Amazon is working to consolidate its healthcare business

Currently, Amazon's healthcare businesses include:

• Amazon Clinic, which works with third-party medical providers to provide online care for common ailments
• Amazon Pharmacy, which originally began as PillPack, a start-up the company purchased for $1 billion in 2018
• One Medical, a concierge primary care clinic with a $199 annual membership fee that also owns other healthcare companies like Iora Health, now known as One Medical Seniors

Over the last few months, Amazon has worked to integrate its separate healthcare offerings. For example, the company offered Amazon Prime subscribers a 50% discount on One Medical memberships. Amazon is also piloting a program that allows One Medical providers to access pharmacy consultation services from Amazon Pharmacy.

At the same time, the company has also laid off hundreds of workers in its healthcare division. According to Neil Lindsay, SVP at Amazon Health Services, the layoffs will allow the company to "invest in inventions and experiences that have a direct impact said that on our customers and members of all ages."

Similarly, One Medical CEO Trent Green said that the layoffs "will position One Medical for long-term, sustainable success" and "help us reposition resources so we can continue providing affordable, high-quality care to a growing number of members and help us take advantage of the resources Amazon has to further integrate our operations and benefit from combined efficiency."

How these changes have impacted employees and patients

Some of the One Medical-specific roles that were eliminated during recent layoffs include front desk staff, office managers, health coaches, behavioral health specialists, and a pediatrician.

According to former Iora Health employees, the transition to One Medical Seniors reduced standard appointments from one hour to just 30 minutes. Doctors were also expected to see more patients per day, going from six or seven to more than a dozen.

"In the last six to eight months, it really became a numbers game again," a former employee said.

Health coaches were also no longer assisting physicians during appointments, and in-person mental health check-ins with behavioral health specialists were switched to virtual visits.

According to another former Iora employee, it was difficult to see her clinic go from a staff of 20 to just five people and see patients "being pushed out to virtual services." Amazon "tried to assure us that not much would change," she said. "But fast forward to today and everything has changed."

Patients have also expressed negative experiences with the recent changes in One Medical. For example, Deborah Wood, a 69-year-old patient with congestive heart failure and chronic kidney disease, said she used to reach a medical professional with Iora very quickly if she needed care. But now, getting a call back can take days.

"Having a [doctor] who can coordinate your health care and is willing to do so on a personal basis was very important to me," Wood said. "And I really feel like that is completely gone, and I feel like it happened overnight."

Commentary

For its part, One Medical has said that it remains "independent of Amazon leadership" and that any changes are unrelated to the company's acquisition. Specifically, the company said appointments were shortened before the Amazon acquisition and that a centralized team now screens patients in advance to save time on administrative tasks.

Recent changes to One Medical have "reduced administrative tasks for care teams and increased the number of appointments available to members," which has allowed "in-office teams to focus on providing care to members," Green said.

According to John League, Advisory Board's managing director of digital health research, many care delivery organizations are applying technology to more patient-facing and clinical processes than ever before, especially as they hope to expand their scale and reach amid a shortage of clinicians.

"That should never mean that care standards are lower," League said, "but it probably does mean that the way care is delivered — and by whom — looks different to patients."

Separately, Sarah Roller, Advisory Board's managing director of physician and medical group research, noted that it makes sense that providers and patients with Iora Health are feeling the workforce changes more acutely than those who are with One Medical.

"Iora is feeling a more holistic change to their business and operating model," Roller said. In comparison, "One Medical is experiencing changes to make their business more efficient and more connected to the broader Amazon enterprise."

Overall, "change is a natural byproduct of acquisition, as any owner seeks to reap the benefits of scale," Roller said. "Unfortunately, in the physician practice sector, I too often see acquiring entities underrepresenting the amount of change they will expect from the practices they acquire — and not just when the acquirer is a corporation." After an acquisition, organizations should be upfront about the tradeoffs practices and providers will need to make or they'll risk disengagement and ultimately turnover, she said. (O'Donovan, Washington Post, 2/28)

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