Changes in elderly patients wood-like highlight Amazon's recent efforts to integrate telemedicine, pharmacy and primary care services follow its $3 billion acquisition of One Medical in 2022. Earlier this month, Amazon announced a corporate restructuring, laying off hundreds of employees across Amazon Pharmacy and One Medical. Current and former employees say the move reignites concerns that the e-commerce giant will begin to prioritize profits over patients.
” [doctor] Having someone who was willing to coordinate your health care and personally coordinate it was very important to me,” said Wood, 69.
One Medical CEO Trent Green said the company remains “independent from Amazon's leadership” and any changes are unrelated to the acquisition.
Amazon has long harbored ambitions in healthcare, but has struggled to realize them. In 2020, the company partnered with JPMorgan Chase and Berkshire Hathaway to try to improve the health care system in a venture called Haven, which has since been shut down. The company recently established a virtual home health clinic, Amazon Care, with the aim of selling it as a workplace benefit, but it struggled to attract customers and closed its doors in 2022.
Amazon built its empire through major acquisitions. He is also known as a frugal man whose basic principle is to encourage his employees to “do more with less.” Amazon has traditionally looked for lucrative deals when acquiring companies, observing and collecting data while allowing the companies it acquires to operate independently. Only then can we gradually begin to shape those companies, as we did with Whole Foods and the gaming platform Twitch.
Amazon's healthcare products currently include Amazon Clinic, an online-only service that works with third-party healthcare providers to treat common illnesses. Amazon Pharmacy grew out of PillPack, a startup the company acquired for $1 billion in 2018. One Medical is a concierge primary care clinic with a $199 annual fee that appeals to young, healthy, urban patients who can conveniently schedule appointments and talk to their doctors through an app.
(Amazon founder Jeff Bezos owns the Washington Post.)
Over the past few months, Amazon has worked to integrate these businesses, placing Amazon Pharmacy flyers in One Medical's waiting rooms, creating a program that allows One Medical doctors to consult Amazon pharmacists for free, and increasing Amazon Prime. It offered its subscribers 50 percent membership in One Medical. discount.
Employees said they were shocked to learn in February that the merger would result in hundreds of jobs being cut.Some of the roles removed were in departments that overlapped with existing Amazon resources in That included the company's marketing, recruiting and finance departments, employees said. But jobs specific to One Medical, including front desk staff, office managers, health coaches, behavioral health specialists and pediatricians, were also cut, according to current and former employees.
Amir Dan Rubin said the change to One Medical “reduced administrative tasks for care teams and increased the number of appointments available to members,” allowing “in-house teams to focus on providing care to members.” said Mr. Green, who succeeded him as chief executive officer. During September.
“The changes we are making today will position One Medical for long-term, sustainable success,” said a February email to Green staff seen by the Post. There is. “These will help us reallocate our resources so we can continue to provide affordable, high-quality care to a growing number of our members, leverage the resources Amazon has, and further integrate our operations. It helps you benefit from overall efficiency.”
Green's email to staff also said One Medical would be introducing the role of regional general manager. One Medical doctor, who spoke on condition of anonymity to protect his job, said after reading the email that he was concerned that the new practice role “could be an easy answer to profitability issues.” He said there was. [that] A fast-paced, humanitarian job can quickly turn into a factory-style competition. ”
One Medical said regional general managers will work collaboratively with regional medical directors who report to clinical leadership.
When Wood, a Georgia patient, felt her heart racing and her blood pressure plummet one night, she picked up the phone and called the Iola clinic. Her medical professional came to get her and told her what medication she should take. “They called me every 30 minutes to make sure I was OK,” she said. “It was wonderful.”
But since Iola became a One Medical Senior, Wood said she has seen rapid changes. “I'm an Amazon patient now,” she said. Ms. Wood, who has congestive heart failure and chronic kidney disease, said her calls are now being routed to a call center on the other side of the country, and it can take days before she gets a call back. Yes, she said.
Iora Health was founded in 2010 on the premise that paying patients more upfront will save them money in the long run. Hot coffee, a cozy fireplace, and free rides weren't just perks, they were meant to help patients stay consistent with their health care. The idea was that a taxi ride might cost the company $10, but an ambulance ride after a 911 call would cost him more.
“Iola's philosophy on vehicles was that even though transportation costs are very high, admitting a patient to a hospital costs even more money. If possible, we would like to eliminate the hospitalization by paying for transportation to and from the doctor's appointment. I want to pay them. It made a little more sense economically,” said a fired former Iola & One Medical employee in Seattle, speaking on condition of anonymity to protect his career.
Once Iola transitions to One Medical Seniors, standard appointment times will go from an hour to just 30 minutes, and health coaches will no longer assist doctors during appointments, according to former employees at other locations. It said it replaced in-person mental health checks with behavioral health professionals. With a virtual visit. The number of patients a doctor had to see each day gradually increased from six or seven to more than a dozen, according to a former Seattle-based employee.
“In the last six to eight months, it's become a numbers game again,” said a former employee.
One Medical said it began shortening appointments before the Amazon acquisition, and patients are now pre-screened by a centralized team to save administrative time in the office. The company said the use of the call center will improve response times and patient care, helping patients find transportation to appointments through insurance and local agents.
Jamie Blackbourn, a health coach who has worked at One Medical for two years and specializes in treating older adults, said in a LinkedIn post that he was “heartbroken” by the layoffs. “This includes patients whose health care and well-being are directly affected,” he said. By these decisions. ” She did not respond to requests for comment.
Since its founding, Iora has focused on providing Medicare to low-income and chronically ill seniors. The company has been a successful business, thanks in part to his federal program called ACO Reach, which focuses on improving health equity for underserved populations. In 2022, more than half of One Medical's revenue came from Medicare payments. As the U.S. population ages, the opportunities will only grow.
But changes Amazon has made to its senior health care business suggest the company may not be taking advantage of that opportunity, according to two former executives familiar with Amazon's strategy. The high-risk population poses a challenge for the retail giant, which has more medical experience compared to One Medical's privately insured patients, who tend to be healthy, young and financially affluent, officials said.
One Medical said it plans to continue providing value-based care to at-risk patients, and some of its facilities near San Francisco are no longer participating in a special Medicare program for underserved areas. However, other facilities said they remain active members.
'Everything has changed'
As Amazon pursues its ambitious healthcare expansion, one of the biggest challenges and opportunities is the expansion of One Medical. To help get there, the company started offering a 50 percent discount to its 300 million Prime members in November.
However, One Medical has less than 200 brick-and-mortar clinics with just 20 locations, mostly in urban areas, meaning that many Prime members who become One Medical patients can only access their services virtually. .
Amazon began sending incoming messages through a central call center called Mission Control to handle the influx of telemedicine patients, former employees said. The company is also training an artificial intelligence chatbot to prioritize incoming patient messages and address administrative inquiries, employees said.
Mission Control was initially flooded with additional calls after layoffs eliminated some front desk roles, according to employee Slack messages reviewed by the newspaper.
One Medical said there has been no disruption and that the centralized system has improved response times. Amazon declined to disclose its AI plans for One Medical, but said it is constantly investing in technology that can reduce the amount of time healthcare providers spend on administrative tasks.
One former Iola employee said it was painful to see her clinic, which once had a staff of 20, cut to five and patients “pushed out to virtual services.”
Amazon “tried to assure us that there would be no major changes,” she said. “But if you look to today, everything has changed.”
