Amazon's Three-D Impact on Healthcare

Much has already been written and spoken about Amazon's One Medical acquisition. It will have an impact for Amazon, for primary care, and for the healthcare industry as a whole. There are so many dimensions to this announcement – it is nuanced, tricky, frightening, exciting, and more. I think there will be a “Three-D” impact on the healthcare industry and I outline those dimensions, below, along with some thoughts on what organizations can do to prepare about the impact this is going to have on the entire healthcare industry in the near future.

Digital will increasingly be a differentiating factor for healthcare and healthcare experiences.

Did you know that consumers really didn’t start buying online in earnest until 2017? By the time we were well into the pandemic, we had evolved so much by necessity that digital became a way of life. In fact, by July 2020 – just months after the beginning of the pandemic – Experian found that 60% of people had higher digital expectations than they did pre-pandemic.

Amazon presents consumers with a virtually flawless, seamless consumer experience from purchasing shoes to computers to even your monthly pills through Amazon Pharmacy. Digital experiences are the wave of the future in healthcare and now that Amazon has gone deeper into healthcare, digital will continue to infiltrate the healthcare experience that it offers, especially now through One Medical. Organizations that can adapt to providing as many digital experiences that are delightful to the consumer and to the patient – whether you are in markets with One Medical or not – will keep their healthcare patients and consumers coming back. I predict, however, that those organizations that cannot provide better digital experiences for patients and consumers will see their patient volume dwindle. Be on the lookout for organizations waking up to the differentiating factor digital makes for consumer experience.

Distribution of care is becoming the norm.

I predicted this in my Top Predictions for 2022 blog post earlier this year, where I noted that there will be a “decoupling of primary care from health systems.” The concept of “primary care” will continue to evolve from “hub and spoke” to a more distributed “point and click at the moment of need” model. It will be more convenient and less relationship-based. Even though the model of One Medical is to have directed, highly accessible care, it’s still a consumer’s world were consumers are increasingly empowered to seek care when, where and how they want it.

“As much as the primary care relationship is so important, it's almost one of the most difficult to get when you need it.” - Sunita Mishra, Chief Executive of Amazon Care Medical

Fewer people have a primary care provider today than ever before; Gen Z and Millennials don’t even want a primary care provider. They just want care when they need care. On average, it takes 24 days to see a primary care provider. But with Amazon’s relationship with One Medical, patients will now be able to leverage a wide range of care options – from virtual care to coaching to in-person care – and will be able to get care when they need it. 

There will be less focus on the primary care provider as the coordinator of care and more on focusing on how to drive care on demand – even if that care is highly distributed, and will become more normal as the years go by. Why? Because Amazon isn’t the only one promoting a change in the primary care model. Right now, Optum, CVS Health, Walgreens and Walmart are all taking a bite out of the primary care market and they all have significant geographical reach across the United States.

Disrupting an old business model is following the same pattern that Uber, Netflix, Spotify used in verticals outside of healthcare.

This Amazon announcement is a tectonic shift for the healthcare industry. And, in thinking about tectonic shifts in other industries, one commonality with the shifts is that the disruptor organizations (like Uber) took over in industries when the consumer was signaling a preference or a need and traditional organizations failed to see and to act on those consumer signals.

We saw this with Uber vs traditional taxis. Netflix vs Blockbuster. Spotify vs. CDs.

All of these organizations took points of friction in the consumer experience and smoothed them out. Amazon is no different – they are taking a broken business model and deep knowledge of consumer preferences and behaviors and are making active moves to change the experience (and to force the industry to make those changes, too). Amazon is disrupting an old business model because that business model is too focused on providers and not focused enough on the consumers and the consumer experience. Maybe now health systems will see the light.

For example, now that we are moving through a different stage of the pandemic, organizations seem to think that in-person visits are the only way to see a patient (rather than readily offer virtual care options). Instead of offering the modality that is patient preference, organizations have tried to go back to the old way of doing business. My husband is a provider at Massachusetts General Hospital (MGH) and has been forced (either federal/state rules or via MGH rules) to be credentialed in additional states bordering Massachusetts to see patients virtually. MGH has all but said to its providers that virtual care is a no-go. This is painfully upsetting to some of his patients who come from states where MGH will not allow a virtual visit and for which he cannot be credentialed (maybe because of MGH's rules? No one really knows). It’s bad for patient experience, it’s bad for the health system and it’s bad for the provider. And, it opens up the door to Amazon.

Amazon can and will offer virtual care options to help a patient better find care when she needs care in the most convenient way possible. The traditional healthcare model will not be around much longer because Amazon will show people that they can get convenient care and a great experience at the same time -- which is entirely the opposite of what most patients experience with traditional health systems. With Amazon, you now can book care online, see a provider virtually or in person, have a provider come to you, and get your pills via online orders through Amazon. Why would a consumer want to go anywhere else if she could help it? Amazon is literally turning the model of healthcare on its head and most healthcare organizations can't figure out how to get out of their own way to make changes that the consumers want.

So what can organizations do?

I predict there will be a few different ways this announcement will impact organizations:

Certain markets will be impacted before others – those markets where One Medical exists will potentially see the changes before other markets. One Medical is largely based on the outskirts of the United States – Seattle, San Francisco to San Diego, Texas through Georgia up through DC, NYC and Boston – their locations basically “cradle” the edges of the United States. 

All current markets in 16 distinct cities have an affiliation with a healthcare organization (e.g., One Medical in Boston is affiliated with Massachusetts General Hospital; One Medical in Atlanta is affiliated with Emory Health.) Will Amazon start to market for primary care patients in these markets? Certainly Amazon’s and One Medical’s ease of use could be quite compelling to change consumer preferences toward One Medical. But never fear, right? You’ll get the referral, so doesn’t this ease your primary care access burden and drive patients to higher-reimbursed specialties?

No! If you are one of the health systems affiliated with One Medical in one of these markets, you likely have a large problem on your hands. Why? Because most healthcare organizations offer a sub-part digital experience, which could significantly impact consumer experience and patient satisfaction at the risk of losing a patient. You’ll need to improve your digital experiences immediately so that you continue to delight a patient coming from One Medical (and Amazon) where they have had an excellent experience, and make sure there is continuity in that experience. For example, my One Medical experience is flawless. I can book an appointment online, communicate with my provider, schedule travel shots and more, all within a user-friendly app. My MGH digital experience via the Patient Gateway app (is Patient Gateway even an acceptable health "tool"?) or accessing information about providers on the MGH website is abysmal. Trying to book a provider via Patient Gateway is subpar and pretty much impossible compared to One Medical.

What will this require organizations to do to level up?

• Organize your provider data. Your providers are your inventory. You need to know everything about what you “sell” – your providers, their schedule availability, what they treat, what they specialize in, who performs which procedures, and on and on. If you don’t have a provider data management strategy, it’s time to do this now. Many organizations are starting this process by engaging in lengthy provider data clean-ups that take at minimum six months to two years to complete. Stop. You already have a list of providers on your website if you have a Find a Doctor (which almost all healthcare organizations have one). Start with that one and start to incrementally clean that data – don’t wait for your “provider data management” strategy to be perfect before you can use it. Cleaning up portions of your data is better than wasting two years forming a committee and circling the wagons to do so. You'll lose time... and patients if you continue down that path. You should especially consider starting to organize provider data for specialties that would receive referrals from One Medical – specialties like GI, Cardiology, Endocrinology, Neurology, etc. Prioritize those providers and store those providers in a platform that can make it easy to build relationships among their various offerings.
• Ensure your providers are discoverable online when people are searching for them. One Medical patients will get referrals from their primary care providers – whether they’ve seen the provider via virtual channels or in person. In our most recent Patient Experience study, we found that 90% of patients are using online resources like search engines, hospital websites and more to conduct healthcare research before booking an appointment (especially if they are waiting on the health system to call them back after their One Medical referral -- which probably happens quite often). Your specialists must have accurate information and positive reviews on search engines and other sites where they are doing their research to put your providers in the best position possible to be selected.
• Ensure your providers are digitally enabled in every way – move toward online scheduling as soon as possible. The experience a patient or a consumer has on your properties – especially after receiving that referral from One Medical – should be exceptional in every way (I can guarantee this is not true today). Amazon and One Medical will amplify this expectation because of their seamless experiences, so any way you can provide online booking experiences and a seamless care journey is one step you can take to keep a patient connected to you rather than have that patient go elsewhere. People won’t tolerate scheduling an appointment digitally with One Medical only to realize they cannot schedule with your system and therefore have to wait forever for an appointment with the affiliated healthcare organization when you have to wait for a call-back or wait for 40+ minutes on a call center hold line.

What about organizations in markets where One Medical exists but aren’t associated with One Medical? (E.g., in Boston, One Medical is affiliated with MGH, but what about Beth Israel Lahey Health or Tufts Medicine)? These organizations can try to fight for referrals by:

• Organizing your provider data. See my first bullet point above. Remember, your providers are your inventory and you need to understand and manage that inventory as quickly as you can. Start organizing provider data incrementally -- start with specialties that would be typical referrals from a primary care physician.
• Focus on SEO for your specialists. Even though patients will receive a referral for care in your market, they are still shopping, especially on search engines. Ensure you are properly marking up your provider pages with the appropriate schema so that your providers have every opportunity to show (and even be featured in a “featured snippet” on Google, if possible) when someone is looking for more information about a doctor online. Don't forget about ensuring every one of your specialty providers has a Google Business Profile. The more search engine result page real estate you can conquest, the better.
• Manage and learn from your reviews – especially for your specialists. If patients are doing additional research about specialists, we know that patients are heavily relying on reviews to help them make the final decision to choose a provider. Monitor your reviews, respond to reviews, and make sure you are doing the best you can to generate third party reviews to boost your SEO and your star ratings for specialists online. Additionally, you can learn a lot from what people are saying in these reviews, so make sure you are tracking review sentiment and performing service recovery as soon as possible from your first and third party review data.
• Stop looking at your local competition (“local hospitals”) as your only competition. I can't tell you how many organization leaders are concerned only with local competitors within a market. It's the wrong focus: your new competitor is Amazon + One Medical. Identify where Amazon and One Medical provide an exceptional customer experience. Are there simple things that you notice on Amazon or One Medical that you could do within your own health system's digital experience that could improve the patient and consumer experience within your health system and that will have a positive impact on patient experience overall? If you are solely looking at what your local competitor is doing, you are just repeating the same old terrible experiences. You are missing the experiences that consumers are trained to have outside of healthcare (and then come to expect within healthcare and are disappointed repeatedly). Amazon entered the physical patient space for a reason: the experience is broken. Look to Amazon and One Medical as a blessing in disguise to truly help you champion a better experience for all patients. Mimic and copy what Amazon and One Medical are doing instead of what your local competitors are doing.

Finally, for organizations in markets where One Medical doesn’t exist – don’t think you get a free pass! Amazon could come for you next… learn from the markets where One Medical does offer in-person care, and consider how you can improve the patient experience for your market to prepare for if (or when) Amazon does arrive. I would recommend three things to focus on:

• Organize your provider data. Do I sound like a broken record yet? Your providers are your inventory! Get started ASAP!
• Roll out online appointment scheduling for primary care, MRIs, "shoppable" services, dermatology, etc. as soon as possible. Don’t fall prey to doctors who claim that they are not ready to open up their schedules. Consumers expect easy options to book care, so get started booking care with the “easier” specialties and services. You will learn a lot and you will be able to set a precedent for other providers to follow suit. When Home Depot was threatened by Amazon in the early 2000s, it incentivized the eCommerce and the retail teams to share the same goals. This moved the needle for them to start operating as a team and to realize how they could effectively compete with a large online organization. Sound familiar? Why not consider incentivizing providers to open their schedules. Give providers an opportunity to be invested in the future and thereby take control of the conversation as opposed to having the providers control you (oh, and by the way, improve consumer experience at the same time)!
• Look at what Amazon is doing and copy it! Don’t recreate the wheel. Know your customer. Initiate an understanding of consumer journeys, needs and sentiment. Collect review data and search data from Analytics platforms, your site search data and Find a Provider tools and aggregate the data to determine your patients’ overarching priorities and then address those priorities digitally. Review this information regularly. If Amazon can do it with a massive product inventory set, you can do it on behalf of your patients and consumers seeking care with you.

This is a really exciting new world. Many of us have thought long and hard about whether Amazon is going to be successful as it steps into the provider space. We don't know what the outcome might be. But, one thing we do know is that Amazon will most certainly force healthcare organizations to wake up and to start heavily focusing on the consumer experience (finally!), especially the digital components of it. What is happening in healthcare now is almost a replica of what happened with the retail industry in the early 2000s, where retail organizations were threatened by Amazon. That industry learned a lot of lessons; Amazon had a similar impact on the retail industry and we have a lot to learn from their successes and their failures.

If you’d like to hear more about how retail organizations dealt with the threat of Amazon, check out my interview with Yext’s very own Head of Industry for Retail and eCommerce, Derrick Jaros.