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.
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.
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.
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.
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.
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.
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 :)
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.
> 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.
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.
>>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...
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
> 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".
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.
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.
> 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.
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
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].
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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
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.
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.
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.
"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"
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.
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.
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.
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.
> 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.
> 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.
> 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.
In Seattle, they’re part of Swedish, one of the major health providers in the area. The doctors are part of the Swedish staff directory and the insurance billing is done from their physician account.
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.
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:
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.
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.
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.
+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.
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.
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.
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.
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.
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.
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!!!
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.
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.
Yep also Amazon gets the need for 180 day refills and will happily issue refills a month or even more in advance.
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
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.
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/
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.
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.
> 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 £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.
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.
So Scotland pays about £3000 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...
About £2500 on average. I've been fortunate enough to have very little go wrong with me over the years, but my mum has had cancer about six times and at the end of next month have just completed two years of immunotherapy so I reckon I've had my five grand's worth.
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.
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.
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.
> 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.
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.
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.
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.
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.
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.
> 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.
>>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.
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.
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
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.
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.
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.
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.
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.
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?!
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.
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
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.
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.
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!
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.
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.
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?
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.