Online Shopping List of the Future: Milk, Eggs, Toilet Paper, and Primary Care

When Amazon announced that it would expand its app-based health care services nationwide, legacy health giants screamed into their collective pillow.

Consulting firm Axial Benefits Group hosted a webinar for brokers titled, “Amazon Care: A Serious Threat!” (emphasis, theirs), the theme of which was that Amazon, Google and Apple will eventually decimate the healthcare industry as we know it.

Anyone who is not a legacy health care player might rightfully answer: “So?”

It’s hard to argue that disrupting the healthcare system is a bad thing when the healthcare system is so mind-numbingly awful. Tech giants and large corporations like Walmart understand customer service and can leverage their size and streamlined processes. Most importantly, they’re not affected by the perverse incentives currently baked into our healthcare system.

So, let legacy health wring its hands. Horse and buggy drivers probably sweated the invention of the car. But it was time to grab the steering wheel then, and it’s time to drive healthcare in a new direction now.

Why This Is Happening

The power shift that we are witnessing has its parallels in the Kaiser Permanente origin story, with Big Business building a bridge over a broken system to provide healthcare access for their own workers and then, eventually, the public.

After the shuttering of its joint venture Haven, Amazon launched Amazon Care for its employees. The move provided much-needed telehealth and in-home services to its Washington-based employees at the height of the pandemic. This expansion builds on the program’s success and lessons learned.

Meanwhile, Walmart has been flying its employees to Centers of Excellence for specialty care for years, finding that it is more cost effective to cover travel and treatment at quality facilities than for patients to seek less-optimal care closer to home.

Walmart is the country’s largest employer and has the clout to demand real change in the industry. And with 195 million weekly shoppers nationwide, it also has the incentive to take consumer health into its own hands. In 2019, Walmart opened 15 in-store clinics and is expected to open another seven this year.

These Walmart Health clinics lower the cost of delivering healthcare services by about 40 percent for patients, chiefly by eliminating “administrative baloney,” according to Walmart’s former health and wellness president Sean Slovenski.

With more money in their pockets, patients at these clinics will be able to afford more cold medication, orange juice and humidifiers before exiting the store, a bonus the retailer is counting on.

So, what will it mean when patients start visiting their primary care doctors while picking up sushi at Amazon-owned Whole Foods, or getting a flu shot while shopping for school supplies at Walmart? For different players, the power shift will mean different things.

What It Means for Hospitals

Even without Big Tech entering the healthcare field, hospitals were suffering. The pandemic is expected to cost hospitals an estimated $53 billion in lost revenue this year. With the public’s swift adoption of telehealth for urgent, mental health and even primary care, it is not difficult to image that hospitals will become the malls of the future: vast, empty buildings searching for a second life.

To reinvent themselves, it is possible that hospitals will take their cue from Walmart and focus on becoming Centers of Excellence. Rather than compete for the same set of patients, these reimagined medical centers would offer expertise in particular areas, drawing patients from across the country to receive specialty care.

Or, to stick with the mall analogy, hospitals can always try to rent themselves out as movie sets.

What It Mean for Payers

For years, insurance companies and health systems gave a lot of lip service to value-based care, which incentivizes high-quality, low-cost care over high-volume, sick care. Tech giants and large businesses are forcing those conversations into action.

To stay competitive, payers like United Healthcare have focused on building their own models of data-backed value-based care that includes infrastructure support such as technical assistance. Meanwhile, others like Blue Cross Blue Shield are looking to collaborate with tech giants to accelerate change.

“I do believe that by applying their ability to innovate and their deep knowledge of consumer behaviors and technologies, these consumer tech giants will accelerate the consumer movement in health care,” Curtis Barnett, president and CEO of Arkansas Blue Cross Blue Shield, said in a speech in 2018.

What This Will Mean for Doctors

Driving a stake in the heart of fee-for-service, tech companies might ultimately be doing doctors a favor. True, reimbursements will change, but physicians will remain relatively high income earners.

Stripped of perverse incentives, internists will find that they get to practice the medicine they thought they were going to practice while in medical school. Like direct primary care models, value-based care could combat rampant physician burnout. And while specialists might earn a little less than in the current model, a resetting of expectations could shift more talented, high-achieving medical students away from procedure-driven specialties and toward the preventive medicine that people in this country desperately need.

What This Will Mean for Patients

Technology has been the great equalizer of our times. The experience you get with an iPhone is the same whether you make $4 million a year or $40,000 a year. Extending that equity to healthcare will have a profound effect on everyone, particularly low-income patients.

Telehealth has removed so many barriers to healthcare that the American Medical Association is urgingCongress to make sure Medicare patients continue to have access to it post pandemic. And technology has the potential to create the kind of cost transparency that could help curb healthcare spending waste.

A Better Future?

While it’s easy to see how consumer-focused tech giants will shake up commercial plans, I would love to see a disruption in Medicaid. Technology could level the playing field, providing easy access to affordable quality primary care and help prevent costly and debilitating illnesses.

Imagine a low-income person not having to ask, “Will this be covered?” Imagine that person’s doctor looking up prescription prices on the spot to recommend the most affordable options. Then imagine this patient picking up those prescriptions right outside the doctor’s doors — just through aisle 8, past the shampoo and toothpaste.