Amazon to Acquire One Medical
press.aboutamazon.com
press.aboutamazon.com
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.
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.
are, are we really still doing this bit?
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...
Sounds like you should stop using One Medical.
[1]: https://developer.amazon.com/blogs/alexa/post/ff33dbc7-6cf5-...
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.
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.
That is the bane of my existence.
>>>>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.
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.
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.
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
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.
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.
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.
Forward outsources a lot of their clinical stuff, so the service ends up being much less premium
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.
> boutique experience
Man, Americans say the weirdest $h@t
I expect the same to happen (or already happening) in the UK.
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.
The first time I read it I interpreted the "their" the other way, and was quite surprised! :D
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.
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.
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".
That said, my experience with pa vs md hasn’t really been that different, they all just follow the same flowchart
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.
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.
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.
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.
"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"
> 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.
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.
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.
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.
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.
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.
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.
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. :\
This is another term that doesn’t legally mean what people colloquially think it means.
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.
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.
They will magically give you the test after that :-)
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.
It's not part of the usual panel, and I get the sense that more and more doctors have been tacking it on for everyone.
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.
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.
Local pharmacy would often only give 30 days at a time and not refill until 3 days before the 30 days is over, are they fucking crazy do they think people don't travel? There are things called planes and trains that they might not yet have heard of, they get people around the world, so I don't sit at home in CA all year
Healthcare is the obvious golden goose in the long-term.
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.
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 £16 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 £8bn, 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.
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...
I can assure you health care professionals in the US deal with far, far worse IT situations. It’s very unfortunate.
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.
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.
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.
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.
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.
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.
> 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.
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.
Amazon are a true conglomerate
Amazon is a true monopoly
[1]: https://amazon.care/
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.
Edit: Oh, and then there's Palantir, Oracle, Salesforce... you know what, how about we just keep tech out of healthcare?
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.
pretty soon we'll see amazon rebrand as "ONE"
“I won't wear a tracking device and see 40 patients while wearing a catheter”
Old companies should be careful.
And don't forget the other company who is already working in making drugs much cheaper.
1) Worse health care
2) Medicare for All is dead in the U.S.