26
The Observer
25.08.19 HealthAmazon has many detractors, but
even they concede it has been highly
successful in improving customer
experiences and cutting costs. Yet
the company’s move into healthcare
raises some fundamental questions.
What precisely are its ambitions?
Can we trust it with our sensitive
health data? And are its commercial
imperatives compatible with the
core values of the NHS, or do they
threaten its very existence?
While Amazon’s recent focus
on health has caught the attention
of observers, its interest in the
sector is far from new. As far back
as 1999 , it bought a big stake in
online retailer Drugstore.com. It
came back for another go in June
2018 when it paid close to $1 bn for
online pharmacy PillPack, which
has licen ces to supply prescription
drugs across the US. The global
healthcare market is worth more
than $7 tn , and health spending
consumes a huge proportion of the
GDP of major economies – 1 7% in
the US, around 11% in France and
Germany and 10% in the UK.
“ Amazon sees a highly ineffi cient,
highly regulated and potentially very
lucrative multi trillion-dollar global
healthcare market,” says Jeff Becker ,
a senior tech analyst at US market
research company Forrester. “While
most other companies are put
off by the high barriers to market
entry, organisations of the size
and complexity of Amazon are not
dissuaded, and see a major fi nancial
opportunity.”
Meanwhile, health systems across
the world are under pressure to
reform to maintain care levels in the
face of major challenges. The NHS
faces an ageing population, rising
demand for services, a funding
squeeze, the continued social care
gap and serious staffi ng problems.
Patient expectations
are also changing
Thanks to digital transformations
in other areas of our lives, we
expect to get what we want quickly,
conveniently and affordably in ways
that take account of our personal
needs. “Consumers in the UK can
order something at midnight and
take delivery the next day,” says
Anurag Gupta, an analyst at global
research consultancy Gartner.
“They’re starting to expect the same
level of service and fl exibility from
healthcare as from other industries.”
Amazon doesn’t like to go into
detail about its long-term vision,
but a series of recent launches,
acquisitions and appointments reveal
a clear strategy. In January 2018, it
formed a not-for-profi t joint venture
with banking giant J P Morgan Chase
and multinational conglomerate
Berkshire Hathaway. Later named
Haven , its public pronouncements
have been vague and modest, stating
that it aimed to provide improved,
cheaper healthcare for the three
companies’ 1.2 million employees
and their family members.
Suspicions that this is far from
the limit of Haven’s aims were
confi rmed in June last year when it
announced its new CEO was Atul
Gawande , a renowned surgeon ,
writer and ambitious reformer with
a fi rm belief in the power of data
to deliver safer, more effi cient and
better integrated healthcare.
Analysts say Haven is in reality a
test bed for new forms of employee
healthcare benefi ts. “The idea is to
apply Amazon’s culture of taking the
friction out for consumers end-to-
end and bring that to healthcare,”
says Becker. “I think Haven is an
incubator for a next-generation
healthcare delivery model, which,
after testing, will be made available
to general consumers.”
Amazon’s choice of partners in
Haven is also instructive. Berkshire
Hathaway ’s multi billionaire CEO
Warren Buffett has described
healthcare as the “ tapeworm ” of
the US economy. JP Morgan Chase
is one of the world’s biggest banks.
Together they would be well placed
to create and sell lower -cost payment
plans for other companies o r advise
them how to do so, based on an
in-depth understanding of insurance
risk and Haven’s experimentation.Amazon Prime
for health
Last year, Amazon unveiled Amazon
Comprehend Medical , a cloud-based
service that extract s information
from medical data including patient
records to provide new insights. In
April, it began offering Pill Pack’s
service – medications packaged by
dose and time – with free delivery
to its Prime subscribers.
Meanwhile, last month’s NHS-Alexa deal is the tip of a very big
iceberg. Amazon has announced
new Alexa applications under
development, includ ing ones that
manage health -improvement goals,
handle blood -sugar readings and
book appointments. Crucially, it
says it ha s created ways for devices
to handle patient information that
conform to US privacy laws.
Amazon consistently refuses to
discuss its healthcare plans. Neither
it nor Haven responded to multiple
requests for comment for this
article. In mid- 2017, it was reported
that the online retail giant had set
up a secretive lab to explore te ch-
driven healthcare disruption called
Amazon 1492 , presumably named
after the year Columbus fi rst arriv ed
in the Americas as a signal of its
paradigm-shifting ambitions.
Becker and others believe the
company is working towards the
launch of an Amazon Prime service
for healthcare. The company already
knows a lot about its customers,
including their reading preferences,
education levels, approximate weight
if they buy clothes, search histories,
and the eating habits of customers
of its Whole Foods subsidiary. Add to
this data from AI-powered extraction
from medical records, Alexa, fi tness
trackers and connected medical
devices , and Amazon will know
those who sign up inside out.
A Prime Health virtual doctor
could decide whether you need a
human doctor or just to stock up on
tissues, for example. Appointments
could be simpler and quicker to
book. Patients with chronic diseases
or those recently dischargedfrom hospital could be remotely
monitored , while medication could
become cheaper and quicker to
access. Alexa could provide alerts
and personalised health advice,
and even reward healthy choices.
“These elements are being
deployed incrementally, and I think
when we step back, what we’ll see
from Amazon is fully curated digital-
fi rst healthcare that, for example,
only brings in your GP when and
where it makes sense,” says Becker.
He is not alone in his analysis.
V enture capitalist John Doerr , a
friend of Amazon founder Jeff Bezos,
told a conference in November:
“Imagine what it’s going to be like
when he [Bezos] rolls out Prime
Health, which I’m convinced he will.”Amazon and the NHS
But aren’t Amazon’s ambitious, data-
driven plans more relevant in the US
than in the UK, where all have access
to free-at-the-point-of-delivery,
more or less comprehensive care? In
fact, NHS patients have been using
virtual GP services for some time. The
most high profi le is London-based
Babylon Health , which has more
than 50,000 registered patients and
recently launched in Birmingham.
Most observers expect digital
healthcare providers to work with
rather than in competition with NHS
providers, as they are already doing.
“These changes are relevant globally,”
says Becker. “There would be real
benefi ts to the UK public in some of
the innovations inspired by the kinds
of incubator models being generated
in Haven. Like the NHS-Alexa deal, IContinued from page 25Are Amazon’s
imperatives in
line with NHS
values – or do
they threaten its
very existence?
Tracking vital
signs at home
is possible
with devices
such as the
Withings
blood
pressure
monitor.
The Babylon
app uses
a mixture
of AI and
interaction
with human
doctors to
diagnose and
advise. In
Rwanda, the
service has
2 million
users; the
app is also
increasingly
being used in
the UK.
Apple Health
Records can
gather data
from clinical
and user-
generated
sources.
In the US,
healthcare
providers
can display
patient s’
records on
the app.
Last month,
DeepMind
announced it
had created
an app
capable of
predicting
acute kidney
problems 48
hours before
they happen ,
enabling
earlier
interventions.monito.GETTY IMAGES/iSTOCKPHOTOHow tech is changing healthcare