Amazon In Healthcare: Disruption, Data Nightmares And Digital Health Dreams

Amazon In Healthcare: Disruption, Data Nightmares And Digital Health Dreams Andrea Koncz

A little while ago we explored Amazon’s initial forays into the healthcare sector, a move that positioned the tech behemoth alongside traditional players in the industry. Amazon’s initial focus was evident: disruption. From obtaining drug distribution licenses in over 10 US states, through acquiring the startup PillPack, to the launch of Amazon Pharmacy and Amazon Care, the company’s intent was clear – to reshape the healthcare landscape. For a detailed look into the first chapters of Amazon’s healthcare journey, click here.

Fast forward to today, and the landscape appears to have shifted dramatically. While Amazon’s ambitions in healthcare remain as strong as ever, the strategies and focal points have evolved. The termination of Amazon Care, the acquisition of One Medical, and the rising concerns over data privacy are but a few major shifts that have taken place in the last two years. Let’s look into  Amazon’s current healthcare initiatives.

The One Medical acquisition

In a strategic move to fortify its position in the healthcare sector, Amazon acquired One Medical for a staggering sum of $3.9 billion, the deal was announced in July 2022. This move added a significant brick-and-mortar presence to Amazon’s expanding healthcare footprint.

One Medical currently owns and operates more than 220 “locations” (clinics, doctor offices) in almost 20 US metropolitan areas, including primary care offices, primary care clinics, primary care offices for specific patients covered by employee healthcare programs and senior health offices. And the number is counting. 

The synergy between Amazon and One Medical is evident when considering the significant 40% of Americans who lack a primary care provider. 

There is fierce competition among tech- and retail giants for establishing footholds in the primary care sector. Major players such as Walgreens, Walmart, and CVS Health have also made significant investments, with Walgreens partnering with VillageMD to open physician-staffed clinics, and CVS Health spending over $10 billion to acquire Oak Street Health​​.

During an interview at HLTH 2023, Neil Lindsay, Senior Vice President of Amazon Health Services, along with Dr. Andrew Diamond, Chief Medical Officer at One Medical, shed light on the company’s methodical approach to expansion. Lindsay delineated three primary focal points stemming from the One Medical purchase: simplifying care access, streamlining medication acquisition, and promoting overall wellness. 

Cutting the throat of Amazon Care

Amazon’s healthcare journey, albeit ambitious, has not been without setbacks, the most recent being the abrupt discontinuation of Amazon Care, its primary care service that combined virtual and in-person health consultations.

Launched in 2019, Amazon Care was initially received as a groundbreaking initiative, expected to transform the healthcare industry. However, despite the rapid expansion and internal promotion as a significant employee benefit, the service was suddenly terminated. This unexpected decision left employees and the public stunned.

Amazon’s journey in healthcare has been marked by both ambition and inconsistency, with high-profile initiatives like the Haven project with JP Morgan and Berkshire Hathaway ending in dissolution.

Expansion of virtual health services through Amazon Clinic

Just 8 months after its launch, Amazon announced the nationwide rollout of Amazon Clinic. Available in all 50 states and Washington, D.C., Amazon Clinic provides users with 24/7 access to third-party healthcare providers directly via Amazon’s website and mobile app​​.

This virtual service offers telehealth treatment for a range of common conditions, such as pink eye, urinary tract infections, and hair loss. While Amazon Clinic currently does not accept insurance for its services, customers can preview the cost before initiating a visit. Prescribed medications might be covered by individual insurance plans​​.

Privacy concerns with Amazon’s healthcare initiatives

The acquisition of One Medical by a tech behemoth with vast data reach across various sectors has triggered a wave of concerns regarding patient privacy and medical ethics. As Amazon’s reach extends from reading preferences to now potentially encompassing intimate health records, the boundaries between commercial interests and patient privacy seem to blur. 

Democratic Senators Peter Welch and Elizabeth Warren have expressed their apprehensions. They’ve voiced concerns about Amazon Clinic’s data practices, specifically the potential “harvesting” of patient health data. Notably, Amazon Clinic’s protocols could, in certain contexts, allow for the sharing of user data outside the purview of HIPAA, the federal health privacy law​​. This has led to speculation about whether such data could be used for targeted advertising, particularly given Amazon’s extensive commercial interests.

Geoffrey A. Fowler of the Washington Post consulted medical ethicist Arthur Caplan regarding the “Amazon acquired my doctor’s office” issue, discussing potential pitfalls, and suggesting that healthcare “synergy” might not always align with patients’ best interests. 

While Amazon asserts its commitment to privacy regulations like HIPAA, the ambiguity surrounding the practical application of these principles remains a significant concern. The potential for health data to be leveraged for targeted advertising, or even integrated into Amazon services like Alexa-based telemedicine, amplifies these doubts​​.

According to Caplan, Amazon faces several pressing questions:

• How will it ensure physician leadership at One Medical?
• How will it segregate sensitive patient data from its vast commercial web?
• Can it guarantee the ethical autonomy of healthcare professionals under its banner?
• And critically, in the face of such transformative mergers, how will government regulations evolve to safeguard patient interests?

Generative AI in clinical documentation

Listening to the sound of the times, Amazon of course entered the generative AI realm as well. 

Web Services (AWS) has rolled out “HealthScribe”, a pioneering clinical documentation service rooted in generative AI. This platform facilitates the creation of clinical applications by utilizing speech recognition and AI to transcribe patient encounters, discern critical details, and craft concise summaries apt for electronic health record (EHR) integration. 

The initial preview encompasses general medicine and orthopedics, with a potential expansion to other specialties contingent on feedback. Nonetheless, questions pertaining to the accuracy and reliability of such AI-driven transcription tools remain a point of discussion.

Alexa’s foray into senior care

Augmenting its digital health footprint, Amazon has launched “Alexa Smart Properties for Senior Living“. This initiative integrates Alexa devices into assisted living and care facilities. It’s tailored to cater to the needs of elderly residents and their caregivers, enabling care providers to efficiently manage and service a fleet of Echo devices. From communicating via voice and video calls to controlling smart home features like lighting or thermostats, Alexa is enhancing the resident experience and amplifying their sense of independence. 

The pursuit goes on

Amazon’s relentless pursuit of healthcare has been marked by numerous challenges. However, the onset of the global COVID-19 pandemic became a pivotal moment for the company, leading to the more strategic and coordinated health initiatives seen today. This shift was articulated by several of Amazon’s health chief medical officers during an exclusive interview with Yahoo Finance in October 2023.

While Amazon’s healthcare endeavors are more coordinated than in previous years, the company’s chief medical officers believe it still has a long way to go before becoming a major disruptor in the massive $4 trillion healthcare industry. A series of acquisitions and initiatives, such as the purchase of PillPack in 2018, learnings from the now-defunct Haven partnership, and the launch/death of Amazon Care in 2019, have shaped the company’s healthcare journey. With the recent acquisition of One Medical and continuous efforts to improve its pharmacy services, Amazon aims to focus on reaching customers directly and locally. 

The executives also highlighted the company’s ongoing efforts to “connect the dots” of health needs for consumers. While the exact nature of these “dots” is still under consideration, Amazon is actively exploring partnerships and internal growth opportunities. Potential initiatives include leveraging AWS for AI-driven physician support and using Alexa for remote patient monitoring. The company’s ownership of Whole Foods might also play a role in connecting patients to healthier food options, addressing some of the social determinants of health​​.

Is it evil? Is it good? 

The amalgamation of services and the convergence of data streams within Amazon’s ecosystem presents a double-edged sword. On one hand, there’s undeniable promise: the sheer efficiency derived from integrating various services, the potential for more affordable healthcare options, and the strides towards a more holistic, encompassing care model that factors in everything from one’s diet to their daily routines. This level of integration could lead to a better understanding of individual needs, towards personalised care.

Yet, the flip side paints a cautionary tale. The concentration of such vast amounts of personal data within a single corporate entity raises significant concerns. Amazon’s potential to have insights into every facet of our lives, from what we eat and read to our health conditions and treatments, could be seen as a formidable power. This not only brings forth issues of privacy and data security but also the philosophical debate about the limits of corporate reach into our personal domains.

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