[HN Gopher] Amazon to Acquire One Medical
___________________________________________________________________
Amazon to Acquire One Medical
Author : ejb999
Score : 195 points
Date : 2022-07-21 12:45 UTC (10 hours ago)
(HTM) web link (press.aboutamazon.com)
(TXT) w3m dump (press.aboutamazon.com)
| nikolay wrote:
| I was trying to become a One Medical customer for months. Their
| defunct signup process (at least in Orange County) pushed me
| away. Hopefully Amazon puts their technology where it must be in
| 2022!
| FollowingTheDao wrote:
| This means two things:
|
| 1) Worse health care
|
| 2) Medicare for All is dead in the U.S.
| ch4s3 wrote:
| What about this acquisition makes you say that?
| candyman wrote:
| Amazon has a terrible track record in healthcare - with both
| internal efforts and acquisitions. I figured they had given up
| but this acquisition suggests otherwise. I think the business is
| just too different from what they know for them to really commit
| to it and be successful. It's a nice rescue for $ONEM stock
| holders!!!
| kgwgk wrote:
| https://www.fiercehealthcare.com/technology/amazon-jpmorgan-...
| metadat wrote:
| The pressure is on now that Oracle acquired CERNER.
|
| Healthcare is the obvious golden goose in the long-term.
| ctvo wrote:
| What other Amazon efforts in health care are you aware of and
| what other acquisitions have there been to call their record
| terrible? I'm only aware of https://amazon.care/
| 1986 wrote:
| https://www.cnbc.com/2021/01/04/haven-the-amazon-
| berkshire-j...
| discodave wrote:
| They bought Pillpack. They also announced a big partnership
| with Berkshire that went... nowhere? I also know of a big
| secret-project kinda effort, where they were employing
| research scientists, and other people with very specialized
| knowledge of protein design... all those people are no longer
| at Amazon.
| vineyardmike wrote:
| I think the Berk partnership led to Amazon care (and
| probably this).
| dheera wrote:
| I use Amazon Pharmacy and thoroughly happy with it.
|
| Local pharmacies were modifying prescriptions on the way from
| the doctors' office to the pharmacy by insurance request and
| Amazon doesn't do that, or at least, Amazon lets me get them
| as-prescribed and not use insurance. Plus, their uninsured
| price is actually cheaper than the local pharmacy's copay price
| in many cases.
|
| I live in California, if relevant.
| NelsonMinar wrote:
| I'm also having a reasonably good experience with Amazon
| Pharmacy (aka PillPack). The website actually works, which is
| more than can be said for any other mail-order pharmacy. Same
| stupid pricing and insurance hijinx as any other pharmacy but
| Amazon seems to do a reasonably good job interfacing with
| that horribly broken industry.
| zamalek wrote:
| This has been my experience too.
|
| After a move across the country, I requested CVS to take over
| my prescription. I can't remember the specifics, but they
| botched it in the most incompetent way possible. My doctor
| recommended asking for a few pills to tide me over while they
| figured it out, and the very same people who botched it
| treated me like a drug seeker (for drugs with no recreational
| use, no less).
|
| Amazon were able to find and transfer my prescription in less
| than 10 minutes. The prescription was on my doorstep a day
| later. For this _very specific_ scenario, I wouldn 't agree
| that Amazon is winning because they are big vs. small. It is
| more competent vs. incompetent.
|
| > their uninsured price is actually cheaper
|
| Yep, I don't use insurance to pay for my prescription.
| [deleted]
| shmatt wrote:
| Google gives One Medical 10% of their revenue, plus they have OM
| offices embedded in Google offices. I wonder if this continues
| and Google lets Amazon employees on premises to collect medical
| information about their employees
|
| Personally my experience with One Medical went from amazed in
| 2015 to pretty bad by 2019. They will charge your insurance for a
| doctors visit but only have Nurses and P.A's available to see. I
| don't even know the legality of that, but it definitely didn't
| feel like they were replacing having a personal doctor follow
| your health
|
| The few M.D's i did like left within a year or two, always
| JohnBjorge wrote:
| This is something I know a little bit about. I'm not a fan of
| this bait n switch practice either. As others have said one
| reason it's done is to increase access and/or reduce costs.
|
| > _They will charge your insurance for a doctors visit but only
| have Nurses and P.A 's available to see._
|
| I can't comment on how One Medical bills for this sort of
| thing. But almost always, at any other "standard"
| clinic/hospital/etc, they will get reimbursed by the payor for
| 80% of what a physician would get paid for an equivalent visit.
|
| As a general rule of thumb, payors reimburse mid-level
| providers (nurse practitioners/physician assistant/etc) at 80%
| of the physician equivalent reimbursement. If you do a little
| napkin math you can see why there is a financial incentive to
| use mid-level providers. Say a family physician makes $250k and
| a nurse practitioner makes $125k each year, and if they bill
| for a similar amount of visits in dollars each year, say $500k
| worth. For the physician the clinic has a $250k profit, for the
| nurse practitioner they have a $500k * 80% = $400k, minus the
| $125k salary, so $275k profit.
|
| I have no idea about other tradeoffs (quality, access, etc)
| regarding the use of mid-level providers in replacement of
| traditionally physician services.
| ImJasonH wrote:
| To clarify, "Google gives One Medical 10% of [One Medical]'s
| revenue."
|
| The first time I read it I interpreted the "their" the other
| way, and was quite surprised! :D
| dehrmann wrote:
| > I wonder if this continues and Google lets Amazon employees
| on premises to collect medical information about their
| employees
|
| This is so disconnected from Google's main business it doesn't
| care. It'd be more likely to cut the benefit entirely to save
| money.
| umeshunni wrote:
| An Update on One Medical:
|
| "When we looked at usage of the benefit, we saw that less
| that 1% of our employee base were DAUs of the benefit, so we
| have decided to discontinue the benefit and focus on other
| efforts instead"
| gennarro wrote:
| Just to echo this - OM was incredible for years but has fallen
| off a cliff in terms of service, responsiveness, overall
| quality. There are more offices now but Dr quality is worse and
| the early set of amazing staff and Drs have all left. It's
| better than the old days of finding medical help but still not
| what it was.
| BurningFrog wrote:
| Hard to know what is pandemic disruption, and what is genuine
| OM deterioration.
| gennarro wrote:
| I'd just note that the deterioration was happening to a
| noticeable extent, at least in NYC, pre pandemic. Quality
| might have better in SF and other places, I'm not sure. The
| top Drs remain very hard to see and booked for weeks if not
| a month now.
| dalyons wrote:
| SF area has declined too; long response times, high dr
| churn. This whole discussion has validated what I'd been
| noticing!
| kelnos wrote:
| Odd, that's not been my experience in SF. I've only had
| one primary physician leave on me in 2018 (I'd been with
| him for 2 years, but only had visited once). My primary
| doc responds to messages within a day or two. Responses
| from the general care team are usually same-day. My
| primary physician is usually booked out a couple months,
| which is a bummer, but I can get next-day appointments
| with a PA or NP, and usually 2-3 days with an MD.
|
| On top of that, it's been mostly easy to get prompt COVID
| testing when I've needed it, and for a while they even
| had 8-hour PCR test results.
|
| For the most part I'm still very happy with the service,
| though this news about the Amazon acquisition is
| definitely making me question whether or not I will renew
| next year.
| dalyons wrote:
| i mean i dont want to overstate it, its still a far
| better experience than dealing with the regular medical
| primary care system. Just, in the last ~12 mo or so id
| had enough problems - multiple MDs id seen before gone,
| 4+ days to get a message back from general/admin, billing
| problems(they coded a normal visit wrong and it cost me
| $600), lost referrals. Compared to basically zero in the
| ~5 years before. Still a good service that ill keep, just
| not as great :)
|
| It was enough that i was wondering if they were
| financially struggling (having seen a lot of startups go
| through this cycle of at-first-excellent then degrading
| service). And i guess they were.
| atlasunshrugged wrote:
| If you're looking for a more boutique experience and being able
| to see an actual doctor, I highly recommend Forward Medical
| (goforward.com) which I've used for a few years and have had
| nothing but great experiences with.
| FollowingTheDao wrote:
| I am just looking for health care but what can I do? I am
| just a homeless guy with schizoaffective Bipolar and
| Ankylosing Spondylitis trying to get better so he can work
| again.
| hammyhavoc wrote:
| Rough hand. Know you've got someone thinking about you in
| the UK.
| pibechorro wrote:
| Charity can more than help those who fall through the
| cracks. Th Charity of individuals, nonprofits and private
| companies that realize investing in helping people will
| help their brand.
|
| Think of all the money that is wasted in todays system. Its
| not a lack of money,its how its badly spent and all the red
| tape in between. Much more efficient to let individuals
| manage it than a burocracy based on forced taxation which
| leads to a lack of accountability as poor performance still
| gets funding.
| [deleted]
| sithadmin wrote:
| Forward went from being great in 2020 when it launched in
| Washington DC to absymal these days. Lots of MD/DO turnover,
| really poor follow-up, and you have to argue with them to get
| an appointment within a reasonable time (no, I don't want an
| appointment 5 weeks from today for what is a very painful ear
| infection today, thank you very much). They've also dropped
| the ball several times for me when referring to specialists.
|
| Forward's 'body scanner' thing and 23andMe results
| interpretation are both embarrassing farces, imo. The former
| much more so than the latter, but even the docs will admit
| that their use of genetics information is basically a dog and
| pony show that rarely if ever impacts how they approach care.
|
| I've given up and joined a concierge medical practice
| attached to a local hospital instead. It's only ~25% more
| expensive than Forward.
| srockets wrote:
| It's as if for-profit health isn't really useful for
| quality of treatment.
| sithadmin wrote:
| For the population in general, no, probably not.
| Especially not for basic primary and preventative care.
|
| But it's also a matter of perspective. As someone that is
| privileged enough to shop for improved healthcare quality
| and access, I've jumped from an old-school cash-basis
| solo practitioner, to One Medical, to Forward, to about
| the highest end concierge practice available in my metro
| region. Every time I've increased my spending, the
| quality of care and accessibility has generally
| increased. One Medical and Forward were still
| improvements over what I'd had access to previously even
| though I chose to move on and pay more money elsewhere
| for an improved experience.
| nerdjon wrote:
| I don't like the genetics or that weird scanner side of
| Forward.
|
| For me Forward has primarily been an anxiety thing. I have
| really bad anxiety largely around health issues. (Real or
| not) and I have found that since being with Forward that at
| least the idea that I can talk to someone at any point
| helps with that anxiety. I do recognize that a lot of that
| is placebo, but being able to help with anxiety without
| medication is preferred to me.
|
| That being said, they are only just now opening up in
| Boston so it will remain to be seen how they actually
| perform in person and not virtual. But their competition
| here is... its a low bar to be better.
| orzig wrote:
| Thanks for the details, I was surprised at the 23andMe
| outsourcing of genetics. I didn't want to give mine to
| that company and (while I'm sure that was in the fine
| print) I assumed I was only going to be dealing with the
| company I actually signed up for.
|
| Forward outsources a lot of their clinical stuff, so the
| service ends up being much less premium
| curiousgal wrote:
| > _medical care_
|
| > _boutique experience_
|
| Man, Americans say the weirdest $h@t
| lotsofpulp wrote:
| Price segmentation and product tiering is an inevitable
| consequence of supply not meeting demand.
|
| I expect the same to happen (or already happening) in the
| UK.
| dixie_land wrote:
| One medical offices I've been to are definitely much nicer,
| the lobby / waiting area (not much wait, that's the selling
| point) feels more like say a WeWork reception than a
| doctor's
| beej71 wrote:
| It makes perfect sense in the context of one of the most
| insane healthcare systems in the world. :)
| orzig wrote:
| We know it's bad, and while we vote for better, we also
| need to get problems solved in the near term.
| curiousgal wrote:
| Voting won't fix anything until the electoral college and
| gerrymandering are abolished but that's an entirely
| different debate.
| orzig wrote:
| Strong disagreement
|
| Forward was expanding to my city and I joined based on SF
| friend's recommendation. They charged me a total of $500
| without ever actually opening the office.
|
| When I requested a refund they said they could only give one
| month, then took so long to process that I got another
| monthly charge in the meantime! I had to follow up weekly for
| months just to get back to the original promise.
|
| Bad, bad experience, and I'm not even medically complex.
| petilon wrote:
| > _They will charge your insurance for a doctors visit but only
| have Nurses and P.A 's available to see._
|
| That little scam is used by my local hospital also. If you
| don't ask for a specific doctor when you make an appointment
| you get a PA (Physician's Assistant). Then they bill the same
| amount as a doctor would. The justification is that the PA has
| access to a doctor if needed. So presumably you are getting the
| same level of service, since the PA can talk to the doctor if
| needed, so this expands his abilities to the same level as a
| doctor.
|
| This practice is legal. To avoid getting a PA specifically ask
| for a "MD Doctor". If you don't say "MD" they will give you a
| PA even if you ask for a "Doctor".
| idunno246 wrote:
| Even more fun, my primary care office billed a visit to
| insurance under the PAs name, so insurance treated it as a
| specialist. So they tried to charge the higher copay... had
| to get them to resubmit with the doctors name, despite not
| seeing them, to get the cheaper rate
|
| That said, my experience with pa vs md hasn't really been
| that different, they all just follow the same flowchart
| throwawaycuriou wrote:
| Wild. The technicality of earning a doctorate to be called a
| doctor is no more.
| ornornor wrote:
| I'm always in awe at all the ways the system in the US finds
| way to screw you over. This one is amazing.
| petilon wrote:
| The problem is that the US is not a true democracy. Because
| of lobbying (a form of legalized corruption) [1], big
| corporations are in control of the country. The laws are
| written by big corporations such as oil companies, big
| pharma, hospitals, gun manufacturers and so on. See
| revolving door [2].
|
| [1] https://en.wikipedia.org/wiki/Lobbying
|
| [2] https://en.wikipedia.org/wiki/Revolving_door_(politics)
| JohnBjorge wrote:
| This is something I know a little bit about, I gave a more
| detailed explanation in the parent comment. I'm not a fan of
| this bait n switch practice either. As you pointed out one
| reason it's done is to increase access and/or reduce costs
| while maintaining quality. I don't know to what extent that's
| true, it's just what we are led to believe.
|
| In your example, the hospital very likely billed the same
| services and charge amounts. This is standard practice. Also,
| captured on the claim form they submit to the payor is who
| rendered the services and also other modifiers/adjustments
| that indicate you were seen by a mid-level provider that was
| overseen by a physician. Regardless, what ultimately matters
| is the negotiated rate. As a general rule of thumb, payors
| reimburse mid-level providers (nurse practitioners/physician
| assistant/etc) at 80% of the physician equivalent
| reimbursement. So if a doctor gets paid $100 for a wellness
| check, then a PA would get $80 for a wellness check assuming
| everything was the same.
|
| This all can get a little hairy / confusing as each state has
| different laws around what nurse practitioners and physician
| assistants can or can not do (which then impacts billing).
| Some states allow little to no oversight by a physician,
| where as other states it is more strict.
|
| I have no idea about other tradeoffs (quality, access, etc)
| regarding the use of mid-level providers in replacement of
| traditionally physician services.
| geoffcline wrote:
| This is my understanding also. Insurance Cos are aware of
| this.
|
| I think people assume that they are receiving worse service
| from a PA vs a MD.
|
| A PA may have more time to research your condition. They
| have more experience with your particular condition.
|
| I went to a PA recently when my usual MD was not available.
| They knew of a recently(ish) released test that could be
| helpful in the situation. I did the test, and the MD
| reviewed it. The MD wasn't familiar with the test, but it
| ended up being very important.
| petilon wrote:
| > _I think people assume that they are receiving worse
| service from a PA vs a MD._
|
| And they have a right to make that assumption. The
| important thing is making sure the patient is aware they
| are getting a PA and not an MD. Let the patient decide if
| that's OK.
| moduspol wrote:
| I'd be OK with this if they'd split the savings with me--at
| least in some cases. I don't always need an "MD Doctor."
| adregan wrote:
| Probably too late, but is there a way to prevent my one medical
| records from going to Amazon?
| adregan wrote:
| Follow up:
|
| Called one medical support, and it doesn't look like there is
| any data deletion process. Apparently, the heath record will be
| held for 7 years and the best I can do is delete my account.
|
| Hoping a process will soon form but this seems like a run
| around of HIPAA to me. All you need is enough money to buy a
| company and you get a lot of juicy health data.
| karaterobot wrote:
| In theory, under HIPAA, your protected health information
| (PHI) can't just be given to everybody at Amazon. One Medical
| can only share it for specific, generally pretty legitimate
| reasons.
|
| HIPAA is pretty strict, and Amazon will be under a lot of
| scrutiny, so I, personally, would not be worried about them,
| e.g., using my PHI to try to market stuff to me, or selling
| it off to the highest bidders.
|
| Here are some PDF fact sheets on the uses and disclosures
| allowed under HIPAA:
|
| https://www.hhs.gov/sites/default/files/exchange_health_care.
| ..
|
| https://www.hhs.gov/sites/default/files/exchange_treatment.p.
| ..
|
| The bad news is they probably don't need to do this, because
| they have more valuable data than this on you already. :\
| Terretta wrote:
| > _legitimate reasons_
|
| This is another term that doesn't legally mean what people
| colloquially think it means.
| pc86 wrote:
| For the record this isn't just a OM thing. There is no
| provision whereby you can request that your valid, correct
| medical data be deleted. 7 years is a pretty common timeframe
| to hold on to stuff in a "just in case" sense, after which
| point the provider may or may not delete it. Larger providers
| have a _ton_ of this data and delete it the second they can -
| when I worked in healthcare software we had large clients who
| would run deletion scripts twice a day, literally deleting
| stuff that crossed the 7 year threshold a few hours ago, to
| keep the storage as minimal as possible.
|
| HIPAA cares much more about how you use data and who can get
| to it and why, than whether or not you have it in the first
| place (it cares about both to an extent). Calling this "a run
| around of HIPAA" is pretty silly, honestly.
| adregan wrote:
| Perhaps it's "pretty silly," but I would not authorize my
| health data to be shared with Amazon, and now it shall be
| against my will. I appreciate your clinical dispassion in
| this issue, but I believe this demonstrates the difficulty
| of the public in understanding how little laws actually
| serve to protect one's privacy as I foolishly thought I
| might have some say in the matter.
| pc86 wrote:
| If you don't have a clinical relationship with OneMedical
| post-acquisition, Amazon has no clinical need to access
| to data, and doing so is a clear HIPAA violation.
|
| Clinical data is not the same as browser history or
| purchase history or ad clicking history or anything like
| that. The public health interest in being able to
| generate accurate diagnoses (among other things) from
| various providers, down to the location/clinic/doctor
| level, grossly outweighs any one person's right to say
| "well I don't like this company so take my email out of
| your database." Taking an extreme example, there are a
| lot of reporting requirements around HIV. Anonymity is
| important but the public health interest in accurate
| reporting outweighs that. Imagine someone being able to
| tell their local clinic 48 hours after an HIV diagnosis
| that they need to delete any record that they were ever
| there. It just doesn't work that way.
| siliconc0w wrote:
| +1s that One Medical has gone down hill. Latest issue was getting
| charged like $300 for a 5 minute video appointment which quickly
| concluded that I should schedule an in-person if the symptom
| persisted. This was coded to my insurance as a 30 minute 'medium
| to high complexity' patient interaction.
| thenerdhead wrote:
| I literally got a recruiter message about working for Amazon
| Healthcare and had no idea what is was. This seems like it...
| __derek__ wrote:
| Amazon Care[1] launched a few years ago.
|
| [1]: https://amazon.care/
| thenerdhead wrote:
| It is called "Amazon HealthCare" is this different?
| __derek__ wrote:
| I don't know.
|
| It wouldn't be surprising if the Amazon Care product rolls
| up into an Amazon Healthcare organization, while it would
| be somewhat surprising if recruiters started working to
| staff a new acquisition before it was publicly announced,
| let alone closed.
| nosefrog wrote:
| Has anyone else noticed that OneMedical doesn't do full blood
| tests during yearly screenings anymore? My girlfriend had to beg
| for a vitamin d test last time she went (they said she didn't
| need one because she looked healthy, and when she got her results
| it said she was low on vitamin d), and last time I went they only
| screened me for cholesterol because I told them I wasn't vegan
| anymore and that I've developed a taco bell habit.
| stuffuru wrote:
| In my experience vitamin D tests were never part of their
| standard blood test panel. They had no problems prescribing it
| for me when I asked but it wasn't covered by insurance.
| zten wrote:
| I know this is the wrong answer, because you should be
| expecting reasonable care from your physician, but if you're on
| an HDHP plan just buy the service from LabCorp and reimburse
| yourself. For some reason, direct-to-consumer blood work is
| becoming a thing.
| bergenty wrote:
| Yeah but I'd like the doctor to interpret it for me.
| Especially on parameters that have dependencies.
| zten wrote:
| I agree and I thought that might be a problem. I would be
| in the same position.
| umeshunni wrote:
| They told me the same thing and that "Nearly everyone has a
| Vitamin D deficiency, so just take the pills."
| ajaimk wrote:
| Every time a doctor refuses a test you asked for, you just need
| to ask them to provide it in writing that they refused to
| provide you that test.
|
| They will magically give you the test after that :-)
| pc86 wrote:
| This is even easier now that most providers are (rightfully)
| giving patients electronic access to their charts. I
| requested a blood test once, the doctor refused saying it was
| unnecessary, I asked that it get documented in my chart. He
| said fine, but didn't. When I sent a message asking that his
| note be updated to include that I requested the test and was
| told it was unnecessary, I got a call from the office... to
| schedule the test.
|
| If you're particularly averse to confrontation you could do
| the above and even skip directly asking them to document the
| refusal. It would probably have the same end result.
| willcipriano wrote:
| I'm kinda-sorta a healthcare IT expert at this point and Amazon
| has been harassing me to interview with them ceaselessly in the
| past 3 months or so. I wonder if this was the reason.
| extant_lifeform wrote:
| Prolly not, Amazon recruitment is a sh*tshow they try to hire
| Amazon employees to Amazon sometimes.
| shepherdjerred wrote:
| I loved getting those emails
| seanmcdirmid wrote:
| Amazon is basically asking everyone in the industry to
| interview right now, especially if you already work at a top
| tier company. You can't really get them to stop, I just expect
| an email a week from them ATM
| _moof wrote:
| Hard-pressed to think of any company I'd trust less with my
| medical records. Maybe Google.
| ctvo wrote:
| Really? Meta, Google, ByteDance, Twitter, ...
| smegsicle wrote:
| wasn't meta originally a medical research company?
|
| pretty soon we'll see amazon rebrand as "ONE"
| _moof wrote:
| Ok, Meta for sure. Twitter wouldn't be awesome but I'd take
| them over anyone else on the list so far.
|
| Edit: Oh, and then there's Palantir, Oracle, Salesforce...
| you know what, how about we just keep tech out of healthcare?
| ctvo wrote:
| Twitter is on my list because Musk may end up owning it as
| a private company.
|
| I'm creeped out imagining Musk with unfettered access to
| medical care over a large population. Come in for a
| physical and leave unexpectedly pregnant because ole galaxy
| brain thinks we need a larger population.
|
| Or more likely, sign up and pay 100K for Full Cancer Cure
| and 15 years later it's still in beta and sometimes
| clearing a small variant of skin cancer, but also sometimes
| outright killing you.
| ginko wrote:
| Can someone explain to me what value there is to allowing an
| online book store to use their funds gained in completely
| different industries to strong-arm itself into the healthcare
| business?
| [deleted]
| felipellrocha wrote:
| I do not need amazon to have my medical records. I guess it's
| time to cancel that subscription.
| nikolay wrote:
| For years, One Medical didn't figure out that a child has more
| than one parents and that there could be more than one child in a
| family! How can a medical establishment with claims to fame not
| get such simple concepts - 1+ parents with 0+ children! This is
| the same with many other companies such as Facebook, Google, etc.
| Only Microsoft gets it! Even Amazon sucks with their "family"
| plan. Recently, Instacart did the same idiotic "family" plan
| killing the shared cart concept along the way! When will product
| managers finally be people representing much of the population?!
| vyrotek wrote:
| If this goes like their acquisition of PillPack it will be
| trainwreck behind the scenes when they try to push the Amazon way
| of doing things onto them.
| weezin wrote:
| Weird they would acquire a company similar to what they are
| already doing with Amazon Care.
| __derek__ wrote:
| Amazon also acquired Whole Foods while expanding Amazon Fresh.
| It's easier to acquire a bunch of existing locations and
| customers than to bootstrap them.
| jpm_sd wrote:
| This type of move is often a signal that the internal effort is
| not going well, so upper management has decided to acqui-hire a
| team who (supposedly) knows how to do it properly.
| bbarnett wrote:
| And then in proper fashion, put the acquired under management
| of the in house team, so the acquired can be told how they
| are doing it wrong.
| saos wrote:
| Swallow the competition. And take market share.
|
| Amazon are a true conglomerate
| FollowingTheDao wrote:
| Let me fix that for you:
|
| Amazon is a true monopoly
| capitalsigma wrote:
| Yes, Amazon, the infamous healthcare monopoly
| nerdjon wrote:
| This makes me wonder, all of these boutique healthcare companies
| (One Medical, Forward, and others that I just don't know about)
| are they actually profitable or are they all just needing to be
| bought out?
|
| On the other side, I am really curious where this makes any sense
| for Amazon? I could see arguments about healthcare for their
| employees (didn't they bring that in house or something?),
| "synergy" with them using AWS (and maybe improvements to medical
| related services in AWS), and/or something related to their 2
| prescription offerings.
|
| But outside of those few things... I am unclear where this one is
| coming from for Amazon.
| umeshunni wrote:
| OneMedical is a public company so looking at their last
| earnings report, they lost $101M on $250M in revenue.
| paulette449 wrote:
| I've been a One Medical customer for quite a few years, this
| might be our last. The service has worsened every year. It has
| been clear for some time they were going for an "early" exit by
| focusing on increasing subscriber and location count with
| medical professional availability lagging woefully. My
| experience and the most common complaint I hear is how
| difficult it is to get an actual appointment to see someone,
| despite paying an annual membership for that privilege. Their
| number of MDs also seems to be shrinking versus the number of
| other health professionals (RNs etc). If you're going for
| something not urgent and can wait a couple of weeks, then the
| system will work for you. But if you need attention in 1-2
| days, good luck. I just had a look and they show one
| appointment available for a single MD across their 14 NYC
| offices this week. The remaining MDs show as having no
| availability for 12-42 days. There has also been an ever-
| increasing turnover speed of their roster of their always young
| medical professionals. I'm not sure we'll renew at the end of
| this period. They sell a solution which would work perfectly
| for us, but it's not the service we have actually received. I
| hope Amazon invests in the service again as part of their wider
| campaign into the healthcare.
| FollowingTheDao wrote:
| > The service has worsened every year.
|
| This is because of finacialization of the capital markets.
| These companies come in flush with cash and services and
| everyone is like "Wow they are great!" Then slowly reality
| hits and they wait to be bought out and they start cutting
| and de funding until there is nothing left.
| lotsofpulp wrote:
| Their own marketing of themselves screams it:
|
| > One Medical is a human-centered, technology-powered
| national primary care organization on a mission to make
| quality care more affordable, accessible, and enjoyable
| through a seamless combination of in-person, digital, and
| virtual care services that are convenient to where people
| work, shop, and live.
|
| Mission, technology, human centered, and promising the
| world but somehow for less money with no technical
| innovation that would result in efficiencies to actually
| lower costs.
|
| Grand claims without grand proof is a nice shortcut of what
| not to invest in as a customer.
| rchaud wrote:
| This kind of hyperbole is standard marketing boilerplate
| for 'dIsRuPTiVe' startups. Behind the veil, it's not much
| different from other companies doing anything to make
| user numbers look good to a potential acquirer.
| macNchz wrote:
| > I just had a look and they show one appointment available
| for a single MD across their 14 NYC offices this week.
|
| I was curious because my own experience with them has not
| really reflected this decline, though I see other commenters
| mentioning it as well (my wife and I have used them since
| 2016, though I am not particularly selective about the type
| of practitioner I meet).
|
| At a glance now in NYC I see an appointment with an MD
| tomorrow at 11am, another DO tomorrow at 9:30am, an MD with a
| full day of open appointments on Saturday. Were I to want to
| see someone sooner I could see a PA a few blocks from my
| apartment as soon as 2 hours from now. I know those
| appointments will start exactly on time and the office will
| be pleasant. That still feels like good value to me as
| compared to most other medical practices out there.
| ejb999 wrote:
| I work in the healthcare space - (I am no expert on how to fix
| it), but my two cents is there is so much inefficiency right
| now across the board that is just crying out for automation and
| complete revamp in how services are provided - which I suspect
| amazon could improve - if I had to guess though, where they are
| going to run into problems is if/when they start treating
| providers (MDs, NPs, PAs) like interchangeable widgets, that
| many will not want to work for amazon and will head for the
| exit - unless the pay is much better than they can get
| elsewhere.
| decafninja wrote:
| I use a rival service of One Medical provided by my employer.
| It's...amazing. It's not perfect, but it removes so much of
| the hassle involved in going through the "legacy" medical
| system, at least for routine and minor things.
|
| My understanding is that these are "concierge lite" services,
| and full blown concierge medicine services like MD2 are a
| whole magnitude even better. Albeit at the cost of paying
| five figure annual membership fees.
| SmellTheGlove wrote:
| What service is that? My family uses one medical and we've
| become pretty unhappy with it over the past year. I'd be
| happy to try something else.
| CSMastermind wrote:
| > where they are going to run into problems is if/when they
| start treating providers (MDs, NPs, PAs) like interchangeable
| widgets, that many will not want to work for amazon and will
| head for the exit - unless the pay is much better than they
| can get elsewhere.
|
| To be fair this is what they do with software engineers and
| their ever-lowering hiring bar aside, they're still managing
| to get people.
| ejb999 wrote:
| >>To be fair this is what they do with software engineers
| and their ever-lowering hiring bar aside, they're still
| managing to get people.
|
| True, but most people don't care who writes their software,
| as long as it works, whereas most/many people really prefer
| to have a relationship with their provider, not see a
| different person every time they come in. Maybe thats more
| of an older generation problem, and perhaps younger people
| will just need to have a different mindset and won't care
| as much.
| lotsofpulp wrote:
| That is already how it works in many areas where many
| providers have been brought under one roof. For example,
| a pediatric group my kids go to has a designated
| pediatrician, but in the event of an acute illness, you
| get to see whichever pediatrician is available.
|
| For my wife and I, we signed up with a primary care
| physician that is employed by the same company that owns
| the hospital we want to go to. They employ all sorts of
| doctors and labs and can easily see medical records
| between them. We also chose our pediatrician group
| because they use Epic and integrate with hospital which
| also uses Epic and so medical records for the whole
| family are instantly available for all doctors at the
| hospital in case of emergency.
|
| When one of my kids has some blood in stool as an infant,
| and we had to go see a pediatric GI specialist, we could
| go see one employed by the same company at a special
| children's hospital, and they had east access to all of
| the same records my kid's pediatrician was seeing.
|
| And, of course, because the whole healthcare provider
| company that operates the hospital and employs the
| doctors is covered by BCBS, we do not have to worry about
| checking for out of network providers.
| nerdjon wrote:
| I don't know for sure how One Medical works. But I use
| Forward personally, it seems like the idea is they don't have
| to deal with that stuff. They don't use my insurance for all
| of my basic care.
|
| Anything not basic is a referral out, but then we are dealing
| with the normal medical system at that point.
|
| So I do totally see the inefficiencies from an outside
| prospective. I just am struggling to see the benefit to
| Amazon for this particular purchase. It feels like a market
| that will be unprofitable for a long time if they are trying
| to make a system that doesn't work like it normally does.
| 1986 wrote:
| Isn't One Medical's entire business model / pitch to
| consumers predicated on the fungibility of providers, though?
| i.e. you can almost always see a OM provider on pretty short
| notice, it's just not guaranteed to be the same provider you
| saw last time
| bick_nyers wrote:
| A challenging part is having automation while also having
| proper processes, risk management, and documentation. They
| tend to be opposing forces, where to do one well the other is
| usually sacrificed.
| geoffcline wrote:
| > I wonder if this continues and Google lets Amazon employees on
| premises to collect medical information about their employees
|
| This is a misunderstanding of the acquisition, and how OneMedical
| operates.
|
| OneMedical (1Life Healthcare) is a tech company that makes the
| OneMedical app. They also make electronic health record and
| clinic management software.
|
| You can visit health clinics branded as "OneMedical" without
| being a member. You just can't use the app.
|
| OneMedical Clinics use the platform, but are (generally, it's
| complicated) privately owned by a physicians group.
|
| In Austin, the OneMedical medical staff are associated with
| Ascension Seton Physicians Group (may have a slightly different
| name). They aren't Amazon employees. The medical staff isn't
| accountable to Amazon leadership/shareholders. They are
| accountable to other medical professionals. This is similar to
| law firms. Side note: this is one reason why innovating in these
| fields is very challenging.
|
| This is the same for Amazon Care. The practicing medical
| professionals are not employees of Amazon.
|
| It is possible that the clinics embedded in Google locations may
| discontinue licensing/using the OneMedical branding. They may
| also transition to using another platform, such as EpicCare, to
| coordinate patient records, scheduling, and Telehealth.
| avanai wrote:
| From a medical provider friend who works at One Medical:
|
| "I won't wear a tracking device and see 40 patients while wearing
| a catheter"
| Sentino wrote:
| Huiuiu something will change the usa health care system.
|
| Old companies should be careful.
|
| And don't forget the other company who is already working in
| making drugs much cheaper.
| smiddereens wrote:
| kelnos wrote:
| I've been pretty happy with OM (member since 2014 or 2015 or so),
| but would only consider staying with them under Amazon if someone
| with some healthcare-related legal expertise could come up with a
| plain-English explanation of what Amazon will and will not be
| allowed to do with my medical data. If it's pretty much status
| quo, and Amazon won't be able to do anything with it (like
| recommend products based on my medical history, ugh), then I'll
| probably stick with OM. Otherwise... no, thank you.
| ejb999 wrote:
| Today Amazon (NASDAQ:AMZN) and One Medical (NASDAQ:ONEM)
| announced that they have entered into a definitive merger
| agreement under which Amazon will acquire One Medical. One
| Medical is a human-centered, technology-powered national primary
| care organization on a mission to make quality care more
| affordable, accessible, and enjoyable through a seamless
| combination of in-person, digital, and virtual care services that
| are convenient to where people work, shop, and live.
| Dowwie wrote:
| The innovative business model of the American healthcare system
| today consists of a physician's office scheduling patients to see
| the doctor but getting nurse practitioners instead, yet charging
| for the physician's services. Doesn't seem legal, and isn't the
| care that patients have signed up for.
| axg11 wrote:
| I expect this won't be the last acquisition on the health front.
| All tech-adjacent companies are cheap right now and Amazon is
| making a big push into health (Amazon Care & Pharmacy). More of
| these acquisitions can accelerate plans. As a bonus, One Medical
| already runs on AWS.
| chevman wrote:
| At the scale of Amazon sized companies in the US, healthcare
| costs become part of the strategic equation of how you manage
| your business.
|
| Get large enough (you will have moved beyond fully insured plans
| to self ensuring your population long ago) and you'll continue to
| look at opportunities further down the supply chain in actual
| healthcare delivery itself to better manage, forecast, and
| optimize costs.
|
| Primary care and Rx are usually the first place to go.
|
| My guess is this is as much about that dynamic, as it is about
| buying some good leadership (look at the board/leadership of One
| Medical and you'll see many familiar faces if you are in
| heathcare/plan/PBM space).
|
| Will be very interested to see if they keep this mainly in house,
| or if they begin to scale beyond that.
| Gordonjcp wrote:
| > At the scale of Amazon sized companies in the US, healthcare
| costs become part of the strategic equation of how you manage
| your business.
|
| Amazon employ about 1.3 million staff. Say you wanted to
| provide healthcare for your employee's families too, so we'll
| pick about 2.75 million in total (because I'm guessing that a
| lot of Amazon employees have a partner but no children). That
| puts you at roughly half the population of Scotland.
|
| Scotland spends about PS16 billion a year on healthcare, for
| everyone in all stages of life, many of whom have extremely
| complex healthcare needs. To provide the equivalent of NHS
| Scotland to an Amazon-size company you'd get change out of
| PS8bn, and that would provide things like free prescriptions,
| and all healthcare requirements free at point of need. I bet
| you could sharpen the pencil a bit on that since you've already
| got massive supply chain logistics in place.
|
| That's not a lot of money really.
| biztos wrote:
| So Scotland pays about PS3000 per person per year for all
| health care?
|
| That's slightly more than my deductible in Germany, and about
| half what I pay for private insurance for one person.
|
| Seems like Prime Health Care could be a good business, and
| "dogfooding" it on their own employees for a few years would
| be the obvious way to streamline it.
|
| Then again, I can't imagine doctors would be happy with the
| AWS Management Console experience...
| ctvo wrote:
| > Then again, I can't imagine doctors would be happy with
| the AWS Management Console experience...
|
| I can assure you health care professionals in the US deal
| with far, far worse IT situations. It's very unfortunate.
| in_cahoots wrote:
| Half the population of Scotland, with very few elderly and
| sick patients since their employees are relatively young and
| healthy. In-house healthcare makes a lot of sense.
| colinmhayes wrote:
| Walmart has done tons of work lowering the prices they pay on
| their self insurance. They pretty recently started flying
| everyone who needs knee surgery out to some hospital in bumfuck
| Pennsylvania. From what I hear most of that hospitals business
| is now knee surgeries for Walmart. It makes sense, the hospital
| can specialize and you can do in patient rehab for way cheaper
| since land and labor are cheaper in the rust belt. In house
| primary care is only the beginning.
| s1mon wrote:
| This was definitely not on my Bingo card.
|
| I've been a customer of One Medical for a while. I really like
| the convenience and simplicity of booking in person appointments
| using an app on relatively short notice, and their video visits
| are often all you need for peace of mind or a simple
| prescription.
|
| I've also been a customer of Amazon for [checks order history,
| gulp] 24 years.
|
| I have a love/hate relationship with Amazon. I was also a
| customer of Whole Foods for many many years. When Amazon bought
| Whole Foods, it kinda stayed the same, but there are enough
| subtle differences that it's a bit like a Truman Show version of
| itself. We stopped shopping there.
|
| I hope I don't have to stop using One Medical. I'm not normally
| super paranoid about data privacy, but this doesn't feel good to
| me.
| gaws wrote:
| > I hope I don't have to stop using One Medical. I'm not
| normally super paranoid about data privacy, but this doesn't
| feel good to me.
|
| Sounds like you should stop using One Medical.
| bbarnett wrote:
| You can probably afford to pay for all medical costs, out of
| pocket, now that you stopped buying at Wholefoods...
| scoofy wrote:
| ...more like wholepaycheck amirite
|
| are, are we really still doing this bit?
| dominotw wrote:
| No because their medical bills will be going up from not
| shopping at wholefoods.
| diogenescynic wrote:
| I know it's a meme that WholeFoods is expensive, but I've
| actually found it pretty comparable in price to other local
| organic markets and co-ops. I think a decade ago it was
| definitely more exclusive, but now it's in the same ballpark
| --I actually find WholeFood's veggies, fruits, meat, and
| cheese are cheaper than my local co-op.
| stjohnswarts wrote:
| Yeah, they can have decent prices especially if you're
| willing to move your eating choices around "what's on sale
| this week". Same with most expensive stores. I definitely
| do it with whole foods, sprouts, and central market. I love
| curb-side pickup :)
| dmicah wrote:
| Maybe it was just local competition, but in college a
| gallon of milk at Whole Foods was about $.25 cheaper than
| the Safeway across the street.
| potatochup wrote:
| Milk is a classic loss leader though. It's
| (intentionally) hard to compare overall prices between
| supermarkets
| stevenwoo wrote:
| The San Francisco Chronicle did an informal comparison
| (equivalent items where identical not available) shopping
| survey last year and found Whole Foods and Safeway neck
| and neck for most expensive groceries among major grocery
| stores in Bay Area.
| macNchz wrote:
| It has been a few years since I regularly shopped at Whole
| Foods, but when I did my impression was that at least some
| of their reputation for high prices came from the fact that
| they had a wider range of minimum to maximum price in a
| given product category than a typical supermarket.
|
| I found their produce and "365" store brand items pretty
| comparable with other shops, but they also stocked high end
| versions of many things that you couldn't buy elsewhere,
| sometimes with eye-popping prices, so you'd have to be more
| selective about what you picked up off the shelf.
|
| Taking spices as a random example: a regular store might
| have own-brand cumin for like $0.75/oz and McCormick brand
| for $2.00/oz. Whole Foods store brand is likely somewhere
| in that range, but they'll also stock Morton & Bassett for
| like $4.00/oz, so if you're not careful you could pay 2-5x
| what you might have elsewhere.
| __derek__ wrote:
| Amazon has been HIPAA-compliant for years at this point. Even
| Alexa has been since 2019.[1]
|
| [1]:
| https://developer.amazon.com/blogs/alexa/post/ff33dbc7-6cf5-...
| Terretta wrote:
| > _Even Alexa has been [HIPAA-compliant] since 2019._
|
| And most major sites still allowing your PII to go to 100
| direct third parties and 4000 indirect parties are GDPR
| compliant.
|
| Regulation compliant doesn't mean what most people think it
| means.
| api wrote:
| Specifically it means that the company found a way to
| comply with the letter of the regulation, and that's it.
| dragonwriter wrote:
| What it actually really means is simply that Amazon is
| willing to sign a Business Associate Agreement with HIPAA
| covered entities for certain services, so that it is
| possible for the covered entity to use Amazon services
| while themselves meeting (one particular aspect of) HIPAA
| regulatory compliance.
|
| At least, that is what it seems to mean given that the
| support for the claim was a link to Amazon's description
| of certain services as HIPAA-eligible, which is Amazon's
| term for services they are willing to sign a BAA for.
| HeyLaughingBoy wrote:
| Compliant doesn't mean what people think it means or do you
| mean people don't know what the regulation says?
| __derek__ wrote:
| Sorry, I didn't follow the connection to the quoted
| sentence. Can you explain?
| WebbWeaver wrote:
| >Regulation compliant doesn't mean what most people think
| it means.
|
| That is the bane of my existence.
| Allower wrote:
| relaunched wrote:
| This website basically says that 6 companies use Alexa, for
| HIPAA purposes - that they are allowing CEs and BAs access to
| an environment that Amazon attests is capable of being HIPAA
| compliant. That's a long way from the statement that "Amazon
| is HIPAA compliant".
|
| >>>>Amazon Alexa is currently providing a HIPAA eligible
| environment to select skill developers as part of an invite-
| only program in the U.S. In the future, we expect to enable
| additional developers to access this capability to build
| healthcare skills, allowing more customers to access
| healthcare services more conveniently using voice. If you are
| interested in getting updates on our HIPAA eligible
| environment for Alexa skills, click here.
| __derek__ wrote:
| The link was intended to date the Alexa comment ("since
| 2019"), but the placement was ambiguous. Anyway, you're
| correct that I was lazy on wording.
| cactus2093 wrote:
| I've been using One Medical for I think like 8 years now, at
| first I paid for it myself but the past few years it's been
| paid by my employer. In my experience they're still a bit more
| convenient than the average medical practice. At least I don't
| have to play phone tag to make an appointment, or have my
| appointment canceled because I was busy and couldn't answer a
| confirmation phone call. That just speaks to how terrible the
| average medical practice is at customer service.
|
| But I feel like One Medical has already started declining in
| quality and reverting to the mean of other providers. It's no
| longer easy to find an open time slot, I had to schedule my
| last physical a month and a half in advance. Last time I tried
| to do a teledoc session which is advertised as a 24/7 service,
| they happened to be closed all weekend (I'm not sure if that
| was a very unlucky one-time thing or how often that happens).
| Like with many other VC-funded companies, the early user-
| friendly imbalance of supply & demand was never going to be
| sustainable as they scaled up.
|
| What I have hated to see most, though, is how they have
| maneuvered their way into being yet another employer-funded
| health benefit. Now that it's "free" for me, my bar for service
| quality is much lower than it was when I was paying $100 a
| year. I already hate that medical insurance is employer funded
| in the US - the best solution would probably be a European-
| style government funded system, but the second best solution
| would just be to ban employer-sponsored health plans and let
| companies pay those amounts directly to employees to let them
| choose their own plan. Right now we have the worst of all
| worlds, it's not universal and it's not market driven either.
| And One Medical is now just the latest example of a similar
| kind of crony capitalism, which was true before Amazon bought
| them and I'm sure will continue being true now.
| kelnos wrote:
| > _It 's no longer easy to find an open time slot, I had to
| schedule my last physical a month and a half in advance._
|
| My experience is similar, but I don't think this is a
| problem. A physical is not remotely urgent and can wait.
|
| What I do care about is that I can get next-day appointments
| for more urgent things like non-emergency injuries that I
| want to get checked out, and that's always been possible. The
| one disappointing bit is that I can never get these short-
| notice appointments with my primary physician, but in general
| that's ok; I'm fine seeing someone else for stuff like that.
|
| I think the thing that I've enjoyed the most, aside from app-
| based appointment booking, is that I can send a message to my
| doctor for some kinds of referrals and avoid an office visit
| or phone call entirely. For example, I wanted an appointment
| with an allergist. I just messaged my primary physician, and
| the next day he faxed a referral to our local university
| hospital.
| sroussey wrote:
| I've been able to use the 24/7 video feature a couple of
| times this year with between one and five minute wait.
| papito wrote:
| Amazon has been testing the waters and doing internal betas of
| something healthcare related for well over a year now. Scott
| Galloway called this a long time ago. Not really a shocker for
| Amazon watchers.
| samstave wrote:
| >> _I 'm not normally super paranoid about data privacy, but
| this doesn't feel good to me. _
|
| Well, the conspira-cynic in me notes that Amazon has a 10
| Billion contract with the USG for various data housing for many
| intel/defense arms of the USG...
|
| So, theres that...
| saulrh wrote:
| It's kind of depressing that the US economy and US healthcare
| industry is so fucked that it's cheaper for a megacorporation
| (Walmart, Amazon) to set up a private little single-payer state
| inside itself. That's really what this is - if you own your own
| doctors, you can close the payment loop, remove the entire
| insurance industry from the equation and all of its misaligned
| incentives and bureaucratic overhead. Kind of inspiring, in a
| way, that we're so advanced technologically and organizationally
| that it's in striking range for non-state actors, but also
| _terrifying_.
|
| We continue to live in the worst cyberpunk utopia.
| drc500free wrote:
| Is this significantly different from HMOs, which have existed
| for at least half a century? Kaiser has been doing basically
| this for a while now.
| giraffe_lady wrote:
| Is a canoe different from a speed boat? In some ways not at
| all, in some quite a bit. Depends on what you're trying to
| explain or do with it.
|
| The fundamental similarities don't override the differences
| and in this case I think "it's owned by a union-busting
| monopolistic megacorporation that is currently redefining
| labor relations and probably not in a good way" is enough to
| make it valuable to consider it a different thing.
| drc500free wrote:
| Kaiser runs massive complex hospital systems, does $93B in
| revenue, and employs over 200,000 people.
|
| One Medical runs a handful of standalone primary care
| offices with bougie waiting rooms, does $250M in revenue,
| and employs 3,000 people.
|
| It's something to keep an eye on, but if there's a canoe in
| this analogy it's the one Amazon just bought. Maybe they
| can turn it into a full navy one day.
| ebcase wrote:
| Fwiw, this is how Kaiser Permanente started. Henry Kaiser
| needed healthcare for his shipyard workers during WWII, so he
| brought in a physician to start and scale up the program in-
| house. Nowadays Kaiser is the insurer, hospital system, and
| healthcare provider for millions of Californians.
|
| https://en.wikipedia.org/wiki/Kaiser_Permanente
| ctvo wrote:
| > We continue to live in the worst cyberpunk utopia.
|
| I sometimes think Bezos doesn't get into politics because he's
| saving himself from a conflict of interest when he becomes
| president of the corpo-state of Amazonia. Oh, and he's also not
| that charismatic.
| dehrmann wrote:
| > a private little single-payer state inside itself
|
| Lots of big companies self-insure. The plan is administered by
| someone else, but the company pays the real cost. What you're
| describing is a single-payer HMO.
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