It’s of course a great validation of the value of the 3G Doctor service that we launched in 2006 that Amazon have put a similar service at the heart of their new Amazon Care service for employees in the Seattle area.
Founded by Jeff Bezos in 1994 Amazon is the world’s largest internet company by revenue (they generated $232Billion in 2018) and the second largest private employer in the USA (with some +470,000 employees it has more staff than Malta has citizens!). This isn’t the first experience they have of trying to run a healthcare service for employees as in 2013 at Zappos.com (a subsidiary since it was acquired in 2009) they launched TurnTable Health as a ‘next generation primary care clinic’ for staff next door to their huge office in downtown Las Vegas. Although Turntable Health was closed after 3 years I have no doubt from my own tour of the clinic that they built that it will have been in an invaluable contributor to helping Amazon get Amazon Care right and it’s positive that this new approach has very much evolved from being clinic centred to taking a Mobile First approach.
Turntable Helath Founder Dr Zubin Damania (@ZDoggMD) gave an interesting round up of the experience earlier this year for the AMA that you can watch here:
It’s great to see the shift to a mobile first strategy. I was given a personal tour of the TurnTable Health clinic and while it was incredible to see what the team were trying to create it struck me that they were obviously missing this transformational component because the clinic was being built next door to the Zappos office and was part of an urban regeneration project. In 2019 a Mobile First approach puts Amazon in prime position to disrupt the entire healthcare industry.
Amazon Care is being billed as “Your first stop for healthcare” but I think the listing of “urgent issues like colds, allergies, infections and minor injuries” is making a common misunderstanding about the mobile consulting opportunity and making the common presumption that complex issues aren’t suited to remote consulting. This presents lots of challenges because giving people easy and free access to undocumented video chats with random Doctors creates lots of repetitive work but doesn’t save anyone much in the way of time or money.
I think this is a predictable issue when a service isn’t well designed because if you’re just having undocumented video chats with random Doctors who know nothing about you and your needs before the chat starts you are pretty much limited to ‘general health questions’ (that you could probably just find the answer to by looking online if you’re someone who works in the tech industry). I’m confident that Amazon Care will soon evolve from the 2000 year old office consult model as they clearly extensively use data to enhance the relationships they have with all their customers.
At Doctors2.0 in 2014 I explained the value of enabling Patients to share the product of clinically validated interactive Medical History Taking Questionnaires with Doctors BEFORE they meet (so the Doctor can get a chance to do her research before connecting with their Patient):
I feel that without tools (like Instant Medical History from Primetime Medical Inc) to prepare Doctors and Patients for the Video Consults that this will also buy a lot of beachside properties for lawyers to retire to while the Doctors involved are forced into bankruptcy as Amazon’s lawyers won’t miss a trick in ensuring they are liable for malpractice if they miss something and there is a bad outcome or didn’t practice defensive medicine and refer their patient onto a specialist. Hopefully Amazon is already onto this as the potential for Alexa to be used to gather a clinically validated medical history (via Instant Medical History) would be a step change in medicine that would deserve a Novel Prize for Medicine…
Over-prescribing and excessive referring issues will no doubt abound with the model Amazon Care are showing here and it’s even obvious to the team creating the website eg. they’ve shown on their website how they prescribed antibiotics for acute sinusitis which is a viral illness!
Privacy and your employer: If this service is enthusiastically adopted by employees it will be a break through that we’ll need to study extensively. We’ve never seen it work before at scale and there are loads of examples of how challenging it can be as employers have a long history of tripping workers up with small print eg. the US telco Sprint (who had 25,000 employees) couldn’t find any employees who would accept a monthly $100 bonus to share their blood glucose monitor readings as part of a study.
Amazon staff are acutely aware of how data is used to derive value for third parties so it’ll be very interesting to see what take up of their “Sexual health services like contraception and sexually transmitted infection (STI) testing” will be like.
The biggest beneficiary of corporate wellness and preventative health programs is the worker and their family so I’m surprised by the restricted eligibility criteria that Amazon have used here. Surely they have the resources to build and validate a completely new care model so why not offer a basic service for all employees that doesn’t require insurer partners snd their third party healthcare provider companies that are invested in old models. Where we’ve seen wellness incentive programs developed by insurers it’s all too often that the employees feel forced to partake in what feels like intrusive bureaucracy or face financial additions to their premiums if they refuse to participate which is not a great way to help people feel generous with sharing information especially as most Americans have heard about job applicants being routinely rejected when they apply for a job based on the data from a personality test, credit score, etc.
I wonder how many Amazon employees are enrolled in an Amazon-sponsored Health Plan that isn’t with Kaiser Permanente and if this additional service is going to be used to entice them across to a different insurer. In the UK major companies have been offering mobile video chat services for years and staff have more often than not been unhappy with how it was implemented so devil is always in the detail eg. at corporations like VISA staff were very annoyed to find that they lost their weekly free cinema ticket perk and had it swapped with a 24×7 mobile video Doctor call service that they didn’t want to use.
It’s interesting that Amazon employees who are enrolled in Kaiser Permanente insurance plans are not eligible. I presume this is because Kaiser Permante were the first major healthcare brand to go Mobile First (back in 2012) and have been offering their own mobile video consulting services to their customers for 6+ years now.
Surely this friction is going to be a huge nightmare for health insurers. Amazon is quickly coming for your business and it has huge troves of data (they even have recording devices in their rivals boardrooms!) that are going to make it a rival that you probably don’t stand a chance competing with unless you’re prepared to disrupt your own business model.
The lack of 24hr coverage is a great surprise. Maybe its just until the service gets up and running but sinking the cost to have a Doctor on call overnight has got to be more cost effective than having staff hit the insurance for a visit to an urgent care clinic and the time off work that could be completely avoided by the advice of an experienced medic on a video call.
Surely they shouldn’t be cheap skating things at the beginning and should’ve sunk some funds into even an under-utilised night shift working staff until demand materialised as 8-6pm opening hours aren’t going to make healthier, happier and more loyal employees especially when they work for a corporation that is a master of the consumer experience at scale.
Presumably it’s going to make it challenging to genuinely present the service as “Your first stop for healthcare” as all the Patients are all Amazon staff who are more than familiar with Chat Right Now messaging assistants etc that they provide to customers.
Will this offer cost savings for Amazon or does it actually need to? I get a feeling that Amazon are going to launch this on the public after trialing it on staff as when the Patients aren’t their employees although it’s not great medicine they’ll have a gold mine on their hands. Most people don’t care a jot about small print so if they bundle this with Amazon Prime subscriptions all the extra data they’ll get will make it incredibly profitable.
I still strikes me as a weird decision to start this service in the USA where the massive sickcare business isn’t aligned with the interests of primary and preventative care, drug companies advertise on TV, and the market is dominated by employer sponsored insurance (that bring a whole host of issues arising from the most profitable use of data being it’s use to detect pre-existing conditions and deny coverage). Surely they could’ve had much more success developing this in a market like the UK or Ireland (where employers aren’t made responsible for employee health insurance and employees don’t have to change insurance every time they change employer etc) and instead of trying to fix an upside down healthcare model they could’ve better focused on leveraging their existing businesses and ignored the complexity of the health insurance market completely (eg. selling products through Prime, WholeFoods, rapid deliveries, etc).
With Amazon Care launching Healthcare providers had better put their best people to work trying to disrupt themselves or preparing to get be disrupted. Medical Schools and professional membership bodies for family doctors (like the RCGP) should be gearing up to develop training courses for these emerging new roles that society expects of Doctors. They are welcome to copy ideas from the mHealth for Healthcare Professionals course that I produced for the Healthcare Informatics Society but they need a ground up revision as the type of medicine that Doctors can now practice cannot be done with the Doctor not using a properly provisioned smartphone (in the UK Doctors aren’t even tested on their use of the internet and still fail their membership exam of the RCGP if they have a mobile on their person).
UPDATE: Sat 28th September 2019
After sharing this post on Linkedin Dr George Margelis informed me that Amazon are cutting the insurance for many of part time employees at the same time as launching Amazon Care which I presume isn’t going to boost feelings amongst staff that this is something that’s going to be great for them.
UPDATE: Monday 7th October 2019
AWS (Amazon Web Services) will be hosting a “Healthcare & Life Sciences Web Day” on Wednesday 13th November 2019. This completely free virtual event will explore how the transformation of healthcare and life science companies is being fueled by cloud technology and will bring together industry leaders to explore how they expedite therapy development, incorporate digital therapeutics at scale, support population health, and improve patient outcomes.
Dr Shez Partovi, Director Healthcare, Life Sciences & Genomics, Amazon Web Services
Ryan Hamilton, Sr. Vice President Population Health, Cerner
Marcello Damiani, Chief Digital and Operational Excellence Officer, Moderna Inc.
Venkat Jegadeesan, CTO, Beth Israel Deaconess Medical Center
Arun Ravi- Sr. Program Manager, AWS
John Brownstein, Chief Innovation Officer, Boston Children’s Hospital
John Axerio-Cilies PhD, Cofounder and COO, Arterys
John Schneider, CTO, Apixio
Chris McCurdy, Lead Solutions Architect, AWS
Bill Nordmark, CEO, Aver.io
Morris Panner, CEO, Ambra Health
Drew Schiller, CEO, Validic
Patrick Combes, Healthcare Technical Lead, AWS Jim Harper, Cofounder and COO, Sonde Health
Nick Hatt, Director of Developer Relations, Redox
Ali Zaman, VP Marketing, Health Gorilla
Patrick Leonard, Founder and CEO, Sopris
Kevin Weinstein, Chief Growth Officer, Apervita
Russell Granzow, Head of Pharma Solutions, Philips
Mikki Nasch, Co-founder, Evidation Health
Aaron Friedman, Solutions Architect, AWS
Kyle Johnson, Data Science Practice Manager, ML Labs
Sivan Bercovici PhD, CTO, Karius
Nigel Beard PhD, SVP of R&D, Mission Bio
Ainslie Hatch, Digital Therapeutics Director, Otsuka America Pharmaceutical
Joris Van Dam, Head of Digital Therapeutics, Novartis
Corey McCann, CEO, PEAR Therapeutics
Yvonne Chen, Director for Digital Health, Icahn School of Medicine at Mount Sinai
Nigel Beard PhD, SVP of R&D, Mission Bio