April 5, 2019
What have those upstart megaliths like Amazon, Apple, Google, Walmart, Lyft and Uber been toying with lately to disrupt our traditional healthcare models? From all appearances, they’re not wasting time; instead, several recent aggressive moves are making many traditional healthcare providers and payers nervous. For the first time “external market disruption” appeared among the Healthcare Executives Group’s top ten concerns in its annual research survey of members. With a membership of over 1500 payer and provider executives, the HCEG reported that 32 percent of respondents anticipate that “disrupting current business models” will have the greatest impact on healthcare in 2019. What disruptors in healthcare are keeping these healthcare executives up at night? Let’s take a look at the latest initiatives of the commercial giants who are putting the most money behind strategies to transform the healthcare industry.
This two-part series begins with an overview of Amazon and Apple’s activities, often in concert with other organizations. Next month’s Part 2 will review the initiatives of Google, Walmart, Lyft, Uber, and IBM.
The “Haven” Initiative
In early 2018 Amazon, Berkshire Hathaway and JPMorgan Chase announced the formation of an independent health care company aimed at improving healthcare and reducing its costs for their 1.2 million combined employees. The new non-profit has recently been named “Haven,” and has pulled together a prestigious leadership team representing both the provider and payer sectors and headed up by CEO Atul Gawande, a visionary surgeon and public health professor, and COO Jack Stoddard, a former general manager at Comcast with executive experience both at Optum and health benefit startup Accolade.
Stoddard recently said that Haven will focus on access to primary care, simpler insurance benefits, and lowering prescription drug prices. He said the three companies want to see if they “can reinvent what insurance looks like in terms of benefit design,” and are also looking at new ways to use data to improve the healthcare system overall. The venture will spend this year doing tests through partnerships with other companies, which could “potentially lead to lucrative deals for those who deliver.” Though the initial focus of Haven is officially the healthcare of the original investors’ employees and families, Stoddard has said, “If you come up with a great solution, why wouldn’t you make it available [to the marketplace]?” CEO Gawande wrote on Haven’s website, “We will create new solutions and work to change systems, technologies, contracts, policy, and whatever else is in the way of better health care.”
Many market reactions have suggested that the Haven venture will impact the entire healthcare industry. As Optum executive Michael Weissel has said, the venture is likely to take products and services to market. “Anytime they sneeze, our stock catches a cold,” he said. “So the market is definitely paying attention and thinks that this is going to be impactful on us.”
— The Alexa Initiative
Alexa is now HIPAA-eligible, Amazon announced April 4. Citing “voice as the next frontier for conveniently accessing healthcare services,” Amazon is following up on Alexa’s remarkably successful and affordable household tool to provide its own brand of patient engagement. It has already launched six initial Alexa healthcare skills working with major providers, payors, and other companies. For example, patients (i.e. parents) at Boston Children’s Hospital, Swedish Health, and Atrium Health can now use voice communication to exchange information on recovery progress and post-op appointments, schedule same day appointments with urgent care systems, and more. Through Express Scripts, a pharmacy delivery service, members can vocally check prescription status and get Alexa notifications when their orders are shipped.
In the early term, the Alexa program is expected to especially benefit the elderly and others who don’t use traditional digital devices like PCs, tablets, or smartphones. Given the nationwide enthusiasm for Alexa to manage tasks like answering doorbells and ordering takeout, it’s likely that soon healthcare tasks that portals are not managing efficiently, like accessing test results, communicating with physicians, and even paying bills will be a breeze with Alexa. Always-available, hands-free voice communications are expected to answer patients’ personal health-related questions and enable appointment scheduling, medication reminders, communications with physicians, and more.
— The PillPack Initiative
Amazon has acquired PillPack, a specialty delivery-based pharmacy company, and plans to combine its services to high-cost, chronically ill patients with Amazon’s “Basic Care” line of over-the-counter products. This move may make Amazon a serious contender in the retail pharmacy space, given its track record of low cost, convenience, and fast shipping, perhaps becoming even more attractive to patients than the community pharmacy.
— The Supply Chain Initiative
Amazon’s shipping prowess also has positioned the company to transform the healthcare supply chain, according to the Advisory Board. Several of its hospital clients are already using Amazon Business, including Summit Pacific Medical Center in Washington, which uses Amazon’s “dash” buttons to address 90% of its supply chain needs.
— The AI Initiative
Finally, Amazon has launched an AI-based data service called Comprehend Medical that is already being applied to pharmacies’ claim processing to predict whether an insurance claim will likely be denied,” according to CNBC in an interview with Taha Kass-Hout, a former FDA official who now runs AI operations for the firm.
— The Interoperability Initiative
Taking advantage of its longtime successful focus on digital consumer devices, Apple and over 200 major health systems and other providers have announced agreements that allow Apple to download the electronic health data of patients onto its various devices, with patients’ permission. Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine, Geisinger, Dignity Health, Allina Health and other hospitals and physician practices are taking advantage of a significant update to the Apple Health app with a new feature enabling users to view their medical records on their iPhones. Apple is also collaborating with EHR vendors, including athenahealth, Cerner and Epic, to help their users access personal health records on iPhones. This capability directly addresses the challenge of accessing healthcare’s holy grail — interoperability.
Apple developed its Health Records feature using FHIR (Fast Healthcare Interoperability Resources), in order to transfer medical records to and from disparate healthcare organizations and EHRs. Per Darren Dworkin, CIO of Cedars-Sinai, who has been working with Apple for some time, “Putting the patient at the center of their care by enabling them to direct and control their own health records has been a longtime focus for us. Apple… is uniquely positioned to help scale adoption because it has both a secure and trusted platform and has adopted the latest industry open standards.”
In New York, Northwell Health is installing Alexa in private rooms to allow patients to tap into their medical records. Mayo Clinic is using voice to deliver wound care instructions to some surgical patients. John Brownstein, chief innovation officer at Boston Children’s Hospital, reports that the institution is “piloting dozens of voice applications. Voice technology still remains at the edges of patient care, he added, but the hospital is already using it to improve the efficiency of ICU care and help prepare doctors for transplant surgeries.”
Apple’s FHIR-based communications achievement is especially significant since the many efforts to exchange health records in the last years have focused on getting doctors, hospitals and proprietary EHRs to communicate securely with each other — an approach that has been a disappointment of cat-herding proportions. The Apple-based strategy puts the data directly into patients’ hands, circumventing reluctant and disinterested industry players. It is expected that more medical facilities will connect to Apple’s new Health Records app in coming months.
— The Apple App Initiatives Using Apple Devices
Apple has created “kits” to enable developers to build apps for the iPhone and Apple Watch specifically in the areas of health information exchange between apps, medical research and clinical trials, and connecting providers with patients.
Health monitoring apps: Apple has provided its watch for studies examining its ability to monitor migraines, blood pressure, adherence in psychiatric care, and even as a virtual therapist for arm recovery in stroke patients, as reported by The Advisory Board. For example, Duke University School of Medicine and Stanford University Hospital have been using Apple’s HealthKit technology to allow chronically ill patients to remotely track and manage their symptoms. It is greasing more wheels through negotiations with at least three Medicare Advantage plans to subsidize Apple Watches to their patients to monitor atrial fibrillation, and already has agreements with Aetna and UnitedHealthcare to discount watches for health monitoring purposes to health plan beneficiaries who walk at least 10,000 steps a day, in order to help users track their progress against personal health goals.
According to the Advisory Board, Apple has filed patents suggesting it might let users measure their blood pressure, body fat, and heart rate simply by pressing their finger on the screen.
John Scully, former Apple CEO, believes that the Apple Watch is Apple’s most notable achievement in relation to healthcare transformation because of its sensory monitoring capabilities that can perform “life-saving feats like fall detection and heart rate monitoring… We’re about to move into an era where sensors … [and] algorithms are getting more powerful,” he said. “Technology and healthcare are moving from a vertically siloed, highly inefficient industry. The big health-care players want to move to platforms, they want it to be a horizontal model, just like we’ve seen successfully in retailing and in fintech and others.”
Research apps: One example of Apple’s foray into health research is the much-publicized Apple Heart Study. In March, the Stanford University School of Medicine presented preliminary results of the study, a first-time virtual study with over 400,000 self-enrolled participants. According to the report, wearable technology can safely identify heart rate irregularities that are later confirmed to be atrial fibrillation, one of the main causes of stroke and subsequent hospitalization. Apple made the study possible through a new app made available to customers age 22 or over who had Apple Watch Series 1 or later. Apple has other studies planned via a new partnership with Johnson & Johnson. One study is planned to investigate whether a new heart health program using a J & J app in combination with Apple Watch’s irregular rhythm notifications and ECG app can accelerate the diagnosis and improve health results of the 33 million people in the world who live with atrial fibrillation.
Apple is also moving into direct provision of healthcare. It has started its own primary care group, AC Wellness, to provide care to Apple employees. The company started with a clinic in Santa Clara County, California, but is reportedly ramping up. Recent hires include Sambul Desai, formerly chief of Stanford’s Center for Digital Health, and M. Osman Ahktar, former COO of Fairview Health. According to CNBC, many of the company’s physicians were hired in part for their experience in alternative management or wellness. Many industry observers are theorizing that if Apple’s approach is successful, it may inspire other large companies to adopt a clinic-based wellness approach and use Apple to test, pilot, and iterate on its own pre-market health care products.
Stay tuned for Part 2 of this report next month, where we will review the latest healthcare initiatives of Google, Walmart, Lyft, Uber, and IBM. Their disruptive ideas are flying!
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