Amazon’s $3.9 billion acquisition of One Medical made big waves when it was announced in July 2022, signaling that the online retailer had bold ambitions to expand its reach in healthcare.
The work of integrating the primary care provider into Amazon’s operations has been underway since February when the deal closed, and One Medical now falls under the Amazon Health umbrella, which includes Amazon Clinic and Amazon Pharmacy.
The integration process is still in “early days,” according to One Medical Chief Medical Officer Andrew Diamond, M.D., Ph.D. “It’s still about getting to know each other's capabilities, strengths and opportunities. There are great discussions happening about where we can help one another and we’re uncovering those opportunities,” he said during an interview on the sidelines of the HLTH 2023 conference in Las Vegas this week.
“The most important thing for us to do in terms of integration is just bringing more awareness of One Medical, and I think that is already happening, thanks to Amazon, and just to the fact that we have joined a high-profile company. That has raised our profile,” Diamond said.
The One Medical deal expanded Amazon's reach into primary care as it now officially operates 220 clinics in 29 metropolitan areas. The deal also gives Amazon rapid access to the lucrative employer market as One Medical works with more than 8,500 companies and has a trove of member health data.
Launched in 2007, One Medical operates as a membership-based, tech-integrated, consumer-focused primary care platform offering care at brick-and-mortar clinics as well as near-site and work-site care along with virtual health services.
Amazon's focus on being "customer-obsessed" makes the online retail giant an ideal company to take on the $4 trillion healthcare industry, according to Amazon Health Services head Neil Lindsay. Amazon's strengths lie in logistics and supply chain to more easily connect consumers with products and services they need.
"In healthcare, we think of our mission as exactly that: It's to connect the dots between the humans, the customers, the patients and the products, services and professionals they need to get and stay healthy," Lindsay said during an onstage interview at the HLTH conference.
There is skepticism about Amazon's ability to scale its healthcare initiatives as previous ventures have faltered. One of Amazon's most high-profile forays into healthcare, Haven, a company formed with JPMorgan Chase and Berkshire Hathaway, shuttered after three years of operation.
In 2019, the company also launched a primary care service for its employees that blended telehealth and in-person medical services. Called Amazon Care, the service later expanded to outside employers and added in-person care options in more than 20 cities, but then was shut down at the end of 2022.
Diamond, an internal medicine physician, joined One Medical 16 years ago when it first launched. Despite Amazon being a relatively new player in healthcare, he said he felt encouraged when the deal was first announced that the two companies had a "well-aligned mission."
"I quickly realized, without knowing anybody at Amazon, that this is the perfect company to acquire us because they're customer-obsessed. They love making things easier. And they love making things more affordable. They also don't have any sort of vested interest in the existing healthcare, medical industrial complex, so to speak," he said.
He added, "They are fine with the idea of patients staying out of hospitals and emergency rooms, and not every entrenched interest is totally OK with that. What I've learned just in the last six months, particularly getting to work with the other chief medical officers here and Neil [Lindsay], is that these are people that I can strongly identify with. And I think we speak each other's language and we share each other's sets of priorities. It's the whole idea of putting a human who needs care at the center of everything."
Consumers can now access One Medical from Amazon.com, and the primary care provider has seen its member subscriptions increase since the acquisition, Diamond noted, but he did not disclose any specific membership numbers.
The company, which went public in early 2020, had 836,000 members at the end of 2022, with the bulk of those, 796,000, among consumer and enterprise members and 40,000 at-risk members, according to a year-end earnings report before the acquisition was finalized.
The Amazon deal also raised One Medical's profile with employers, Diamond said, which are shifting their strategies from offering concierge-type primary care services as a "perk" to their employees to viewing integrated care services as a need-to-have to tackle rising healthcare costs.
A study of one of One Medical's employer clients published in JAMA in 2020 found that One Medical's primary care model resulted in 45% lower total medical and prescription costs for participating members. The model also led to decreased downstream care such as emergency care, hospital visits, prescription medications and radiology.
"We're continuing to invest in these types of services that reduce total costs and not just 24/7 availability that helps you figure out if you need to go to the ER in the middle of the night and not just chronic disease management programs that help you control your high blood pressure or your diabetes but also virtual physical therapy and virtual behavioral health," Diamond said.
Through the One Medical deal, Amazon also gained a foothold in the Medicare Advantage market thanks to the company's acquisition of Iora Health in 2021.
Iora Primary Care, which has 40 clinics, has been rebranded One Medical Seniors, Diamond said.
“While the name has changed, patients can get the same high-quality, human-centered care that they’ve come to expect at Iora, with added access to 24/7 virtual care services in select cities. Patients can access our dedicated virtual medical team 24/7 for help with a range of services, including symptom-based questions, treatment options, prescription renewals, referrals and lab reporting,” he said.
Diamond did not provide details about One Medical Senior’s growth plans but said, “We continue to work together to increase access to high-quality care and high levels of service to senior and Medicare populations.”
Amazon Health is now focused on expanding more services in the markets where it operates.
In the short term, Diamond said he is focused on making sure the One Medical clinical team is “right-sized” as it continues to scale under Amazon. “If we're going to successfully care for a lot more members, we want to make sure that we're adequately prepared for that," he noted.
Amazon Health executives are now looking at ways to combine One Medical's expertise in patient care with Amazon's tech capabilities to scale up integrated primary care and dramatically improve both the patient and provider experiences.
"The sky's the limit, but I think the most obvious areas of opportunity are to alleviate the administrative burdens that primary care clinicians face," Diamond said. "We've already taken out 40-plus percent of the typical tasks that a primary care clinician would have to deal with, but there's an opportunity to take out even more surplus administrative tasks and also support the truly clinical work that a clinician has to do. Those applications of technology in general are very exciting. One Medical is already, I think, leading the industry in terms of a place where practicing medicine is joyful and feels sustainable."
One Medical also can leverage Amazon's deep tech expertise to build more advanced predictive models to identify patients at high risk of a serious health event and intervene earlier by sending "nudges" or other digital engagements.
"Also applying Amazon's tech and expertise in logistics to make people can get the medical equipment, medications and treatments that they need more quickly and more reliably and being able to send diagnostic tools into the homes of people who live in remote areas, or who otherwise can't come to the office. There are ways to enhance One Medical's already pretty amazing virtual care capabilities," he said.
The biggest potential for Amazon Health and One Medical to "move the needle" in healthcare is to leverage its care model combined with tech to tackle the burden of chronic diseases in the U.S., according to Diamond.
"A great example is cardiovascular disease, the No. 1 killer in the U.S. It is largely preventable. If we can modify the key behaviors to get people to manage their high blood pressure, treat their diabetes or avoid diabetes, we could unseat cardiovascular disease as the No. 1 killer in the United States," he said. "We're already sending people on that trajectory. If we do that at a greater scale as part of Amazon, if we apply Amazon's technology to help us understand when we should intervene, if we can better model risk and intervene on higher-risk individuals in more thoughtful ways and doing that at scale, we will unseat heart disease as the number one cause of death.
A study by One Medical examining its Impact by One Medical chronic care management program found that participating patients adopted healthier lifestyle habits and reduced certain risk factors associated with developing chronic conditions such as diabetes. Patients enrolled in the program have seen a substantial reduction of HbA1c by three to five points and average cholesterol/LDL reduction from 60 mg/dl to 20 mg/dl, according to the company.
Previous studies have found that a one point reduction in HbA1c is linked to a reduction in risk of death by 21%, heart attacks by 14% and microvascular complications by 37%.
Amazon's scale and investment also will help One Medical open up access to primary care and provide more services for common medical conditions. "We can also continue to invest in really thoughtful partnerships with specialists and we can do what we've already shown we can do, taking out 45% of the total cost of care, and we could do that at greater scale. There's so much money to be saved out there by doing primary care better," Diamond said.
He also sees the potential to use tech and innovation to bring the younger generation into medicine as the industry faces high levels of burnout and many clinicians are leaving the profession.
"We can bring more people into the fold of healthcare delivery by making the job awesome. The more people are interested in primary care careers, the more impact we can have on community health," he noted.
Diamond said he feels that it is his personal mission to help recruit more medical professionals into primary care. "I want my kids, maybe 10 years or so out, I want them to be able to say, 'I think I want to be a primary care clinician and maybe take over Dad’s practice.' I want to stick around until I can confidently tell my kids you absolutely should go into it."