Amazon has approval from FTC to acquire One Medical primary-care clinics

https://www.wsj.com/articles/ftc-wont-block-amazon-purchase-of-one-medical-network-of-health-clinics-c635495e

by qclibre22 • 3 years ago

119 178 3 years ago

wsj.com

EarthIsHome• 3 years ago

https://archive.is/Sc50Z

X-Istence• 3 years ago

How do I get one medical to delete all data they have on me?

ceejayoz2• 3 years ago

That may be challenging. Most states have a retention period required by law.

NY, for example: https://regs.health.ny.gov/content/section-40510-medical-rec...

Medical records shall be retained in their original or legally reproduced form for a period of at least six years from the date of discharge or three years after the patient's age of majority (18 years), whichever is longer, or at least six years after death.

jessriedel2• 3 years ago

How do you get the 10 docs you've visited in the last decade to delete all the info they have on you? I'm not sure, but I'd bet on it being harder than with One Medical.

subulaz• 3 years ago

too bad this country can't seem to leave essential services like health care in the hands of medical specialists instead of capitalists. no matter how Amazon tries to spin this one out, it's unlikely to end well:

"By taking a large portion of healthy, well-educated patients who require less-complex care out of the usual primary care system, tech companies such as Amazon will leave primary care, a specialty essential to the future of health in the U.S. that is already on life support, even more desolate."

https://www.statnews.com/2022/07/23/deal-between-amazon-and-...

lr4444lr• 3 years ago

Last I read, PCPs were in incredibly short supply in the US. If urgent care can reduce unnecessary strain on their thin ranks, so much the better.

nostrebored2• 3 years ago

Yes, PCPs are in short supply. Much of this is artificial due to the limits accrediting organizations have placed on the number of new doctors per year.

ekele• 3 years ago

This statistic is a bit misleading because NPs and PAs are basically replacing PCPs.

ejb9994• 3 years ago

>If urgent care can reduce unnecessary strain on their thin ranks, so much the better.

You are not completely wrong, but it is not that simple - the problem most PCPs have is that 'doc in a box' places tend to soak up all the quick and easy visits, that pay just as much as the long and complicated ones that can takes hours for a typical PCP to resolve - but they often pay the same - so urgent care clinics see you, look at your throat, write you a prescription and send you on the way - "treat'em and street'em"

Meanwhile the 82 year old 400lb diabetic, pre-dementia patient on 12 different medicines with 7 different things they want to talk about during the visit, takes a doctor and team of nurses and medical assistants a hugely disproportionate amount of time to diagnose and treat - and they can't bill all that much more than the doc-in-the-box got for writing a script for a sore throat.

In other words, these places are skimming all the profitable and easy to resolve cases, and the PCP now only has complicated patients that proportionally pay less, further eroding the finances of most primary care facilities, which then means they can't pay as much, so then they have an even harder time attracting talent.

It is also difficult to ask a PCP to see 16-20 complicated cases in a typical day - they need a few easy ones thrown in that they can quickly resolve and move on. Nobody can go 100% all day long on hard problems.

MonkeyMalarky• 3 years ago

Sounds a lot like what happens with public and charter schools?

footlose_3815• 3 years ago

Nothing good for the public will come of this

mouse_• 3 years ago

If our society and bureaucratic process has let the Amazon situation get this bad, what makes anyone think it's not simply going to continue to get worse at the same (logarithmic) pace? The oligarchs aren't going to do anything they're not forced to, and right now, they're the ones forcing the hand of the system.

woodruffw6• 3 years ago

As a One Medical customer, this makes me very unhappy: even if internal controls protect my data from the rest of Amazon’s business, I struggle to believe that their interests are aligned with mine.

nostrebored2• 3 years ago

Could I ask why?

forevergreenyon2• 3 years ago

I'll venture a guess:

For the human individual person, the interests (the goal) is to care for their health; but amazon is a corporation: for them the real goal is profit, not health.

I'm saying that for the human the incentives should be all about health. the money, the costs are the "obstacle".

On the other hand, for the corporation the incentives are the profit. The health is a cost (or "obstacle").

with this 'frame' in mind I'm saying the incentives are not aligned on their own because the priorities are in conflict.

What's truly the problem here, is how healthy patients aren't 'good' customers of health-services. Then again, this is not a problem unique to Amazon, but they're getting into this 'rodeo'.

woodruffw6• 3 years ago

On a purely corporate level: Amazon’s business ethos seems in tension with the things I want from my PCP. I don’t want to be A/B tested for retention and mean time between visits in my doctor’s office.

On a more practical level: Amazon is gargantuan, and I don’t necessarily trust them to have the scoped vision necessary to run a good medical practice, rather than just a large one that fits their portfolio. This is true for any large company; Amazon is large even by large company standards.

jessriedel2• 3 years ago

I have been using OneMedical since 2019, Amazon Pharmacy since 2021 (a few months after they began operating), and regular Amazon since forever. Happy customer in each case. Anything could happen with this acquisition, of course, but I'm pretty optimistic.

hellomyguys2• 3 years ago

As a One Medical customer, the experience post IPO has been awful. Hard to get appointments and less and less MDs available with incredibly high turnover. I wouldn't say their interests are aligned with mine at all, but agree the customer data being in Amazon's hands isn't great.

coredog642• 3 years ago

Let's segregate customer data from medical data: The US has some (IMO) pretty strict laws about protecting PHI. One Medical isn't going to keep your data in an open public S3 bucket, and random Amazon employees aren't going to be snooping around your medical records on their intranet.

ejb9994• 3 years ago

this is not a problem with just One Medical - it is a huge problem in primary care everywhere.

New doctors generally don't want to go into primary care anymore - it doesn't pay nearly as much as being a specialist does, and you are expected to be available to your patients 365 days a year, 24 hours a day (at least that is what many patients think).

It is a pretty miserable business to be in right now, and not sure what is going to make it better.

smith7018• 3 years ago

That's probably an industry-wide phenomenon. One Medical IPO'd in January 2020. You know what happened after that? Covid, mass deaths, high burn out amongst medical staff, and a lot of career changes away from meeting Facebook-informed clients face to face.

Fuck Amazon, though.

lokar• 3 years ago

The turnover rate was really high in 2018/2019

BlackjackCF• 3 years ago

That's really disappointing to hear. I stopped using One Medical because I moved out of the country. I loved One Medical and was thinking about moving back to it this year now that I've returned to the US. Good to know that it's not a good idea.

haliskerbas• 3 years ago

Also hidden fees. I never know what is free through insurance and the $200 video call they'll send me a bill for a long time later.

ctvo3• 3 years ago

Amazon customer service isn't what it once was, but it's still better than 99% of the industry. 30 seconds to a call with a human, instant refund, etc.. They're still one of the few large companies you can get on the phone and speak to someone with for a 5 dollar order. Try that with anything Google, Meta, ... related. Heck even in ecommerce, try that with an order online from Walmart.

I have some hope that they can do something that's better than the low, low bar that is the US healthcare system.

Edit: Thought about this some more, and I think consumers shouldn't be nearly as worried as doctors, nurses, pharma cos, and insurance companies.

Amazon is cutthroat in its dealings with stakeholders who aren't its direct customers. Amazon has no issues squeezing book publishers, vendors, and employees. They justify this as the means of getting the best price and experience for customers. Translate that to the healthcare industry and I'm not sure what to think. Some of the actors in the space could use a wake up call, but overworked nurses, GPs, etc. are not ideal.

woodruffw6• 3 years ago

This is a technocratic framing: I’m not trying to get a $5 refund from my doctor, or to speak with customer service. I want to speak to my doctor on the phone, to have a years-long relationship with them (so that they understand my medical history beyond whatever a DB schema supports), and so forth. It is not remotely clear to me that Amazon is equipped to provide these things.

JohnFen11• 3 years ago

Amazon customer service isn't what it once was, but it's still better than 99% of the industry

Your experience with Amazon's customer service and my experience with it are completely opposite.

crazygringo8• 3 years ago

They were already a publicly traded corporation. Their interests have never been aligned with yours fundamentally, they've been aligned with a fiduciary duty to make profit for shareholders. Literally nothing about the profit motive has changed.

But fortunately their business model has been about providing a superior level of care for a small extra fee, and presumably Amazon is buying them for that strength. Otherwise it would be a pretty pointless acquisition.

But who knows, maybe now there'll be a discount if you have a Prime membership or something. :P

eli• 3 years ago

Amazon has a reputation for ruthless efficiency. Seems speculative to assume that they bought One Medical because of its high level of care and that they are able to manage the company in a way that it continues.

There are plenty of Amazon acquisitions where the service got worse post-acquisition, was relaunched as something else, or was simply shuttered.

kortilla• 3 years ago

They were already a publicly traded corporation. Their interests have never been aligned with yours fundamentally, they've been aligned with a fiduciary duty to make profit for shareholders. Literally nothing about the profit motive has changed.

This is a trope that needs to stop. Public companies are not alike and the fiduciary duty is only a very high level one that can be used to justify both squeezing every customer as much as possible to losing money to support growth.

What the shareholders want matters and an acquisition changes that completely.

loeg2• 3 years ago

a fiduciary duty to make profit for shareholders.

This is a fake rule that people love to repeat. It isn't true.

E.g., but feel free to google it yourself -- there are a multitude of articles on the subject: https://www.nytimes.com/roomfordebate/2015/04/16/what-are-co...

yunwal5• 3 years ago

Amazon's likely buying One Medical for the same reason as most of it's acquisitions: to have an in-house team to dogfood AWS solutions. They'll care about customer experience enough to maintain a reasonable customer base, but improving the state of primary care won't be the priority.

manv1• 3 years ago

You're assuming that One Medical's interests are different than Amazon's. You're probably wrong.

One Medical is there to make money. Amazon will make One Medical more efficient at making money, even if that means forcing you to be healthier.

How?

One nagging problem with healthcare is doctors believe that medicine isn't a cookie cutter problem when in fact it is. For the vast majority of conditions there are standard treatments that work. If that wasn't the case modern medicine wouldn't exist.

Every doctor can whip out some corner case and say "but what about this." Sure, that's great. But for condition A the standard treatments usually work. The trick is to know when the standard treatments aren't working and what to do.

Amazon, or any healthcare company with enough data, can look at the data and see what treatments actually work and what treatments don't. It's not a hard problem, really, but traditional health systems don't care, and to be frank, academic researchers are basically too lacking in imagination to understand how to do it or why it should be done.

Amazon at the very least will try to apply quantitative methods to the problem.

polygamous_bat2• 3 years ago

You know what's one case of a quantitative solution to a medical problem? Take a physically healthy but severely mentally ill person, and harvest their organs to transplant. It's surely gonna bring in profit and increase our GDP!

However morally abhorrent this practice may be, I do not trust Amazon to NOT do this if there aren't any laws against it, which is why I am against this acquisition. I know some people may find it debatable, but I believe healthcare should be run with a Kantian framework where every life is priceless rather than a utilitarian one.

burnte• 3 years ago

I'm in healthcare IT, there are incredibly strict regulations about what we can and can't do with your PHI. Amazon isn't big enough to fuck with the OIG.

hourago• 3 years ago

Amazon philosophy of growth and medical care are totally incompatible.

This is one of the reasons that capital profits should be taxes way higher. Letting one company accumulate such power in such a short period of time makes society unstable.

I hope the best to the American citizens that will suffer thru this situation.

theGnuMe4• 3 years ago

I think Amazon is tired of paying a small fortune in healthcare costs which have to be renegotiated every few years and administered by some moronic organization like Cigna.

Maybe they can do better? Fee for service is kind of insane. Urgent care strep throat $250 + meds makes no sense. It should be $50 total or less.

ceejayoz2• 3 years ago

One Medical doesn't replace health insurance; you still need coverage for ER, hospitalization, prescriptions, etc. You won't get a discount on all that for having a One Medical subscription, either.

bbarn3• 3 years ago

I spent a good portion of my career in the insurance space, and got to the point I just won't work in that industry anymore. Not only because I think benefits coordination companies like you mention are awful, but also because of the sheer amount of bloat I've seen in that industry. Most major cities have literal towers of offices just filled with insurance workers, many of whom do almost nothing for their salary. I personally know one developer at a large one that hasn't talked to his manager in months, and hasn't done any coding at work for almost as long because he has no tasks to complete, and was told "we're waiting on this project to be approved". He collects a paycheck and doesn't even go into the office. He is one of ten on his team. I think Insurance and banking may be the last of the big corporations you can still get lost in.

So yeah, maybe Amazon can do better at least on the administration side.

htag4• 3 years ago

In what world should strep throat cost less than $50.

1. You interact with a receptionist. They use commercial software to track your visit, find an appropriate medical professional for your condition, and fit you into a schedule/queue.

2. You see a medical professional, often a nurse, that checks your vitals and updates your chart. This professional will often take a swab of the infected area.

3. The swab is sent to a lab, where medical grade equipment and a trained technician analysis the sample.

4. You see a medical professional with the prescription pad. Usually an MD or NP. They are responsible for the diagnosis. Strep infection could be a symptom of a larger problem. People without a bacterial infection need to be treated, but shouldn't be given antibiotics. This professional needs to carefully listen to the patient and clearly explain their condition, and what to expect from treatment.

5. You see clerk at checkout. Your entire bill is reviewed by your insurance company.

6. You see a pharmacy tech, a pharmacist oversees your prescription being filled, a medical grade product is provided. Lots of liability at this step. Lots of security and shrinkage concerns for the business.

Keep in mind that throughout this entire process staff is held to higher education, background, and training standards than the general population, all software is built for HIPPA and costs more than standard enterprise software, all equipment is built to a very high standard, all offices are more sanitary than average businesses, and many of the trades are seeing long term labor shortages. Throughout the process you'll probably take an hour of professional time.

Workaccount22• 3 years ago

I am more surprised that people aren't calling for breaking up Amazon.

SQueeeeeL• 3 years ago

There are quite a number, but our primary mechanism for sharing ideas and information are incredibly pro-conglomerate (most large media organizations are the result of decades of mergers). Those in power heavily studied the anti-trust actions of the early 1900s and worked to prevent them from happening again and threatening their bottom line. Quite ingenious if you ask me, that's why you see dozens of people in this very thread touting why a mega corp buying a medical provider is actually a good thing.

ch4s3• 3 years ago

Why would anyone? They aren't the biggest player in eCommerce, cloud computing, grocery, or warehousing. As a customer I'm usually quite happy with the service they provide. I recently bought some heavy items from them that would have cost more than $300 in shipping from the manufacturer, but Amazon delivered the items for free as I am a prime member. Whole Foods has been a fantastic value since Amazon took over and high quality produce is much cheaper than it was prior. I'm not here to say Bezos walks on water, but as far as big companies go, Amazon is probably the best to interact with as a customer.

rr8882• 3 years ago

I dont like Amazon much but healthcare is an industry that desperately needs some smart new players bringing some new ideas.

JohnFen11• 3 years ago

I agree that the healthcare industry desperately needs change.

I very strongly disagree that Amazon will accomplish more good change than bad.

mikece• 3 years ago

Is there any industry that Amazon doesn't want to enter and dominate?

AndrewKemendo3• 3 years ago

A book store is now the hospital. When margin seeking is the goal, everything is up for grabs.

Mike Judge literally wrote this story as a warning and we're just making sure it happens.

"Welcome to AmazonGo we love you"

bbarn3• 3 years ago

There's a scene in the hospital in that movie where a roomba-like machine is just moving back and forth saying "your floor is now clean". Broken tech devices has become something I constantly see now. We have all this junk and 4-5 year old IoT toys not working, fridges with blank screens that no one cares about.. and it keeps getting worse.

That and, my experience at the doctor now feels quite similar. "Says here you're retarded"

fallingknife2• 3 years ago

Even Google Maps has gotten almost unusably buggy over the last couple years.

spking• 3 years ago

Carl's Jr: "F--k you, I'm eating!"

NickC254• 3 years ago

Seriously. This whole notion of "corporations must grow infinitely and indefinitely" is straight-up cancerous.

Can't we for once have legislators who can say something to the effect of "stay in your lane" to a corporation and actually enforce it?

How does a bookstore go from being a bookstore that now controls the internet's infrastructure and now my healthcare?

HarryHirsch• 3 years ago

How does a bookstore go from being a bookstore that now controls the internet's infrastructure and now my healthcare?

I don't know but money isn't the answer. Back then, in 1980's Germany book wholesellers Koch, Neff & Oetinger and Lichtenbrink pioneered robotic storage, and for very much the same reasons as Amazon. They were logistics giants that would deliver your book overnight, but they did not go on do dominate the world.

AndrewKemendo3• 3 years ago

How does a bookstore go from being a bookstore that now controls the internet's infrastructure and now my healthcare?

Despite my sneering comment, Amazon was never supposed to be a "bookstore"

Bezos's goal was to be the largest intermediary for all commerce worldwide.

This was the quote: "To be Earth’s most customer-centric company, where customers can find and discover anything they might want to buy online, and endeavors to offer its customers the lowest possible prices"

rr8882• 3 years ago

but it's got electrolytes.

hidelooktropic• 3 years ago

Mike Judge? What?

AndrewKemendo3• 3 years ago

https://archive.org/details/Idiocracy_201507

superb-owl• 3 years ago

When did Amazon become a private equity firm?

ryanianian• 3 years ago

There’s an interesting rabbit hole in this snark. Something like public equity eating private equity’s lunch? Please expand.

htag4• 3 years ago

Amazon over private equity is simple.

1. The numbers on Amazon's quarterly reports are huge. They are playing in the big leagues.

2. Everyone with money remembers when they were just a book store and the dotcom bubble burst. The narrative that they can go into a market and dominate it in a few years is a strong one everyone has a lot of belief in.

3. They are one of the leaders in using technology to upgrade traditional business lines. Every industry still experiences Fear of Missing Out on the latest technology change. Imagine how great of a position Sears Catalog would have been in if they could have held their strength for another five or ten years. They had brand name recognition, supplier relationships, warehousing, distribution, and physical locations for returns.

4. When a tech company enters a market there is a higher level of risk accepted than private equity. The private equity firms usually pick more sure bets than this.

moneywoes• 3 years ago

Surprised this got past Lina Khan

airstrike• 3 years ago

She can't make up new laws

IncandescentGas• 3 years ago

Would an Amazon owned clinic responding to an injured warehouse worker not be incentivized to protect the parent company instead of treat the patient?

ROTMetro3• 3 years ago

Pretty sure Amazon already lost court cases where their onsite 'medical' has done this.

yeahbutiguess• 3 years ago

What a truly devastating outcome. Amazon has no idea how to run healthcare, and they will apply their "squeeze the customer, squeeze the provider" ethos to it. I'm so sorry for all the employees and patients at one medical.

robg• 3 years ago

If this makes telehealth easier to use and more widely adopted, sign me up. One click appointments should be the default for many medical needs.

oneepic• 3 years ago

I noticed One Medical is actually already a publicly traded company under ONEM. I'd think this is quite a bit different, than if Amazon bought a nonprofit hospital/health system like Sutter Health, or Allegheny Health Network, or even the clinic across your street that you naturally assume is a nonprofit.

xen2xen1• 3 years ago

Google's health care will be provided by Amazon? Nifty

crazygringo8• 3 years ago

Yeah that's definitely the funniest part to me.

Honestly would have expected Google to buy it before Amazon, halfway just for that reason.

bmitc2• 3 years ago

Why?

I'm pretty sick of this stuff. As if a multi-conglomerate will have no want to abuse the access to new data and push medical access in directions it shouldn't be going. Amazon just bought iRobot. So now they have microphones and cameras in your home, they know what you eat, buy, and watch, and now they get your medical information.

I honestly don't have any hopes anymore. The U.S.'s democratic process and regulation entities are corporate captured. We're owned and controlled by institutional corporate shareholders.

robertlagrant5• 3 years ago

We're owned and controlled by institutional corporate shareholders.

Government is still in charge.

It just chooses to be captured, even though its first job - which it gets paid for by extracting money by force - is to not be captured.

flandish3• 3 years ago

Are you saying that a captured government is still in charge?

That’s … not how capture works.

dwallin• 3 years ago

The perception of a singular power of "Government" is an illusion. Government in reality should be seen as more of an ecosystem, with numerous centers of power of various sizes and areas of influence. When a part of government is captured it means that individuals with power within that substructure have little ability to push back against larger external forces acting upon the structure itself. To override that would involve large numbers of people within the structure coordinating against their individual interest, or power from outside that substructure with the ability to apply a countervailing force.

deltree7• 3 years ago

Geez, if this is your biggest problem you life, you are indeed leading a very privileged life.

Count your blessings

bmitc2• 3 years ago

I didn't say anything remotely close to that. Not sure what you're referring to.

flandish3• 3 years ago

If you can’t see how big this problem actually is - start by reading “The Jungle” and realizing nothing has changed for the better for us workers, in a very long time.

Blessings not from corporate kindness, by the way.

The only thing a corporation can do, especially at Amazon’s size, is evil for the worker and community. They are built to expand into infinity, consuming all for shareholder profit.

ChatGTP2• 3 years ago

I know it's easier said than done, but if this is something you're passionate about, why not start your own "whatever you think sucks as a public company" as a not for profit ?

I mean if you're passionate about it.

polygamous_bat2• 3 years ago

Paraphrasing a little bit, but

Why don't you start X to compete with a trillion dollar behemoth Y?

Because if they think they can make a profit, they have a trillion dollar that they will freely leverage to strangle the living air out of your company. Weak US anti-trust laws won't do anything until there is a "significant, provable harm to the consumer".

The general lesson here is more capitalism won't solve the issues of unchecked capitalism, you will have to get the legislative system to intervene to make sure you can have fair competition in the market.

brutuscat• 3 years ago

This was idea of Todd Combs, an investing manager of Berkshire Hathaway. It failed before (Buffet BRK, Dimon JPM & Bezos AMZN venture called Haven went bust a while ago), but I think Bezos just keeps trying...

https://archive.is/nU8j2

sklargh2• 3 years ago

Whole Foods and OneMedical represent a strategy of locking up wealthy households into the broader Amazon ecosystem. It’s iMessage, but for your bad knee.

Buying Whole Foods was a way to buy a freezer and small warehouse with the grocery budget of the top ~3% of US Households attached. OneMedical is a way to do the same. I expect they’ll try to roll up Summit or another group next.

danpalmer2• 3 years ago

...represent a strategy of locking up wealthy households into the broader Amazon ecosystem.

I find this an odd but interesting approach, because I associate Amazon as being a bargain, low quality sort of brand. It's a good service, but it's definitely not premium. In some cases I'd say it borders on tacky and tasteless. This is not just about the product catalog too, it's site/app quality, Fire and Alexa devices, selling ads on Kindle lock screens, being completely shameless about service quality issues, AWS shipping services 2 years before they're actually any good, and so on.

Whole Foods probably isn't like this yet, although I haven't been in since pre-acquisition because there are only a few in the UK, and I don't know anything about OneMedical, but if Amazon's brand permeates into these, either visibly or invisibly, I can't imagine it going well.

LatteLazy• 3 years ago

Amazon have basically outperformed every other company out there by doing basic logistics and simple useability.

I think that would add a lot to healthcare especially in the US.

gdurham• 3 years ago

I mentioned this in another thread…I’m waiting for this to become the “company town” of tech. Employees make money, forced to spend it at the company store. Is Amazon in housing yet?

Amazon has approval from FTC to acquire One Medical primary-care clinics

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