Amazon really believed it could sell you a healthcare fantasy – The Market Herald


What if you could get healthcare as quickly and easily as ordering socks and kitty litter? It sounds fanciful in a country where people are dying waiting to see a doctor, but Amazon thought it could do for healthcare what it had done for shopping. Hailed as “the future of medicine”, Amazon Care’s telehealth and call-to-home service has been touted to employers as “high-quality care, convenience and peace of mind”.

Last week, however, the company announced that it would shut down Amazon Care at the end of this year. For the second time in two years, Amazon had to concede a failure to attack the American health system. It might be possible to deliver a spatula to someone’s apartment within 24 hours, but applying the same approach to healthcare seems like a more difficult task.

Still, Amazon isn’t giving up: It plans to buy One Medical, a membership-based primary care provider with in-person and telehealth services in 19 cities. One Medical might prove to be a better business bet, but there’s no magic bullet for the healthcare system to be made here.

Any company claiming that its innovation will single-handedly revolutionize American healthcare is selling a fantasy. There are no technological miracles waiting around the corner to solve the problems caused by decades of careless political decisions and widespread fraud. And a solution aimed only at the top layer of employer-sponsored health coverage has no hope of making health care more accessible to those who are truly being left behind.

Amazon Care and One Medical saw the same market opportunity within America’s crisis-ridden healthcare system: a paying loophole for the well-to-do. Not the truly wealthy — they’ve always had concierge care on demand — but middle-to-upper-class workers who have jobs and insurance, but can’t believe how hard it is to see a doctor .

One Medical, billing itself as “a doctor’s office unlike any other,” allows people with means to avoid the hassles and waits of American health care, while promising longer appointments and friendlier doctors. Its offices are concentrated in wealthier areas and do not accept Medicaid, which reimburses providers far less than private insurance and tends to cover sicker patients who require more expensive care.

Amazon will have a big job to do to keep One Medical running: The company, which charges $199 a year for membership, was not profitable, losing $91 million in the first quarter of 2022.

Amazon Care hoped that companies would pay for their employees to benefit from on-demand telehealth and home care, allowing them to skip the process of finding a provider in their insurance network, making an appointment which can take weeks and time off from work to get going. Amazon would send a nurse to you, to “give people back valuable time in their day,” its website promises.

But these promises exceeded the reality. Shortly before Amazon Care was announced to be closing, The Washington Post reported that former clinical employees alleged the service had “prioritized patient convenience over providing the best care,” trying to grow. too quickly to establish good practice. Telehealth providers struggled with regulations and patient care logistics in many states, unsure whether they could prescribe antibiotics or where to refer patients for X-rays.

The Post also reported that Amazon instructed nurses to “store and dispose of medical supplies at home and stabilize patient blood samples using centrifuges in their personal cars.” (Amazon told The Post that mobile nurses received disposal materials. The company said it prioritizes patient and employee safety.)

The company’s approach to work was characteristic of Amazon. A nurse formerly with Care Medical, the independent company founded and essentially controlled by Amazon that provided the actual healthcare for Amazon Care, told the Post that the contract nurses used were “essentially gig workers, and their training was really poor. “. She also said an Amazon staff member told her nurses were considered “Amazon Care’s warehouse workers.”

That’s chilling to hear, given years of complaints from Amazon warehouse workers about oppressive, even dangerous, working conditions. The whole brand of Amazon is speed and convenience – for the customer. The price of this speed is hard work and sometimes impossible standards for workers, resulting in extremely high turnover. Such a model is more difficult for a healthcare company to sustain, with workers typically requiring years of training and amid a shortage of nurses.

One Medical has also been accused of putting profits ahead of patient care, with staff members complaining that executives have cut appointment times and placed unrealistic expectations on call center workers since the company went public in 2020. (One Medical has denied these accusations.)

Replacing the easy parts of primary care is, well, easy. But part of the reason Amazon Care has struggled is that not all aspects of primary care are so simple that they can be done at home or via video consultation (which is nonetheless a valuable service that is without any doubt here to stay). For anything more complicated, patients would still have to go to a traditional clinic, which means they’d have to deal with the most annoying things about American health care: insurance, phone calls, and drug prices. – if they can take the time to see the doctor at all.

At the same time, Amazon Care has struggled to offer enough services to compete with other telehealth and in-person providers, including One Medical, which has about 200 physical locations and partnerships with more than 8,000 companies.

Amazon is right about one thing: American primary care is troubled. Much evidence shows that good primary care improves health and reduces costs, but primary care is one of the lowest paid fields of medicine. Independent practices are increasingly being absorbed into larger hospital systems, which can more easily make money on referrals to their specialists; this process further increases health care costs. America spends more than double what other rich countries spend on health care, while having poorer health outcomes. We have it all back.

This imbalance results from a thicket of incomprehensible financing systems. Hospitals say they are losing money treating Medicaid and Medicare patients, so they have to charge private insurance more to make up the shortfall. Prices are negotiated with insurers for thousands of individual procedures and services, but even the hospitals themselves may not know how those numbers relate to the actual costs incurred. Insurance companies are making a growing share of their huge profits by administering Medicare Advantage plans, which have received billions of dollars in inflated payments for pretending their patients are sicker than they are. Wealthy hospitals abound in wealthy areas while rural hospitals close.

Amazon might think it can fix everything with enough money, technology, and logistics, but Amazon Care had no hope of unraveling this mess. Against most companies that sell products in America, Amazon is a Goliath. Put it up against the problems of America’s healthcare system, and it looks like David with a slingshot made of wet spaghetti.

This article originally appeared in The New York Times.

Libby Watson is a writer who covers health care.

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