Has Amazon lost its ‘edge’ in healthcare? Or finally seeing reality?

December 1, 2023 | by | No Comments

Amazon’s long and winding road to Healthcare Reality is no surprise to those tracking Amazon’s moves over the past few years. And Bloomberg agrees. In the eyes of many of the industry, Amazon was one of the top companies revolutionizing healthcare in a consumer-focused, tech-driven model. They were making The Big Moves along with giants CVS and Walgreens with an open wallet, with Walmart lagging and tagging behind. But when you turn a Gimlet Eye to the track record, The Big Moves were marked by hubris, uncertainty, lack of focus, lack of healthcare expertise, and just plain bad judgment.

  • First, there was the sinkhole known eventually as Haven, 2018-2021. This partnership with JP Morgan and Berkshire Hathaway (RIP to the legendary Charlie Munger) generated truckloads of 50,000-foot quotes by JPM’s Jamie Dimon and B-H’s Warren Buffett about the ‘hungry tapeworm’ of healthcare costs and the need to simplify it for their million-odd employees. It was clear that Amazon was relegated to the ‘junior partner’. Their reaction was to go their own way well before the shutdown and make its own acquisitions, acquiring PillPack in mid-2019 as the first move towards a PBM, Amazon Pharmacy, then pushing Amazon Care for large employers. TTA 6 Jan 2021
  • Then there was the brief and mysterious life of Amazon Care, 2019-2022. Their mix of virtual care, in-home, and telehealth services, signing up large employers such as Hilton and (of course) Amazon with the eventual vision of delivering in-home care of visits and medications via mobile providers. Despite pivoting behind the scrim but eventually going nationwide with some, not all, of their services, their vision wasn’t attractive to most large employers. Even before One Medical was acquired in July 2022, Amazon decided to ditch Care by end of 2022. TTA 25 Aug 2022
  • And $3.9 billion later, there is One Medical, acquired earlier this year. It has never made money and it doesn’t resemble an Amazon-style delivery model either. It’s a practice group with individual paying members plus 9,000 corporate service contracts and telehealth. Of course, it’s being offered to the millions of Amazon Prime members at a drastically discounted rate starting earlier this month.
  • Bubbling under this is Amazon Clinic, an asynchronous virtual consult service leaked in November 2022, formally announced in June 2023 but delayed until August on data privacy issues that attracted Senatorial scrutiny on whether information could be used by other Amazon services [TTA 27 June]. Visits cost an average of $50. Amazon is surprisingly mum on Clinic’s status.

From the collection of articles linked above, plus TTA’s ongoing chronicle of FTC’s (and DOJ’s) consistent scrutiny (some call it vendetta) re Amazon [TTA 24 Aug, 27 Oct], one cannot conclude that Amazon has lived up to its publicity as a Healthcare Transformer. In that last article, this Editor’s doubts were summarized as “What we view as a juggernaut is facing more than their share of distractions and changing circumstance.”

It is awfully nice to know that Bloomberg has taken our small ball of misgivings and run with it. Their article describes, through interviews with current and former employees, patients, competitors, and industry analysts, a culture of hubris, believing that “Silicon Valley-style invention could outsmart industry incumbents” and not listening to the industry people they did hire. The hubris goes back to the very beginning. Even transitioning a company like PillPack that fit easily into the Amazon model took an inordinate amount of time. Amazon Pharmacy, built on the PillPack bones, doesn’t seem to be meeting expectations, running headlong into local retailers such as CVS, Walmart, and Walgreens, discounters such as GoodRx, and deliverers such as Mark Cuban Cost Plus. Wall Street doesn’t like it much either, despite the promises from CEO Andy Jassy that healthcare is their long-term growth area, carrying through the vision of former CEO and now chairman Jeff Bezos. It also doesn’t help to be the target of the FTC, not mentioned in the Bloomberg article.

TTA’s Hello to Fall 8: Walgreens’ 2nd corporate quake, Amazon Prime deep discounts One Medical, Owlet’s Dream Sock clears FDA, Best Buy-Mass General partner, healthcare VR revives, more!

November 10, 2023 | by

 

 

Our lead and breaking story is about more corporate shakeups at Walgreens, starting in the suites. There’s better news at Owlet, Best Buy, Envision, Walmart, and Philips. VR looks like its day in healthcare may finally come. And Amazon bites a bullet and deep discounts One Medical virtual services for Prime members. (But what if they actually use it?)

Breaking: Walgreens lays off 5% of corporate staff; chief medical officer, chief of staff for CEO to depart (The quake shakes the suites)
Short takes: Owlet Dream Sock FDA clearance; Best Buy-Mass General partner for at-home care; Amazon offers Prime members deeper One Medical discount (Need to pay off that $3.9 billion!)
Get your goggles on! Augmented and virtual reality finally taking off, from alleviating child pain to astronaut mental health (‘Bout time)
Early news roundup: Envision exits Ch. 11, splits; Walgreens’ new CIO; Philips’ $60M from Gates Foundation; more on Walmart-Orlando Health partnership; Cigna may sell MA business

A jam-packed week kicks off November with major payer and Amwell Q3 earnings. We catch up on Oracle Cerner and VA news, including a dubious AI effort. Some end-of-year signs of life with sales, financings, and partnerships. But sadly more layoffs (Centene, Carbon Health) and foldings (OliveAI). And once again, DOJ says it’s out to make M&A difficult.

Week-end short takes: payer earnings for Centene, Cigna, Humana; Centene and Walmart partner in FL; Dispatch Health and US Acute Care partner; Amwell widens loss; ProMedica $710M home health sale; AQuity’s $200M sale to IKS Health (Not beer and skittles for payers)
This ‘n’ that: HHS settles *2017* ransomware breach, Carbon Health lays off 114 in restructuring, why oh why VC General Catalyst wants a $3B health system, when Larry Met Billy, a lexicon of workplace terms
Catching up on Oracle Cerner and the VA, plus the AI ‘tech sprint’ (More distractions for the VA)
Olive AI selling rest of business to Waystar Health and Humata Health, winding down: reports (Another unicorn minus a horn)
News roundup: Walgreens & CVS pharmacy staff 3 day walkout, DOJ ramping up healthcare acquisition scrutiny, Cantata Health sold to TT Capital, Lancashire County Council chooses Progress Lifeline for TECS (UK) (On DOJ and M&A, we told you so!)
UHG’s Optum UK closes £1.24B buy of EMIS Group (One year later)

A busy week with some signs of life–and the first IPO in a year–in healthcare/tech funding. But others run out of money runway as year’s end approaches. Teladoc’s 2023 far better than their disastrous 2022–why stock doesn’t reflect it. Apple Watch violates patents again according to ITC. And can prescribed apps win in the UK?

Weekend reading: new study finds lack of GP and healthcare access driving 55% of UK patients to online/apps, desire for prescribed apps (Maybe now’s the time in the UK)
Breaking: ITC bans Apple Watch imports on violating Masimo blood oxygen measuring patents (updated) (David v. Goliath Redux)
Teladoc narrows loss in Q3 and YTD, grows revenue, adjusted profits…but stock sinks (Time to change direction again)
News roundup: Waystar’s $8B IPO plan, Perficient to buy SMEDIX, PicnicHealth buys AllStripes, MDLIVE buys Bright.md, Sage garners $15M, Cureatr shuts suddenly, Calibrate reorganizes, BetterUp lays off 16% (updated)

Big changes and losses roil the retail healthcare side through to primary care. Big reorganizations, closings, layoffs at Walgreens, VillageMD, and CVS Health. Rite Aid goes Chapter 11 to deal with litigation and losses. One Medical’s Iora Health finally rebrands in moving under Amazon.

Turmoil smacks retail healthcare (updated): Walgreens to shut 60 VillageMDs, as Village names 3 new presidents; CVS shakeup continues; Rite Aid bankrupt; Amazon’s One Medical rebrands Iora (Seems like the projections were more than a little off)

A busy HLTH brings news and a lot of resetting, notably Walgreens’. Big Investor General Catalyst gets into the ‘health assurance’ business (sigh) and merges two portfolio companies. Big Funding for rural health. Cano Health scrambles to survive, Babylon UK transitions but Rwanda shuts. And DEA kicks the controlled substances telehealth prescribing can down the 2024 road.

Short takes: follow up on Cano Health’s survival moves, eMed transitioning Babylon Health UK but Babyl Rwanda shuts, DEA extends telehealth prescribing for controlled substances thru 2024 (Closing chapters)
Walgreens’ transformation continues: new CEO enters, CIO exits, launches Virtual Healthcare in 9 states (The tap dance accelerates)
Two studies: telehealth’s ‘generation gap’ and $22B target for healthcare generative AI–by 2032
Funding/new business roundup: General Catalyst’s HATco ‘health assurance’ venture and $6B portfolio merger, Brightside Health expands, Diana Health’s $34M, Headway’s $125M, Main Street Health’s $315M (Back to ‘transforming healthcare’)

The EMIS acquisition cleared the CMA in the UK. Rock Health tries to put the best face on Q3’s US digital health funding doldrums.

Rock Health Q3 funding roundup: shrinking to fit ‘the new normal’ = the doldrums (Nothing mighty about being stuck in the horse latitudes)
CMA clears £1.2B EMIS acquisition by UnitedHealth Group’s Optum (UK) (It took a year, but UHG nabs the UK GP EHR leader)

It’s feeling like autumn in endings and change. Cano Health is being parted out like an old unrestorable car. Veradigm’s Nasdaq troubles accelerate with delisting and UpHealth is another cracked SPAC. Yet there is encouraging fresh growth with one big merger in employer wellness benefits and two fundings in women’s midlife health and home-based acute care.

News roundup: Veradigm facing Nasdaq delisting, UpHealth files Chapter 11, Virgin Pulse-HealthComp $3B merger, MidiHealth’s $25M Series A, Inbound Health’s $30M Series B (Veradigm still hasn’t figured out a financial software problem after 6 months?)
Cano Health’s dismemberment: Texas, Nevada primary care centers sold to Humana’s CenterWell for $66.7M, more to come (Parting out the old car)

Catching up on industry fundings and pivots, ATA, Walgreens at a crossroads, and the controversies surrounding DocGo in New York.

Short takes: Intuition Robotics gains $25M funding, Akili Interactive abandons digital Rx therapeutics, NextGen goes private for $1.8B, ATA’s DC advocacy ‘fly in’ + launches new tools on disparities
Walgreens trying to reboot “healthcare transformation” momentum, looking for new CEO, settling with Theranos litigants (The high cost of an industry race)
Could DocGo be another Babylon Health or Theranos? CEO resignation may be only the start of their troubles. (NYC/NYS controversy that may forecast further problems)

Following up on Babylon’s bankruptcy and administration, was it simply another Theranos? The fate of the GP at Hand (UK) service seems to be separate from Babylon. 

Echoes of Theranos in Babylon Health? And additional information on GP at Hand.
Babylon Health UK in administration, assets sold to eMed Healthcare Ltd.

Best of back posts!

Short takes: FTC’s Lina Khan’s vendetta on tech, employers disillusioned with virtual care, telepsychiatry cuts LOS and inpatient ED, Lotte’s AI-assisted telepsych diagnostics, ThymeCare’s $60M Series B (Why Cassandra is warning you!)

Weekend reading: Forbes picks the next $1B startups, is TV streaming analogous to the future of healthcare? (Yes, there may be unicorns, and the fracturing of TV and healthcare)

Babylon Health files for US Chapter 7 bankruptcy, winding down Babyl Rwanda and ending care for 2.8 million users (Hull loss for Babylon. Parting out starts 12 Sept)
 

M&A and FTC/DOJ antitrust changes

Healthcare M&A hit a 3 year low in Q2 2023, to the surprise of none: KPMG (Many reasons why-and we add a few observations)

FTC, HHS OCR scrutiny tightens on third-party ad trackers, sends letter to 130 hospitals and telehealth providers

Another antitrust shoe drops: FTC, DOJ publish Draft Merger Guidelines for comment–what are the effects? (New restrictions not good for founders, managers, VCs)

FTC, DOJ float enhanced information requirements for HSR premerger notification filing process–what will be M&A effects? (More dampers on a down market?)

Insurtechs and their pivots

Living to fight another day: insurtechs Bright Health, Clover Health, and Oscar Health report improved Q2s, H1s (updated) (Bright still at brink, but Clover and Oscar pivoting)

Legal roundup: Dorsata sues athenahealth, provider group on trade secret theft, Nevada terms Friday Health Plans (Dorsata as another ‘David’)

Why the ‘insurtechs’ didn’t revolutionize health insurance–and the damage they may have done (Back to the legacy payers)
Bright Health to exit insurance business, selling California plans to Molina for up to $600 million–contingent on surviving to 2024 (A dicey proposition all round)

Funding for telehealth and digital health
Rock Health’s first half funding roundup adjusts the bath temperature to tepid, the bubbles to flat (2020-22 an aberration)

“Hope is not a business model”–advice from two VCs, with a bit more advice on basic banking (We unpack good advice for early-stage companies)

‘Warning flare’ study: will pandemic-induced digital health solutions get renewed by hospitals in 2023-4, or will they churn? (Get cracking with your account relationships)

Watch your cash burn! Now 31 months average for startups between Series A and B. Now what do you do? (Cautionary advice for startups)

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Short takes: Owlet Dream Sock FDA clearance; Best Buy-Mass General partner for at-home care; Amazon offers Prime members deeper One Medical discount

November 10, 2023 | by

Some really good news for Owlet. The Dream Sock finally got to the mountain top and received de novo FDA clearance for pulse oximetry. To date, it is the only over-the-counter medical pulse oximetry device for the baby market. This adds to the device’s Baby’s Live Health Readings, including pulse rate and oxygen saturation level. The platform also provides Health Notifications, which send alerts to a smartphone with lights and alarm sounds if baby’s readings fall outside of preset ranges. Existing and new Dream Sock buyers will be upgraded to the new features by end of 2023. The Dream Sock is for use with infants 1-18 months and 6 to 30 pounds. Pricing observed for the current Dream Sock is in the $300 range. Owlet release

This follows FDA clearance for the prescription BabySat in June [TTA 21 June]. That is scheduled to be introduced later this year in the US only. The non-prescription Dream Duo, which combines the Dream Sock with a baby cam, will continue to be sold. 

Financially, things have improved a lot since last year. The stock as of 11 July was restored to NYSE listing, but it required a reverse split and an 18 month compliance plan, Currently, it’s trading at about $4.80 which is NYSE compliant, up from well below $1 in June. Also in July, they hired a new president and chief revenue officer, Jonathan Harris, from recently acquired air purification system Molekule. In August, they reported a Q2 adjusted EBITDA loss of $4.3 million, narrowed substantially from prior year Q2’s $16.7 million. This was achieved on lower revenue of $13.1 million versus last year’s $18.3 million. Q1 revenue was $10.7 million. Q3 will be reported on 13 November. Release  Having followed them since the ‘telehealth for the bassinet set’ days of 2012-2013, their continued independence, and their focus on baby health, this Editor continues to wish them bonne chance.

Mass General Brigham’s hospital-to-home and home care programs get a Best Buy boost. Mass General plans to integrate Best Buy’s delivery capabilities for their Healthcare at Home program in several areas. For Home Hospital acute care, Best Buy will supply the Current Health remote patient monitoring program to build out a technology-enabled clinical delivery model that connects patients to nurses, paramedics, advanced practitioners, and physicians. For Home Care, Best Buy will supply Lively Mobile Plus personal emergency response system (PERS) and leverage out capabilities such as Geek Squad to supply Mass General Brigham (MGB) patients with delivery of home-based care and logistics management for the care team. MGB plans to introduce Best Buy as part of Home Hospital in five Boston-area acute care hospitals. The program is for patients with heart disease, chronic obstructive pulmonary disease (COPD) and infections. While their Home Care operation is stated by MGB to be the largest certified provider in New England, the Home Hospital program can presently cover only 33 patients at a time. MGB’s goal is to shift 10% of inpatient care to patients’ homes over the next five years, so expanding capacity and capabilities are critical. FierceHealthcare, Mobihealthnews, MGB release

Get your One Medical now, just $99 per year or $9 a month! It’s an offer hard to refuse for Amazon Prime members. It’s half off the annual membership of $199, with additional members up to five for only $6 a month or $66 annually. What Prime members get is 24/7 virtual care access without further charge through their app that includes video chats with licensed providers plus their “Treat Me Now” service, fast care for common issues like cold and flu, skin issues, allergies, and urinary tract infections. It does not include any One Medical in-office services, if available in the member’s area. The 200 million+ Prime members were briefly offered in February a $144 membership but apparently this new incentive is not only at a deeper discount, but also longer term or permanent.

Time to make that $3.9 billion acquisition pay off. This push is clearly to build up One Medical membership, which stood at only 836,000 members at end of 2022, and build up cash flow. Amazon is not reporting on the success of the earlier discount offer. A question this Editor has–if 1 million Prime members signed up–that’s only a 0.5% rate–does One Medical have the telehealth capacity to serve these patients, especially at peak usage such as cold and flu season?

Prime members are also able to access Amazon Care, which is virtual only, cash-only by medical event asynchronous telehealth services. If a Prime member goes in person to a One Medical practice, they do take insurance. FierceHealthcare, Healthcare Dive, Amazon Prime offer page

Yes, Virginia, there is an Amazon Clinic, after all; stripped down, non-face-to-face consults for common conditions

November 16, 2022 | by

On the move while Care is shutting down and OneMedical is not yet onboard as awaiting Federal approvals, Amazon Clinic’s premature leak generated press for the service’s formal debut on Tuesday. The leak was remarkably accurate [TTA 11 Nov] in describing it for the New York Minute it was up. According to their introductory blog, Amazon Clinic will operate in 32 US states (not specified, but a quick check indicates it’s not available in Alaska and New Hampshire). It provides message-based virtual care for more than 20 common health conditions, such as allergies, acne, eczema, UTIs, and hair loss. (The website lists conditions covered and prescription renewals for previously diagnosed conditions such as asthma, hypothyroidism, high cholesterol, and migraine.)

What it is: a stripped-down, questionnaire-driven provider referral platform, enabling a non-face-to-face telehealth consult or prescription renewal. It’s not clear from available information whether the messaging is synchronous, asynchronous (delayed), or a combination of both. This certainly sounds less ambitious than the home-based delivery/enterprise membership model of Amazon Care. How Clinic works:

  • Select your condition
  • Pick your preferred provider from a list of licensed and qualified telehealth providers. Costs and if available in your state are disclosed in the selection process.
  • Complete intake questionnaire
  • Connect with clinician through a secure message-based portal
  • After the message-based consultation, the clinician sends a personalized treatment plan via the portal, including any necessary prescriptions to the customer’s preferred pharmacy including Amazon Pharmacy. Here, costs may be covered by insurance.

As Care was, payment is upfront as Amazon doesn’t accept insurance. The cost of consultations will vary by provider and condition but tend to be in the $40 – 50 range. This includes ongoing follow-up messages with the clinician for up to two weeks after the initial consultation. Some conditions, such as rosacea, require a prior diagnosis.

In addition, the services provided are available only to those aged 18-64, which strikes this Editor as discriminatory for those 65 and over who can well pay cash and might prefer a ‘visit lite’.

No mention of whether those laid off at Amazon Care or through the rest of Amazon (10,000 announced) can apply for jobs with this new service; it sounds largely referral, highly automated, manageable, and not requiring heavy oversight. The last can be a problem all its own. TechCrunch, Mobihealthnews, CNBC

Short takes: Will there be an Amazon Clinic?, Transcarent and Teladoc, perfect together?, Get Well partners with Palomar Health, expands with Veterans Health Administration

November 11, 2022 | by | 1 Comment

Did Amazon prematurely leak an initiative? Or was it an error? The Verge reports that a video was uploaded to Amazon’s YouTube page on Tuesday–then taken down–describing a new service that would offer assessment, diagnosis, and treatment of common conditions such as allergies. The Amazon Clinic video depicts a user taking an online questionnaire about their symptoms, After paying a fee, a clinician reviews it, diagnoses, and prescribes as needed, sending to the patient’s pharmacy. The disclaimer: “Telehealth services are offered by third-party healthcare provider groups.” The video directs to amazon.com/clinic which is not live. Another Amazon Mystery. Amazon Care is shuttering and the company is jumping through Federal hoops to get approval to close their buy on OneMedical. Hat tip to HISTalk today.

HISTalk also pointed to a Forbes article on health navigator companies such as Castlight and Firefly Health, with a bit of a ‘sting’ at the end. Transcarent, a health navigator that takes on risk integrating its services into employee benefits, is the latest enterprise founded by Glen Tullman, a serial entrepreneur who founded Livongo, investor group 7Wire Ventures, and built up Allscripts as CEO. The writer speculates that Tullman should buy Teladoc to give Transcarent a distribution system–a built-in network of physicians and health system relationships. Yes, this is the same Teladoc that Tullman sold Livongo to for a tidy $18.5 billion, then earlier this year wrote off $6.6 billion as an impairment. This one drips with irony. With its stock down nearly 90% from its January 2021 high, it’s never been cheaper!

Get Well, an RPM, patient care management, and workflow automation company, announced new and expanding partnerships. The new one is with Palomar Health, a health system in Escondido, California. This will implement Get Well services in four phases in five areas to improve patient experience: digital care management (GetWellLoop), inpatient experience (Get Well Navigator and a workflow automation for hospital staff), emergency department experience, care gap closure, and health equity through additional features. Becker’s  The second is an expansion with the Veterans Health Administration (VHA) into 70 Veterans Affairs Medical Centers (VAMC) and a fifth Veterans Integrated Service Network (VISN) with nine facilities. They also now have a FedRAMP “In Process” designation for cloud services which is enabling expansion of GetWellLoop care plans with a VAMC. Release (Business Wire)

News briefs, catchup edition: UnitedHealth/Change decision October?, CVS wins $8B Signify Health auction, Walgreens majority buy of CareCentrix, FTC requests more info on Amazon-One Medical

September 15, 2022 | by

Your Editor is semi-returned from Almost Two Weeks in Another Town, with a few more days to close out September (and summer into autumn) coming up. A lot of big news broke despite the usually slow Labor Day holiday week.

UnitedHealthcare Group/Change Healthcare Federal lawsuit to be decided in October–reports. The bench trial in the US District Court in Washington DC pitted the Department of Justice and state plaintiffs against UHG’s massive $13 billion acquisition of claims and EDI/data processing giant Change. It concluded 16 August with closing arguments presented 8 September. Dealreporter via Seeking Alpha reported that UHG and Change effectively countered DOJ’s antitrust objections to the acquisition. Change Healthcare had previously sold their claims editing business to TPG Capital to ease antitrust concerns.  Whether that will be enough in the current environment with greater sensitivities around healthcare consolidation remains to be seen. If approved, Change will be folded into OptumInsight. For a deeper dive into the issues, see TTA’s earlier reporting 3 August and 23 March.

CVS Health beat out other contenders with an $8 billion cash bid for Signify Health. It was a busy Labor Day for CVS as Signify’s board met and decided that day on CVS’ cash offer of $30.50 per share in their unusual auction. Amazon, UnitedHealth Group, and little-known Option Care Health were the other bidders. Signify is a strategic boost for CVS in becoming a major player in primary care, provider enablement, and home health as we’ve summarized here from CVS’ Q2 earnings call. Signify’s capabilities in in-home health delivery and provider services were cheaper to buy than to develop. Based on the weight given to it in the CVS release, Signify’s Caravan Health and their Medicare ACOs furnishing value-based care management services to 170 providers was a significant factor in the top price paid.

New Mountain Capital and their investors own 60% of Signify and will be exiting. Signify had in July announced their own exit from the costly and problematic Episodes of Care/BPCI business acquired with Remedy Partners back in 2019. This led to most of the over 480 staff layoffs announced last month. The sale is, as usual, pending regulatory approvals and isn’t expected to close until first half 2023. Kyle Armbrester, Signify’s CEO Kyle Armbrester will continue to lead the company as part of CVS Health. Healthcare Finance, FierceHealthcare

Rival Walgreens Boots Alliance completed their acquisition of a majority share of home care coordination platform CareCentrix. Walgreens’ final payment was $330 million for 55% of the company at an $800 million valuation. As noted previously, Walgreens ‘go big or go home’ strategy in primary care kicked off in 2020 with growing investments in VillageMD, culminating in last year’s $5.2 billion for 63% of the company. The plan is to co-locate Village Medical offices with 600 Walgreens locations by 2025 [TTA 14 Oct 2021]. CVS’ recent actions can be seen as a reaction to Walgreens’ aggressive moves. Healthcare Finance

Amazon now under FTC scrutiny for One Medical acquisition. If shutting down the much-publicized Amazon Care wasn’t quite enough last month, the Federal Trade Commission (FTC) will be reviewing Amazon’s $3.9 billion buy of One Medical. This was announced in a 1Life Healthcare (parent of One Medical) 8-K filing with the Securities and Exchange Commission (SEC). Both 1Life and Amazon received requests for additional information on 2 September, above and beyond the usual required Hart-Scott-Rodino Act (HSR) reports that will be reviewed by the FTC and DOJ. Effectively it extends the HSR waiting period by 30 days after One Medical and Amazon have substantially complied with the additional information ‘second request’.

The FTC isn’t winning popularity contests with Amazon’s legal department, as the agency is reviewing their acquisition of iRobot, maker of robot vacuum cleaners. Mobihealthnews

Breaking: Amazon Care shutting down after three years–what’s next? (updated)

August 25, 2022 | by

Amazon Care to cease operations after 31 December. Amazon Health Services is throwing in the towel on its primary care service for enterprise customers, after failing to make much headway with its mix of virtual care, in-home, and telehealth services. An internal email from Neil Lindsay, Amazon Health Services senior vice president, sent today (24 Aug) to employees but leaked to the press, stated that “This decision wasn’t made lightly and only became clear after many months of careful consideration. Although our enrolled members have loved many aspects of Amazon Care, it is not a complete enough offering for the large enterprise customers we have been targeting, and wasn’t going to work long-term.”

Employees who have been part of Amazon Care may have the opportunity to transfer to other parts of Health Services, according to the memo, or will be ‘supported’ in finding other roles within or outside the company. The total number of employees was not disclosed, but this Editor expects layoffs to be announced by the fall as Amazon Care winds down.

Amazon has been moving in a different direction with enterprises for some months. Reportedly the decision was made to ditch Amazon Care prior to agreeing to acquire One Medical, which was announced late in July. However, recently revealed negotiations actually started last February, with One Medical pitting Amazon against CVS until CVS dropped its bid effort [TTA 19 August]. 

As this Editor noted last month with the One Medical acquisition, “…for this Editor it is clear that Amazon with One Medical is buying itself into in-person and virtual primary care for the employer market, where it had limited success with its present largely virtual offering, and entreé with commercial plans and MA.” With One Medical, they will be acquiring an operation with 790,000 patients (including 40,000 at-risk, presumably Iora’s), 8,000 company clients, 125 physical offices in 21 US metros (including projected), and an established telehealth/telemedicine protocol. In other words, a ready-made provider and enterprise base to build on and sell into, for instance Amazon products like Pharmacy and PillPack.

Not addressed is what will be done, if anything, to transition current employer agreements for Amazon Care to One Medical.

It’s now a matter of whether HHS, DOJ, and FTC will agree to the buy or ask for additional divestitures. One conflict–Amazon Care–has just been removed. And this may clear the deck for other acquisitions, such as Signify Health [TTA 24 Aug], if Amazon wins the auction against CVS, UnitedHealth Group, and Option Care Health, though for a newcomer to healthcare Signify may very well be A Bridge Too Far.

What’s in play?

  • One Medical’s Iora Health and its high needs/high costs Medicare patient base. This has very much been held in the background, leading this Editor to think it will be sold to another health plan.
  • The status of the previous agreement with Crossover Health for 115,000 Amazon employees and dependents, delivered through their employer-based onsite clinics in 11 states in addition to concierge care [TTA 17 May]
  • Another previous agreement with Ginger for telemental health, only announced last week.

Amazon was touting Amazon Care as recently as earlier this year to shareholders. They had acquired employers outside Amazon such as Hilton, but not quickly enough. Expansion talk and the usual touting within the industry weren’t happening. There was an ‘air of mystery’ about what Amazon Care was doing, going back to the beginning.

Perhaps a major ‘tell’ was that Kristen Helton, general manager in charge of Amazon Care, was reported two weeks ago by Bloomberg News to be taking an “extended break to spend the summer with her family.” She had been in the GM position for three years after joining Amazon in 2015.

Count Amazon Care as one expensive learning course in the insanely costly University of Healthcare Delivery. This won’t be the first lesson, but Amazon can afford the tuition.

Geek Wire, FierceHealthcare, 

Wednesday roundup: Amazon Care now (actually) nationwide, Australia’s Eucalyptus telehealth’s A$60M, Withings 2 buys, Glooko buys xbird, HoloLens for nurse-GP comms in Cumbria

February 9, 2022 | by

Amazon Care, which has compiled a history of playing their news quite close to the vest, coyly dropped another hankie on their website today with a blog post that confirmed that their virtual care platform is now available nationwide. In 2022 they will be adding in-person services to 20 more cities, including San Francisco, Miami, Chicago, and New York City. Companies offering Amazon Care as an employee benefit include Silicon Labs, TrueBlue, and Whole Foods Market (an Amazon company). Back in October, TTA outlined our thoughts on Amazon Care’s structure, offerings, cheap pricing, and our opinion that Amazon’s real aim is to accumulate and own national healthcare data on the service’s users. Then they will monetize it by selling it to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. Patients may want to think twice.

On a lighter note, Australia’s Eucalyptus telehealth scored a tidy Series C of A$60 million ($42 million), led by Airbnb and Canva’s early investor, BOND, plus previous investors. Eucalyptus’ telehealth platform markets five services: men’s health-focused Pilot, women’s fertility brand Kin, skincare site Software, sexual health business Normal, and menopause service Juniper. The fresh funds will go towards software development and expanding into the UK. Mobihealthnews

Withings is also on a bit of an acquisition tear, buying Berlin-based nutrition app 8fit on top of last month’s Impeto Medical, which developed a tool for monitoring peripheral neuropathies. 8fit offers efficient workouts, customized meal plans, and self-care
guidance in six languages. While the acquisition cost was not disclosed in the release, Withings plans to invest $30 million to integrate 8fit features into their products. Impeto, a R&D company, developed an FDA cleared technology that measures the ability of sweat glands to release chloride ions in response to electrical stimulus. For those with neuropathy, that sweat gland innervation is reduced and sudomotor function is impaired. Impeto’s tool has already been integrated into Withings’ smart scale, the Body Scan, to be released in the second half of 2022 after FDA clearance. Release, Mobihealthnews

Another Berlin-based company in AI that’s been acquired is xbird. The buyer is Glooko, a diabetes and chronic condition monitoring platform. xbird captures data generated by devices and processes it through algorithms and machine learning models, and will expand expands Glooko’s advanced analytics capabilities and tools. The management and staff will join Glooko GmbH. Glooko release

Closing our update is a Cumbria catchup. Nurses at Kendal Care Home are wearing Microsoft’s mixed-reality HoloLens 2 headset to call GPs through Microsoft Teams. Using the HoloLens, doctors can talk to both the nurses and patients. Kendal Care Home has been working with local GPs, Kendal Integrated Care Community, and University Hospitals of Morecambe Bay NHS Foundation Trust to train staff in the use of the headset, which started use at Kendal in October 2020 and has largely replaced their tablets and smartphones for telehealth consults. In addition to Kendal, the Heart Centre at Alder Hey and Imperial College Healthcare NHS Trust used HoloLens 2 during the pandemic. DigitalHealth.net

News and deal roundup: Amazon Care lands Hilton, Lightbeam buys CareSignal RPM; aptihealth’s $50M, MedArrive’s $25M, Ribbon Health’s $43.5M

November 19, 2021 | by

Amazon Care nabs a big one in Hilton Hotels (US). Hilton Worldwide Holdings Inc. will now offer Amazon Care to its US employees on a corporate health plan starting in 2022.  Text chats will be free, with virtual or home visits with providers available for a small fee. Availability will depend on where the employee is. Care Medical will provide national virtual visits, while house calls are in limited metro areas: greater Seattle and the Washington-Baltimore metro area at present, with expansion plans to Los Angeles, Chicago, Dallas, Philadelphia, and Boston. Hilton is only the second company (after Precor) disclosed by Amazon. At the end of 2020, Hilton had 141,000 employees, but that includes worldwide properties so the US number remains in Amazon style–opaque. Amazon’s Kristen Helton announced it at Reuters Total Health on Monday. FierceHealthcare

Lightbeam Health buys CareSignal. Lightbeam, a population health analytics and management platform, closed its acquisition of CareSignal, a ‘deviceless’ remote patient monitoring (RPM) system that uses phones for patient reporting via SMS and (hold your beer or wine!) interactive voice response (IVR). CareSignal adds direct RPM reporting data for chronic conditions, behavioral health, social determinants of health, maternal health, and additional monitoring to the Lightbeam platform used by ACOs, payers, provider groups, health systems, and other healthcare organizations. Financial and organizational terms were not disclosed. Lightbeam’s backers are Hearst Health Ventures and 7wire Ventures through a Series A and undisclosed venture round five years ago (!), with CareSignal barely out of seed with $7.5 million invested. Release

And Series A and B raises continue… 

Behavioral health tech continues to attract substantial investment. Boston-based aptihealth’s (not a typo) $50 million Series B will be expanding its clinical science, technology, and services for higher acuity behavioral health conditions. Funding was from Takeda Digital Ventures, Pivotal Life Sciences, Vista Credit Partners, Olive Tree Ventures, Claritas Capital, and What If Ventures for total funding of $65 million. aptihealth coordinates patient access to care teams from any point of care. The company has signed 27 health plans, health systems, and physician practice customers to date. Release. 

MedArrive’s $25 million Series A continues home care’s hot streak. Section 32 led the round with participation from new investors, 7wireVentures and Leaps by Bayer, and existing investors Define Ventures, Kleiner Perkins, and Redesign Health. MedArrive connects telehealth from payers and providers to a network of EMTs, paramedics, and other skilled healthcare workers for hands-on care. The New York-based company currently operates in California, Florida, New Jersey, North Carolina, and Texas, partnering with SCAN Health Plan, Clover Health, Bright HealthCare, Molina Healthcare as well as ACOs and government entities such as the LA Department of Health. Release, FierceHealthcare  Hat tip to HISTalk for this and aptihealth

Ribbon Health’s Series B funding of $43.5 million will be used to further develop team expansion and technology investments around their API layer, using data on doctors, insurance plans, costs, and quality of care for predictive care decisions. The raise was led by General Catalyst, with participation from Andreessen Horowitz (a16z), BoxGroup, Rock Health, and Sachin Jain. Since 2016, the company has raised $53.8 million. Release, FierceHealthcare

Amazon Care confirms five more cities, beefs up DC lobbying–but what’s the real game?

October 22, 2021 | by

Amazon Care will be expanding in 2021, confirming five new locations–and maybe more. Kristen Helton, the director of Amazon Care, confirmed at HLTH21 that 2021 rollouts of the virtual + mobile care service would include Dallas, Chicago, Philadelphia, Boston, and Los Angeles, ‘to name a few’. Ms. Helton confirmed that Washington DC and Baltimore region are live. The website does not state active cities, only permitting a zip code search and confirmation. Pharmacy delivery is also available in select, but not stated, areas. Healthcare Dive

Amazon Care originated with Amazon employees as a telehealth service, with in-person available to employees in the Seattle area. By March, they opened the full service (Video and Mobile Care Medical) to other Washington state companies. At that time, they announced that Video Care will be available nationally to companies and all Amazon employees by the summer–and claimed that in-person services would be rolled out to multiple cities by the summer. That did not happen. 

In June, at a Wall Street Journal Tech Health event, while being coy about the rollout, Amazon Care VP Babak Parviz said that the service would look like:

  • Clinician chat/video connected within 60 seconds
  • If an in-person visit is required, a mobile clinician arrives within 60 minutes, who can perform some diagnostic tests, such as for strep throat, provide vaccinations and draw blood for lab work. For other diagnoses, that clinician is equipped with a kit with devices to monitor vital signs which are live-streamed to remote clinicians.
  • Medication delivery within 120 minutes

Basically, what is not being said is that Amazon has been slow walking Amazon Care, probably wisely. With telehealth visits, mobile care, and pharmacy, there are multiple and complex elements to mesh seamlessly, which is after all Amazon’s Promise. What’s not so seamless is paying for it. While for Amazon it is with immediate payment for service, it is not for the patient–obtaining reimbursement, if available, is left up to the patient–at least for now, as reports indicate they are negotiating with Aetna. Amazon Care is also its own closed network.

There’s also the blunt fact that Amazon is moving into territory well staked out by major players that integrate employers, insurance, primary care, and pharmacy: Teladoc, Amwell, Included Health (Grand Rounds + Doctor On Demand), MD Live. They are now joined by UnitedHealth Care’s announcement a few days ago of NavigateNOW, a new virtual-first commercial plan rolling out next month to employers in nine markets and 25 markets by end of 2022. It offers 24/7 primary care, urgent care, and behavioral health care services through Optum as well as UnitedHealthcare’s national provider network. Many services and medications will have $0 copayments. Healthcare Dive, FierceHealthcare

However, if the cost of Washington lobbying is any indicator, Amazon is blasting off in healthcare. According to a report in OpenSecrets.org, “Amazon, which is creating its own health care service, is the biggest corporate lobbying spender so far in 2021. The company has spent nearly $10.2 million on lobbying in the first six months of the year, and spent $18.7 million in 2020.” The (unfortunately paywalled) report in STAT confirms the hire of Claire Winiarek from PCMA to be their new director of health policy.

This Editor’s opinion remains as in June–that Amazon’s business plans for Care and Pharmacy, and generally in healthcare, are really about accumulating data, not user revenue, and are certainly not altruistic no matter what they say. Amazon will accumulate and own national healthcare data on Amazon Care and Pharmacy users far more valuable than whatever is spent on providing care and services. Amazon will not only use it internally for cross-selling, but can monetize the data to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. That’s a very different game than traditional insurers and the telehealth giants.

What’s next for telehealth? Is it time for a correction?

October 14, 2021 | by

crystal-ballThe boom may be over, between shrinking visit volume and a pileup of providers. Is a correction in the cards? The flood of funding that started in 2020 and has not abated was kicked off by the pandemic and a massive shift to telehealth visits in March/April 2020 from a barely-above-plant-life number in January/February.

Post-pandemic, the shift corrected.

  • The peak of 69% of visits tracked by Epic in April had tailed off to 21% as early as May 2020 [TTA 2 Sept 20].
  • National commercial claims data via FAIR Health was lower. They tracked its peak also in April 2020 at 13%, falling continuously monthly: May to 8.69%, 6.85% in June, 6% in August, and 5.61% in October [TTA 9 Jan].
  • By mid-year 2021, the claims numbers continued to lose altitude: June 4.5%, July 4.2% (FAIR Health monthly report).

Despite the numbers, telehealth companies raised $4.2 billion of a total $15 billion in digital health funding in the first half of 2021, according to Mercom Capital Group, a global communications and research firm. So…what’s the problem with les bon temps rouler?

CB Insights notes the increased specialization of new entrants and, as this Editor has noted previously, the blending and crossing of business lines.

  • Companies like Heal, Dispatch Health, and Amazon Care will send a clinician to your house for a checkup–no running to your urgent care.
  • Kidney disease? Monogram Health. Musculoskeletal pain? Hinge Health. Child with an earache or fever? Tyto Care. Check symptoms first? Babylon Health.
  • Telemental health has gone from cocktail party repellent to the belle of the ball, concentrating on cognitive remote therapies. For the past year, it moved to more than half of all telehealth claims, with currently over 60% of procedure codes–and it’s consolidating. AbleTo was bought by Optum, Ginger bought by Headspace, SilverCloud by Amwell.

So for the Major League–Teladoc, Amwell, Doctor on Demand, Grand Rounds, and MDLive–what does this mean? If this interview with Teladoc’s CIO is an example, they plan to segue to a ‘hybrid’ model of virtual quick response plus integrating providers into a continuing care model with patients, creating a relationship with history and familiarity. A model that’s very much dependent on IT, analytics, and connecting with willing providers. But in this free-floating sea of verbiage, it didn’t come into misty focus till the very end, when he mentions Primary360 [TTA 7 Oct] and a virtual primary care team. (And let’s not forget Babylon360 along similar lines.) He finally sketches a view of all the connections to conditions coming together on a very far horizon. 

One can say it’s a cloudy crystal ball, indeed. FierceHealthcare, HealthcareITNews (Teladoc CIO interview)

Is healthcare too much for Big Tech’s Google and Apple? Look at the track record. And David Feinberg’s $34M Cerner package.

August 24, 2021 | by

With Google scattering Google Health to the four winds of the organization--the heck with what employees recruited for Health think of being reorg’d to, say, Maps or YouTube and falling through the corporate rabbit hole–more detail has leaked of Apple’s struggles. This time, on the scaleback list (a/k/a chopping block) is Health Habit. It’s an app in the Apple Store that connects users with AC Wellness, a doctor’s group in Cupertino, California. The ‘eligible participants’ are restricted to Apple employees. From the app site, they can check weight, nutrition, blood pressure, and schedule wellness checks. It seems to be the typical ‘skunk works’ project that’s not ready for prime time, but its public fate seems to be poorly timed and simultaneously, overblown because they are–well–Apple. 

Bottom line, is healthcare once again proving rather resistant to being leveraged by technological solutions? Those of us who go back to the Stone Age of health tech, or those of us who joined in the Iron and Bronze Ages, remember when you couldn’t get into a conference cocktail party without a “wellness” app. (You say you’re in behavioral and remote patient monitoring for older adults? Oh, look! A squirrel!)

Microsoft was going to dominate consumer health with their HealthVault for personal health records (PHRs). We know how that turned out–dead apps, Fitbit an also-ran bought, Pebble and Misfit going to the drawer of failed toys, Jawbone t-boning plus Intel and Basis written off in 2017, and HealthVault unlamentedly put out with the trash at the end of 2019. Oh yes, there was an earlier Google Health for PHRs, which died with a whimper back in 2012 or so.

The press releases crow about Big Tech’s mastery of complexity, yet going off on their own without partners–or even with partners–never seems to work. In the industry, it makes for a few good articles and the usual rocket launching at places like Forbes, but the pros tend to treat it with a shrug and pull out a competitive plan. Glen Tullman, founder of Livongo who will never have to worry about paying for chateaubriand for two for the next billion years or so, stated the obvious when he said that patients cared about the overall experience, not the tech.

Speaking of experience, Amazon Care promises the best for its employees and enterprise accounts–a one-minute telehealth connection, a mobile clinician if needed within the hour, and drugs at the door in two hours. All with direct pay. This has met with skepticism from telehealth giants like Teladoc and Amwell with established corporate bases. There’s also CVS Health and Walgreens. The Editor has opined that care isn’t Amazon’s game at all–it’s accumulating and owning national healthcare data on Amazon Care and Pharmacy users that is far more valuable than whatever is spent on providing care and services [TTA 16 June]. Will Amazon really be able to pull it off?

Paddy Padmanabhan, the author of Healthcare Digital Transformation, lists a few more reasons It’s Too Hard For Big Tech In Healthcare in his HealthcareITNews article here….

  • Healthcare is a part-time job for Big Tech
  • Big tech firms want to solve the healthcare problem by themselves
  • Selling technology is not the same as selling healthcare services

…but holds out some hope that the initial success of “digital-first and virtual-first providers of healthcare emerging as challengers” will point the way for them.

And speaking of Google Health and former employees, Cerner’s necessary SEC disclosure today of new CEO and president David Feinberg, MD’s compensation package was sure to create some talk in Googleville among his now-scattered team. $34.5 million over the next 15 months is structured as follows:

  • $900,000 base salary
  • a target cash bonus of $1.35 million
  • a one-time cash bonus of $375,000 stock
  • $13.5 million in Cerner’s restricted shares for 2022
  • $3.375 million in stock shares for the fourth quarter of 2021
  • a new hire award of $15 million in restricted stock shares to offset his equity loss with Google. 

Whew! Becker’s HealthIT

Telehealth usage going flat, off by 1/3 and declining: Trilliant Health study

June 30, 2021 | by

Trilliant Health, a healthcare data analytics and advisory shop based in Tennessee, has run some projections on the US healthcare market and telehealth, and they’re not as bright as many of us–and a lot of investors plus Mr. Market–have believed. It opens up on page 4 of the electronic document (also available in PDF) with this ‘downer’–that the largest sector of the largest global economy is overbuilt and unsustainable. Hospitals and health systems have operated for decades that basic economic factors–demand, supply, and yield–don’t apply, and there are more companies competing with them for the consumer healthcare dollar than they realize–with more proliferating every day. 

Sledding through their 160-page report, we turn to our sweet spot, telehealth, and Trilliant is not delivering cheerful news (pages 32-43). 

  • Unsurprisingly, demand for telehealth is tapering off. Based on claims data for face-to-face video visits, excluding Medicare fee-for-service (Original Medicare) and self-pay visits, they peaked above 12 million in April 2020 and, save for a bump up in December 2020-January 2021, steadily declined to about 9 million by March 2021.
  • Teladoc, the leading provider, is projecting that 2021 volume will only represent 4 percent of the US population–a lot more than before, but not growing as it did in 2020.
  • Telehealth’s growth was astronomical on both coasts–California, Massachusetts, Vermont, Oregon–and Hawaii–but relatively lower in middle and Southern America in places like Wyoming, North Dakota, Mississippi, and Iowa. Telehealth usage is declining sharply in that region as well but across the board in all states including California. In fact, Phoenix and Dallas had higher telehealth utilization pre-pandemic than during it.
  • Mental health drove telehealth growth during the pandemic, representing 35 percent of claims, almost four times the next group of categories at 8 percent. The largest group of diagnoses were for anxiety and depression among women 20-49. With the reopening of the US economy and children heading back to school, will this sustain or decline?
  • Women 30-39 are the largest users of telehealth–pre, during, and post-pandemic

Telehealth is not only proliferating, it is going up against now-open urgent care, retail clinics from Walgreens, Walmart, and CVS, plus tech-enabled providers that blend virtual care with home care, such as Amazon with a full rollout of Amazon Care and other employers. The cost of care is also a negative driver. FierceHealthcare analyzes other parts of the report impacting practices, health systems, and hospitals.

 

Disruption or giveaway: Amazon Care signs on employers, but who? Amazon Pharmacy’s 6 months of meds for $6. (updated)

June 16, 2021 | by

Is this disruption, a giveaway, or blue smoke requiring IFR? An Amazon Care VP, Babak Parviz, said at the Wall Street Journal’s Tech Health virtual event that all is well with their rollout of virtual primary care (VPC). Washington state is first, with VPC now available nationally to all Amazon employees as well as companies. However, Mr. Parviz did not disclose the signed-up companies, nor a timetable for when in-person Amazon Care practices will be expanding to Washington, DC, Baltimore, and other cities in the coming months.

Mr. Parviz also provided some details of what Amazon Care would ultimately look like:

  • Clinician chat/video connected within 60 seconds
  • If an in-person visit is required, a mobile clinician arrives within 60 minutes, who can perform some diagnostic tests, such as for strep throat, provide vaccinations and draw blood for lab work. For other diagnoses, that clinician is equipped with a kit with devices to monitor vital signs which are live-streamed to remote clinicians.
  • Medication delivery within 120 minutes

FierceHealthcare

The timing of the Amazon Care rollout has not changed since our coverage of their announcement in March. This Editor noted in that article that Credit Suisse in their overview was underwhelmed by Amazon Care as well as other efforts in the complex and crowded healthcare space. Amazon Care also doesn’t integrate with payers. It’s payment upfront, then the patient files a claim with their insurer.

Existing players are already established in large chunks of what Amazon wants to own.

  • Both Amwell’s Ido Schoenberg [TTA 2 April] and Teladoc’s Jason Gorevic (FierceHealthcare 12 May) have opined that they are way ahead of Amazon both in corporate affiliations and comprehensive solutions. Examples: Amwell’s recently announced upgrade of their clinician platform and adding platforms for in-home hospital-grade care [TTA 29 Apr], Teladoc’s moves into mental health with myStrength [TTA 14 May].
  • Even Walmart is getting into telehealth with their purchase of a small player, MeMD [TTA 8 May].
  • CVS has their MinuteClinics affiliated with leading local health systems, and Walgreens is building out 500 free-standing VillageMD locations [TTA 4 Dec 20]. CVS and Walgreens are also fully integrated with payers and pharmacy benefit management plans (PBM).

Another loss leader is pharmacy. Amazon is also offering to Prime members a pharmacy prescription savings benefit: six-month supplies of select medications for $6. The conditions are that members must pay out-of-pocket (no insurance), they must have the six-month prescription from their provider, and the medication must be both available and eligible on Amazon Pharmacy. Medications included are for high blood pressure, diabetes, and more. The timing is interesting as Walmart also announced a few days earlier a similar program for Walmart+ members. Mobihealthnews.

crystal-ballThis Editor’s opinion is that Amazon’s business plans for both entities and in healthcare are really about accumulating data, not user revenue, and are certainly not altruistic no matter what they say. Amazon will accumulate and own national healthcare data on Amazon Care and Pharmacy users far more valuable than whatever is spent on providing care and services. Amazon will not only use it internally for cross-selling, but can monetize the data to pharmaceutical companies, payers, developers, and other commercial third parties in and ex-US. Shouldn’t privacy advocates be concerned, as this isn’t being disclosed? 

Walmart Health moves into the hot telehealth area with MeMD buy

May 8, 2021 | by

Retail giant Walmart’s health arm, Walmart Health, has agreed to purchase privately held telehealth provider MeMD. MeMD provides telehealth services in primary care, urgent care, women’s/men’s health, and mental health services to both individuals and organizations for their employees. Neither purchase price nor executive leadership transitions were disclosed. The transaction, which requires regulatory approval, is expected to close in the next few months.

The relatively low profile MeMD was founded in 2010 by ER physician and entrepreneur John Shufeldt, MD. The company is headquartered in Scottsdale, Arizona, and offers national coverage for its five million members.

A big move that indicates a strategic wobbliness? Walmart Health’s strategy has been a roller coaster over the past few years. Aggressively starting out of the gate in 2018 with high-profile exec Sean Slovenski leading and plans to open up 1,000 clinics, they retrenched in 2020 with his departure and slowed down the opening of Walmart Health locations. Virtual visits, which are merchandisable in-store and online, signal a different direction that may be easier to scale than brick-and-mortar locations, and have proven their market. Meanwhile, back at the stores, last month Walmart announced a partnership with Ro to put its trendy Roman men’s sexual health and vitamin product lines into 4,600+ Walmart stores starting 1 May. RetailBrew 

Looming in the background, of course, is CVS with their MinuteClinics, Walgreens with 500 free-standing VillageMD locations [TTA 4 Dec 20], and Amazon rolling out Amazon Care nationally. Walmart’s employees have used Doctor on Demand’s services, with the company dropping the visit cost to $4 during the pandemic. With the Grand Rounds merger [TTA 18 Mar], this may have been another reason for Walmart to bring in-house a telehealth provider. Who may be feeling the most heat from Walmart’s and Amazon’s moves? Teladoc and Amwell. Walmart release, Becker’s Hospital Review, Engadget

Weekend reading: the strange reasons why Amwell doesn’t consider Amazon a competitor; ground rules for the uneasy marriage of healthcare and technology

April 2, 2021 | by

Yahoo Finance interviewed co-CEO/founder of Amwell Ido Schoenburg, MD on the company’s 2020 results and forecast for 2021. It makes for interesting but convoluted reading on their growth last year in what is a consolidating field where Amwell was once one of the undisputed two leaders. They now compete against payers acquiring telehealth companies (MDLive going to Optum) and mergers like Doctor on Demand-Grand Rounds that are taking increasing market shares. Then there are specialty providers like SOC Telemed and white-labels like Bluestream Health. However, there are a couple of whoppers in the happy talk of growth for all. Dr. S pegs the current run rate of telehealth visits at 15-20 percent. The best research from Commonwealth Fund (October) and FAIR Health (August) tracked telehealth at 6 percent of in-office visits. Epic Health Research Network measured 21 percent at end of August. [TTA summary here] 

Then there’s the tap dance around Amazon Care. His view is that telehealth companies all need a connective platform but that each competitor brings ‘modular components’ of what they do best. What Amazon excels at is the consumer experience; in his view, that is their contribution to this ‘coalition’ because healthcare doesn’t do that well. There’s a statement at the end which this Editor will leave Readers to puzzle through:  

“And Amazon and others could bring a lot of value to those coalitions, they should not be seen as necessarily competing unless you’re trying to do exactly what they do. And there are some companies, including some telehealth companies, that that’s what they do. They focus on services. They try to sell you a very affordable visit with a short wait time and a good experience. They should be incredibly concerned when someone so sophisticated as Amazon is trying to compete in that turf.”

The last time this Editor looked, none of these companies were non-profit, though nearly all are not profitable.

Gimlet EyeLooking through her Gimlet Eye, Amazon Care is a win-win, even if the whole enterprise loses money. In this view, Amazon accumulates and owns national healthcare data far more valuable than the consumer service, then can do what they want with it, such as cross-analysis against PillPack and OTC medical shopping habits, even books, toys, home supplies, and clothing. Ka-ching!

A ‘bucket of cold water’ article, published in Becker’s Health IT last month, takes a Gimlety view of the shotgun marriage of healthcare and technology. Those of us laboring in those vineyards for the better part of two decades might disagree with the author in part, but we all remember how every new company was going to ‘revolutionize healthcare’. (The over-the-top blatherings of ZocDoc‘s former leadership provide a perfect example.) The post-Theranos/Outcome Health/uBiome world has demonstrated that the Silicon Valley modus operandi of ‘fake it till you make it’ and ‘failing fast and breaking things’, barely ethical in consumer businesses, are totally unethical in healthcare which deals in people’s lives. Then again, healthcare focused on ‘people as patients’ cannot stand either. Stephen K. Klasko, MD, President and CEO, Thomas Jefferson University and Jefferson Health in Pennsylvania, advocates for a change–far more concisely than Dr. Schoenburg. You may want to pass this along.