Making sense of Amazon and Apple’s health care forays

Rebecca Vesely

About Rebecca Vesely

Rebecca Vesely is AHCJ's topic leader on health information technology and a freelance writer. She has written about health, science and medicine for AFP, the Bay Area News Group, Modern Healthcare, Wired, Scientific American online and many other news outlets.

Photo: NayverM via Flickr

Tech giants Amazon and Apple both made waves in recent weeks for announcements that some interpreted as a first stab at disrupting the health care sector.

Plenty of observers have offered opinions on whether tech companies can truly shift the (often frightfully unmovable) machinations of the health care system.

Let’s take a look at the reality and how journalists might find fresh angles in the months ahead.

For Amazon, the joint announcement between Amazon, Berkshire Hathaway and JPMorgan was vague but it said the goal of the venture was to improve patient satisfaction and lower costs for the companies’ own employees. The focus would be on “technology solutions,” according to the press release.

Employers have long used their own workers to test out new models of care delivery and the restructuring of benefits to see if they achieve desired results. Many companies large and small have tried health coaches, wellness programs, on-site health clinics and weekly farmers markets to improve the health and satisfaction of their workforces – with mixed results.

However, Amazon and its partners do have deep pockets to acquire technology that they think could improve satisfaction and lower costs. How this translates to the general public is anybody’s guess.

The low hanging fruit of technology disruption of health care to potentially improve satisfaction and reduce costs are telehealth and remote patient monitoring. Some have speculated that Amazon and partners will start in that direction. They may also partner with tech savvy medical groups (perhaps Forward Health or One Medical) to deliver non-emergency care, for instance.

The venture raises more questions than it answers. Considering Amazon’s size, other large employers, insurers and health systems across the country will be monitoring results and could replicate their moves.

As for Apple, the company announced in late January that it would bring patient health records to the iPhone. This followed the Food and Drug Administration approval late last year of the first medical device accessory for the Apple Watch, an EKG reader.

The health records piece is a step forward because it gives individuals more power over their health information, and their records will travel with them. This type of portability has long been sought but difficult to obtain because of lack of interoperability between hospital and medical group records’ systems. It will be interesting to see whether patients use the new feature, and how many medical institutions and EHR companies sign on to participate. If the records aren’t comprehensive or helpful in making care decisions, patients won’t use the feature. Reporters can see the list of initial participating health systems here.

On the Apple Watch news, it’s another example of the hope and hype around wearable devices. Once again, it’s up for consumers to actually use the product to collect the data, and its up to providers to include that data in care decisions. None of this is yet certain.

Further reading:

2 thoughts on “Making sense of Amazon and Apple’s health care forays

  1. Norman Bauman

    I was writing about computers in medical practice (and legal practice) for many years. This Amazon-Hathaway JPMorgan plan is bullshit.

    Computers have done certain tasks very well, like filing Medicare/Medicaid bills, or PubMed, spreadsheets, and of course Word processing. But there were other tasks that didn’t work well, like identifying contraindications for drugs. The big mission was to create an electronic medical record that manages all of a doctor’s information, like EPIC or VISTA. Doctors complain today that data entry adds an hour or more to their day, sometimes filling in meaningless checklist entries (like, “Is this a pill or a capsule.”)

    The way for a scientist or evidence-based journalist to figure out whether it’s bullshit is to ignore all the marketing and computer buzzwords that computer salesmen use to sell a product.

    The important question for us to ask is: Does it work? What’s the empirical evidence? Has it been tried before, somewhere in the world, and was it successful?

    The answer is that these products have been tried before, many times. The best ones can, at best, manage documents and information better and faster than the paper records. But more typically, they can manage documents well, but require more doctor’s time and effort.

    Their goal is to reduce costs. Employers have been trying to create “workplace wellness programs,” whose main goal is to reduce costs, at least since the 1970s. They were a big corporate fad, with cover stories in BusinessWeek. They didn’t work. There were articles published in the NEJM and other authoritative, peer-reviewed journals which said they didn’t work.

    (There are really 2 parts to the problem: (1) Figuring out how to get employees to change their habits, like smoking, sloth, and going to the ER too much, which will make them healthier and cheaper (2) Figuring out how to get a computer system to “incentivize” them to do it. Health care managers haven’t even shown us that they can do the first part.)

    When an approach has a consistent track record of failure, but you’re a true believer, you may want to keep trying. But the scientific approach is to see if you can get it working in small pilot projects, not to roll it out over entire enterprises, in the hope that it will finally work if you could just do it at large enough scale.

    Here are a couple of recent articles which support what I’ve said above. The real, solid evidence is in the peer-reviewed journals. Read the background evidence and ask the proponents, “Why do you think you can succeed where everybody else has failed?”

    https://www.nytimes.com/2018/02/01/upshot/employer-health-insurance-amazon-berkshire-hathaway.html
    Employer Health Insurance: Often-Hated, Sometimes Pioneering, and Now on Amazon’s Radar
    Everyone likes to complain about our company-based system, but there have been real examples of innovation.
    By Margot Sanger-Katz
    New York Times
    Feb. 1, 2018
    Critics point to numerous problems with the system…
    Have employers used these advantages to find huge savings? Not over all. Employer health insurance tends to be more expensive than public insurance, and its growth has traditionally followed the trajectory of other parts of the health industry. Some employers simply select from standard offerings, essentially outsourcing any innovation potential to notoriously risk-averse insurance companies.
    There have been less successful innovations. Workplace “wellness” programs, which provide financial incentives for lifestyle changes, were initially built and bought by employers. But a growing body of evidence suggests they haven’t delivered much in the way of results.

    https://www.washingtonpost.com/news/wonk/wp/2018/02/09/health-care-the-industry-thats-both-begging-for-disruption-and-virtually-disruption-proof/
    The tech industry thinks it’s about to disrupt health care. Don’t count on it.
    By Carolyn Y. Johnson
    Washington Post
    February 9, 2018
    In 2016, IBM employees in the Raleigh-Durham area were offered access to a handy new health-care app with tools to help patients navigate the many choices they face when they fall ill.
    The app offered a symptom checker, an overview of the options for care, a map of nearby facilities covered by the person’s insurance, free video consults with a doctor 24 hours a day and a breakdown of the out-of-pocket costs people would face at different locations.
    The pilot feasibility study, a collaborative effort between a Harvard Medical School physician, the health insurer Anthem and IBM was designed to test whether employees and insurers would both benefit from putting more power in the hands of patients.
    Two years later, it is defunct.
    “The short answer is nobody really used the tool,”

    (BTW, if you click on the Comments links to these stories, you’ll find many, often hundreds, of comments saying, “The real solution is single payer.” As AHCJ member Michael Corcoran has documented in many articles, there is a significant gap in media coverage of single payer. Which you might want to write about instead.)

  2. Ruth Taber

    Improving medical care will be difficult until we cut back on over screening, over diagnosing and over prescribing. Medicalization of this country is furthered by sensationalist style medical reporting, horrific tv advertising and medical centers equally concerned with profits and cures.
    And with an aging population there seems to be no shortage of ridiculous medical procedures that will make no difference in an elder’s remaining years – other than relieving them of funds.
    I recommend every book written by Dr. Nortin Hadler (most recent: Rethinking Aging) ; He writes for the medical profession and the lay public with carefully researched statistic to back up his statements.
    And finally, we should be actively trying to attract more people to the geriatric field. (especially geriatric psychiatry.) I am 89, my retired physician husband is 91 and there isn’t a single internist, board certified in Geriatrics in El Paso. (There are 227 in the state of Texas but I have no idea where they’re located.)
    Dr. Hadler writes about over-treatment of our aging population. Lost of money available caring for older, often frightened citizens.
    We’ve come a long way in health care improvement since I received my MPH from Yale in 1954 and my husband received his MD from Harvard in 1952 but we have an even longer way to go in really “caring” for people.
    Ruth Taber, El Paso TX

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