MIAMI—Sunita Mishra, M.D., spent more than 15 years in medical practice as an internist and primary care doctor and recognized the challenges for some patients to access care.
"I'm really passionate about access to care. As much as the primary care relationship is so important, it's almost one of the most difficult to get when you need it," she told Fierce Healthcare during an interview at the ViVE 2022 conference in Miami this week.
When Mishra's mother became sick in 2011, she experienced firsthand the difficulties of navigating the healthcare system and saw opportunities to rethink the patient experience, she said.
Mishra spent five years at Providence, a major health system based in Washington, where she focused on consumer innovation and digital health and worked on a pilot that eventually became the health system's Express Care service line.
At the same time, she recognized fellow primary care doctors were experiencing burnout. "I've been on a quest since then to discover a way to deliver primary care in a way that nourishes both the clinician and the patient," she said during a session at the ViVE conference.
This led her to Care Medical, the healthcare delivery arm of Amazon Care, the online retail giant's business that offers both virtual and in-person care. As the medical director at Care Medical, Mishra says she is focused on designing the healthcare practice of the future.
"We want to make healthcare easier for all and to create the best place for clinicians to practice care," she said.
She believes Amazon's scale and consumer-centric focus will enable the company to help reimagine primary care.
"The need to create access is so huge. I couldn't think of another player in the industry that has the ability to think at scale and to really think backward from the customer. In healthcare systems, you talk about things like the patient-centered medical home, but they're not really centered around the patient, they're really centered around the care model. I just felt that was a really great opportunity to just build it from the ground up and think about it from the patient's perspective," she said.
Amazon piloted its healthcare business in 2019 to provide virtual urgent care services to its employees and their families in the Seattle region. The idea came from an employee who was inspired by her own frustrations with the healthcare system and proposed a healthcare model that was designed around the patient, Mishra said.
In March 2021, Amazon Care announced it would begin serving other Washington-based businesses. The company also added in-person care and prescription delivery to its virtual services. The company then opened up the medical business to employers around the country, and it now offers its virtual primary care service to companies and Amazon employees in all 50 states.
Amazon Care also offers in-person care in cities including Seattle, Baltimore, Boston, Dallas, Austin, Los Angeles, Washington, D.C., and Arlington, Virginia.
The company is on track to rapidly expand its hybrid care model to more than 20 additional cities in 2022, including major metropolitan areas like San Francisco, Miami, Chicago and New York City.
Amazon has been able to leverage technology to improve operational excellence and make it seamless for patients to buy the products they want and need.
Mishra believes this model can be applied to healthcare to help "connect the dots" and think about the patient experience end-to-end.
"That DNA of like, thinking backward from the customer and thinking about what pain points you can knock out and continuing to hear the patient's voice as you build out your services, I think that puts them in a good spot," she noted.
The virtual care program forms the backbone of Amazon Care, or the "command center," according to Mishra.
The company's in-person care service augments the reach of primary care clinicians by sending nurses into patients' homes to do additional diagnostic evaluations for prevention, acute and chronic care services.
"If you imagine a person who is diabetic and they are having a difficult time with their blood sugar control. They can connect with a care team member in minutes who can do an assessment and send a nurse into the home to do blood work, make sure their glucometer is working properly and review what's in their refrigerator," she said. "Patients love the convenience and continuity of care they get in this format."
Clinicians who work at Care Medical have an opportunity to see a patient's environment at home to evaluate their diet, any possible allergens and other social determinants, she said, noting, "We have an opportunity to offer a deeper level of care using this format."
Mishra declined to disclose how many clinicians Care Medical employs but said the company is "growing rapidly."
"We're hiring folks that are interested in practicing medicine in a different way," she said.
Amazon Care is open to expanding into more specialty services, she said, and those efforts will be "customer-led."
Amazon Care is focused on ramping up partnerships with employers and currently works with Silicon Labs, TrueBlue, Whole Foods Market, Precor—a Washington-based fitness equipment company that was acquired by Peloton—and Hilton.
"Our road map has really been built based on what our enterprise customers have been asking for" and delivering services in geographies where those employees are based, Mishra said.
For now, Amazon Care is focused on offering virtual care and at-home services. "If we start to find there may be benefits to having some brick-and-mortar clinics, I think we'd be open to it. But at this point, we're going to learn with what we have."
Despite Amazon's scale and operational muscle, the company is not interested in "taking over" healthcare, she said.
"We don’t view healthcare as a zero-sum game. There’s so much opportunity for us to serve patients better, and we come into healthcare with a lot of humility," she said during the ViVE session.
"We feel that we have great expertise in technology and operational excellence, and we are bringing that together to really raise the customer voice and raise the bar for what customers deserve in healthcare. We think we can work with others to raise that bar for folks," she said.