – to found Haven.

Haven

I had such hope for Haven, especially when it was headed by Atul Gawande, a very smart surgeon. But it failed. According to the Financial Times, “even with the three companies’ collective heft, it was still not enough to pressure established health providers into cheaper care.”

My experience tells me that they discovered that healthcare changes slowly and that no one individual decides within a health system; committees rule. Let me steal for a moment from the work of John Green’s Anthropocene Reviewed (which you can hear or read). I give Amazon Care two stars.

[1] What is it about Texas and artificial intelligence? The Financial Times reports that Amazon’s digital assistant is at Houston Methodist.

Source: The next Big Tech battle: Amazon’s bet on healthcare begins to take shape Financial Time