Amazon Buys One Medical

> Companies that fail to abide [...] can violate Section 5 of the FTC Act

I'm sure the fine will be a real deterrent. Just like the fines have deterred Amazon to stop their anti-union practices. I wonder if we will ever see some antitrust measures ever again, or if it is just going to be a free for all from now on.

In this case, it's a bit different. Pretty much all of that information is protected by HIPAA.

I'm not sure the FTC will be Amazon's primary regulatory concern in this instance. And HIPAA is just the start. The FTC really is the least of your concerns once you start playing in healthcare on a diagnostic level.

Full disclosure, I've exited a diagnostic medical imaging software company and have been through the regulatory proctology exams that are 510(k) and HIPAA.

> One key issue facing Haven was that while the firm came up with ideas, each of the three founding companies executed their own projects separately with their own employees, obviating the need for the joint venture to begin with, according to the people, who declined to be identified speaking about the matter

Man, tanked their own venture.

Yeah, it is really a shame. It would be great to see some new competition in the pharmacy benefit managers and pharmacy sector

No idea.

NowRX does meds regional delivery, ExpressScripts was one of the first by mail, and other US pharmacy chains are sending meds by mail too.

Amazon has PillPack, where they combine meds by time of day.

That makes me feel a little better.

FYI: https://galileohealth.com/

They’re both $200ish a year. What distinguishes them from each other in this regard?

I see

One Medical - $199/yr ($144 first year)

Galileo - $249/yr (or $348 paid monthly, or $45 single visit)

Is there something else in the pricing that makes Galileo cheaper for poorer people?

a telehealth-only practice inherently cannot provide the same benefits, no?

And here 8 months ago:

https://news.ycombinator.com/item?id=32178643

and which SciFi story with a mega-corp have you consumed where the mega-corp wasn't the antagonist?

One Medical is basically a conglomeration of doctor's offices with an app that allows for easy scheduling, remote visits, chat, and other stuff.

I have one medical. Basically the value proposition for me is that its easier interface to the whole medical system. Finding a primary care physicians can be done in like 5 minutes. Stuff like scheduling appointments, virtual visits, vaccines, tests and what not through the app is super easy. IDK if it will get mainstream adoption but to me it takes the edge off seeking medical care. Also their clinics are nice and in convenient places.

If it's anything like BetterHelp, you'll just be scheduled to the first available, lowest cost provider who get paid half or less the market rate for professional care. And knowing Amazon, they'll innovate newer ways to make it a dystopian dehumanizing process that leaves all parties with less care, less money, except for the shareholders.

My employer has a relationship with them. They have multiple locations at our various offices. I have on in my building. The convenience is unbeatable, both the on site services and convenience of the app. I always can get an appointment.

That being said over the last five years the quality of care has gone down. The good practitioners have left, and now there is quite a bit of turnover. I’ve had to change PCPs 4x in the last three years.

One medical is just a medical group like any other. They aren't insurance, they bill your insurance. They also charge a subscription fee which is not covered by insurance for membership. Out of membership you get access to their convenience services like mobile consultation. Most of these conveniences have been incorporated into big insurance players platforms by now, because they save money. They do so by trying to preempt you going to the clinic and starting to rack up charges when a video nurse could have told you to just take a chill pill. They also claim to offload much of the administrative and annoying health insurance work so you don't have to worry about it. I found this to be mostly true, but again becoming replicated by improved UX on the insurance providers sites. The other nice thing about them being a group is they have multiple clinics scattered around bigger metro areas. You can go to any site kinda like you would an urgent care.

I don't use One Medical any more because I no longer live in an area where they exist. They were a good customer experience for the basics. I will note that they are really just a triage replacement and the people you see are often less experienced. And they don't do specialists, really. If you get into anything complicated you're dealing with the general medical system as normal (annoying trips to random floors in big research hospitals to do weird tests that don't really tell you anything other than you already know type of vibe, not really knowing if you're in network or not because nobody can tell you a straight answer type of vibe, not knowing up front what classifies as a co-pay and what's a covered benefit, why is "hospital" lab work billed more than clinic lab work and why does that mean my insurance covers less of it and I have to pay extra more type of vibe). They're not vertically integrated like a Kaiser.

used it about 5 years ago in SF, switched to finding my own PCP since I moved elsewhere

now that amazon owns it I wouldn't go near it

I signed up after learning that a simple visit takes weeks to get an appt if you’re a new patient. At the time one medical offered same day appt and it was a big deal. Some of this has now been matched by insurance providers providing video visits for free, medical providers (like Kaiser/Shutter) and urgent care centres providing quicker appts. I now stay with them because it’s still easier to get all the usual stuff done through them, their offices are nicer and cleaner and having a reachable PCP really helps navigating the American system for me when I need a specialist consult or a prescription filled. During the early days of Covid it was super easy to get tested at their offices as well.

I had BetterHelp through my old job, and used their telemedicine feature...until they realized that I didn't live in a state that they had an "official" location in, so, they cancelled my membership (ironically enough, when I used their telemed offering, I was in a state that they had offices in, just not near me!)

...only to reactivate it again when my employer questioned why, and have them cancel it again two weeks later.

I haven't even tried to use them or look at their offerings after being de-platformed on repeat for the longest part of a year until my employer dropped them.

Before at home Covid tests were available this was the most convenient way to get a test without waiting in line

In my opinion the best thing they offer is little to no wait time even for same day appointments. Beats urgent care experience by a massive amount.

I'll echo some of the other responses. I'm a One Medical customer - started with my previous company, then when I left my employer I decided to still pay the annual subscription fee (was basically $100 with a promo for folks who just left an employer).

So far I've been a huge fan. Things like scheduling appointments, getting labs done, having an easy back-and-forth with a provider when you just have a question and nothing major, is way, way, way better with One Medical than with any of my previous doctors. I will challenge a bit another commenter's statement that "Most of these conveniences have been incorporated into big insurance players platforms by now" - while that's true, other insurance corp apps have generally been absolutely abysmal. One Medical's app is generally excellent IMO.

Of course, the big question has to do with quality of the practitioners. I've found that I really like my doctor at One Medical, but he is only recently out of training, so not sure how long he'll stick around

I would not have understood the benefits until I moved to DC from a smaller town.

In my home town, it was relatively trivial to find a competent GP who took my insurance. In the much larger market of DC, totally the opposite! Which led me to using OneMedical for a while.

The main advantages they had a few years ago were:

- Multiple locations (including near my apt and work place)

- easy to schedule appointments on short notice with either my PCP (if available) or anyone else on their staff (if not)

- Very easy to communicate with doctors/etc online, generally their portal was "not shitty"

- Appointments always started on time

The downside was the extra cost (trivial compared to the hassle it was to deal with other services) and the staff being a bit more impersonal -- they really hurried you out of there, which is the flip side of always starting on time. :)

I've actually kept up my account even though I see a different PCP these days, since it felt like it could be useful as a fallback on short notice. I'm thinking about cancelling now that Amazon has bought them, though.

A previous employer paid for it, now I pay for it out of pocket. The convenience of scheduling routine things or setting up a video visit with a provider is more than worth it. There are many things where you might have considered going to an ER or making an appointment with your PCP, but instead you can have a quick video call which can help triage/understand what you're dealing with.

A few months ago I got a stomach bug traveling, and was able to do a quick video visit and get a script for antibiotics sent to a local pharmacy even though I was out of my home state. The ease of that one event is well worth the annual fee. There was no additional charge for the video visit.

During the height of covid, I got some other respiratory thing that I thought might be covid and I was extremely stressed. I did a video visit with a provider who was working (from home) while sick with covid. I thanked her for her service and started to cry.

I had access to--and used--OneMedical through my employer-provided health insurance for a couple years. The way to understand it isn't as an alternative to your health insurance, but as a care-provider network with a nice app and a bunch of offices (at least in the Bay Area, where I lived at the time) that you pay a subscription to.

Overall, my experience was pretty good (with the caveat that this is all in the context of the US healthcare system, so the bar is rather low): I was happy with my PCP[0] and the overall level of care provided, and scheduling appointments (with my PCP or otherwise) was always really easy and straightforward[1]. I also never personally ran into any weird/scammy billing issues, something which I have encountered with some frequency at other healthcare providers[2].

That all being said, my work provided access to OneMedical as a perk, and I'm not sure if I'd pay the membership fee out of my own pocket if I ever move back to a city where they offer coverage (even setting aside concerns about its acquisition by Amazon).

[0] n=1, and I'm a white dude without any serious chronic illnesses or ailments, so take with the obvious grains of salt

[1] I was basically always able to schedule appointments within a week, and usually same- or next-day, which IME is unheard of in the American medical system in general. As a contrasting example, when I tried to find a PCP about a year prior to enrolling in OneMedical, but still living in the same metro area, most scheduling offices told me that there would be a 3-6 month waiting period for scheduling a routine physical, assuming they were taking new patients in the first place.

[2] Again, n=1, so I doubt this is really a generalizeable data point.

It's paying $100-200 a year to be able to get labs done pretty much immediately, schedule appointments easily, sit in waiting rooms that aren't depressing, and have a PCP and office workers that are nice to you and treat you like a human. Oh, and the video appointments are amazing. One time I had a really terrible UTI and got antibiotics within the hour from my phone.

I've been a customer of theirs for at least 12 years, I think (I have an entry in my password manager from about that long ago, and I might have had an account before that). It's been fantastic, in general: I can get a phone consult anytime I've wanted one, and can get in to see a doc with pretty short notice. They are good at giving me the referrals I ask for, even if they are weird (eg., after listening to Chamath Palihapitiya talk about Coronarary Arterial Calcium scans, I got curious and wanted one, and 1med got me the referral I wanted/dealt with insurance, etc.). About the only downside is that it's a bit harder to keep a very consistent GP, in that 1med seems to have a fair amount of turnover. I don't know if it's hard to keep a consistent GP in other contexts, as I pretty much didn't go to doctors between the time I left high school and when I started using 1medical.

Echoing other comments here, I use One Medical and am an extremely happy customer — I pay the yearly subscription out of pocket. Online scheduling + video calls at any time with their staff make it well worth it, and they have offices in many cities and states so I've even seen doctors and gotten bloodwork + vaccinations done while traveling (domestically in the US). My experience with their doctors has generally been top notch as well, including one doctor visually and immediately diagnosing a family hereditary condition that had taken my sister years to get diagnosed through other doctors. And since they have so many offices, I can pretty much always get a next-day appointment in the Bay Area. I've never had to wait a memorable amount of time once I show up, and they can do a lot of labwork immediately onsite if you need or want it without additional scheduling or needing a return trip.

I've traveled and lived abroad, and IMO One Medical clears even the relatively high European-style medical system quality bar.

Happy for them that they got acquired by Amazon, since the scheduling + online stuff is a big part of what makes One Medical great and Amazon is quite good at that.

I used it, but will transition away. They kept ratcheting down the time a doctor can see with the patient and increasingly make each visit "special" so they can charge $250 for a 25 minute session.

I already didn't like it, I like it even less now.

One Medical is a primary care clinic, not a replacement for insurance. They will accept your insurance same as any other doctor. They have a bunch of locations and a decent sized staff. Their selling point is quick (sometimes same day) appointments and quick/cheap lab services.

It's very convenient to be able to book visits next day from an app. If you don't have any significant illnesses, maybe the convenience is worth it, but the medical care I got there was atrocious. I went in with a serious complaint and was just told "there's not much you can do about that" (turned out to be completely untrue). My provider repeatedly wrote prescriptions wrong. Over and over and over. And she would often forget what I told five minutes after I said it. Even though she was supposed to be my PCP, she seemed completely clueless about my conditions on every visit. My impression was that the providers are overworked and not able to really give patients the time and consideration needed.

One Medical would write adderall scripts for people during the pandemic. I think they stopped, but idk I went back to using a regular psychiatrist. Pretty wild to think that nurse practicioners were prescribing schedule IIs.

source: I got all of my adderall through them for nearly two years

I'm really happy with it.

The video visits are especially useful. Generally if you click "emergency video appointment" in the app you'll be in a video chat with a nurse practitioner in less than five minutes - often faster - no matter what time of day or night it is.

One thing I've used that for is emergency prescriptions: say I'm traveling and I forgot to bring a medication, I usually find that a five minute video chat will result in the medication I need being made available at a pharmacy in whatever town I'm visiting.

I paid for it out of pocket, the experience is pretty great in theory, but it doesn't make up for the apparent doctor shortage in SF. It's very difficult to get appointments with an actual doctor without waiting months.

> if you have health insurance through your job, what does it provide that your insurance does not

I have no idea, but it worked. I went to the One Medical office nearby, and the doctor fixed my problem. All communication after was through the One Medical iPhone app, which was pretty good for medical software but was still complicated for no reason. The relatively few things the doctor wanted to tell me were scattered around different menus, and I missed some. He could've just given me a piece of paper, and it would've been way easier.

Yep. It's $200 to join. My insurance doesn't cover it but I can see an MD anytime. I can telehealth or visit my PCP through them usually next day. They have labs onsite. The wait is minimal, maybe 5 minutes.

I’m not sure how much of it was luck, but my provider at One Medical tested for Lyme disease and caught it in me. My provider seemed to be extra cautious based on very limited clues and I think that is somewhat related to it being a premium product.

Lyme can be super awful in some cases, especially when you’ve had it for a while without knowing. Given my experiences in other care systems, I don’t have a lot of faith they would have tested for it with any rigor.

I use one medical even though my insurance doesn't cover anything through them, as they're vastly more convenient for scheduling, telehealth, Rx renewals, etc., and the doctors I've seen are all good. They also have locations in "good" cities in the US, and thus if I'm traveling there, I have a decent local option. Completely happy with it.

They were great with one major problem though, they don’t filter for science based medicine. They have all kinds of woo services they try to push like chiro, crystals, aroma, etc.

If you can get through the scammy stuff they’re pretty good though for the convenience

My employer pays for my membership. I use them for primary care and for getting blood labs drawn.

They're just like any other in-network clinic, except they try to provide an above-average experience. They bill your insurance, and you're still on the hook for copays. I suspect that they're more likely to write off stuff that insurance rejects rather than bill you, but all I know is I've directly paid them maybe $40 over the last 3 years.

Their clinics are comfortable and pleasantly decorated. Their front desk workers are all friendly and happily tackle clerical issues like tracking down external lab orders in other networks' systems.

Their app is about as meh as any other, but their scheduling system is actually usable with plenty of available appointments. For labs in particular, I can just drop in without an appointment and be done in 15 minutes. All the phlebotomists I've had have been skilled and empathic. I was able to get a 12-lead ECG there, too.

Their video sessions are very easy and convenient, and I've never had to wait more than 10 minutes or so. They aren't really going to solve any problems unless you just need an obvious prescription filled, but it's very comforting to be able to get a quick opinion from a random nurse practitioner. It's a nice way to help decide whether or not a problem is worth a trip to urgent care.

this is announcing the closing of the deal (late last month)

Even older, this was announced last year.

Should companies as big as Google not be allowed to buy startups? That's going to go down well here... /s

Companies 10% as big as Amazon probably shouldn't generally be allowed to buy other companies.

I disagree, companies should all have the same rights regardless of their size.

What exactly about "big" is it that makes you say this? Is it the amount of money they can throw around? Is it the ability to integrate these bought companies in with the rest of their companies? Is it that there aren't enough people at the top of the company?

Strongly agreed. There have been plenty of people banned for life for returning too many items, or sometimes just one large item. Fine, no more shopping at Amazon. Now, there goes your healthcare provider(s) too.

Google was scary enough with so many digital properties tied together, but now a bohemoth expanding into the 'real' world should give everyone pause.

Eh.. I'm open to see what happens. I'm currently being ground to a bloody pulp through the US medical machine. It has been one of the most stressful experiences of my life. It can't possibly get worse if Amazon gets its fingers into a small part. If they can squeeze even a few percentage points of improvement out of the process it'd be a huge win in my book. The current system makes one want to give up.

Easy to say until a bunch of small and midsize companies go out of business.

From their 2022 filings:

* Loss from Operations was $419.7 million, or 40% of Net Revenue; Net Loss was $397.8 million, or 38% of Net Revenue.

*2022 Ending Cash and Marketable Securities of $262.4 Million

It had less than one year of runway.

Why?

What moral or economic principle determines why one company shouldn't be allowed to buy another, as long as it's not reducing competition (e.g. Amazon buying Barnes and Noble, or Amazon buying Wal-Mart)?

If Amazon simply built its own One Medical that grew to the same size, should that similarly be prohibited? And how are you going to determine the dollar value valuation of a company where it's not allowed to buy companies anymore?

Because conglomerates -- corporations that have products in lots of different industries -- have been around for a long time. They grow when they think they can generate economies of scale and synergies, which is good for consumers.

I agree. I think there should be a size and value threshold where it is determined that your company can reasonably just spend to build using your own R&D for literally anything, and that performing an acquisition at all (whether or not it makes you a monopoly) is harmful for the overall market.

Take Apple for example. It bought most of Intel's modem business to build its own product.

Does anyone seriously believe that Apple couldn't have built that kind of technology from scratch? How many modem businesses could they build before running out of cash? Wouldn't it have been better for Intel's modem business to go to someone else who might make the product available outside of Apple's closed product ecosystem?

I'm pretty sure Apple would have no problem bootstrapping an oil company or an industrial container ship manufacturing business, that's just how much money they have.