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 Today in Health it, the catalyst for our conversation is that Amazon Care expands their telehealth offering for employees to 50 states, and we're gonna riff on this and what it means for health systems. My name is Bill Russell. I'm a former CIO. For a 16th hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged.

Today's sponsor is Sirius, Sirius Healthcare and they are a fantastic sponsor. They have been supporting us since the start of the Pandemic, really is where we came together. They were excited about our mission to develop the next generation of health leaders and they wanted to be a part of it, and the rest is history.

If you believe in our mission and wanna support our show as well, please shoot me a note partner at this week in health it.com. Alright, today's story, uh, Amazon Care, expanding their telehealth in 50 states. I'll go to Healthcare IT News, give you a little background on this. Uh, sources told Insider that the company plans to make its app-based Amazon care services available to employees throughout the country.

We actually talked about this earlier in the week, either on the Newsday show or on a previous today show. And the reason we talked about, it's because the partner that Amazon has in the Washington State has filed to operate in 17 more states, and that was the precursor to saying, Hey, they're taking Amazon care out to all of their facilities.

Today's announcement or revelation that healthcare IT news came up with essentially is identifying that. They're taking their app and their telehealth services out to all their employees in all 50 states. So this is a precursor to them making a significant move, not only for their employees, but into the employer market, which as we know is the commercial payer market.

And direct to employer is one of the most lucrative for health systems. And so that's why it is an important part of the conversation. What is Amazon Care? We talk about this a lot. Amazon Care is essentially a concierge level service for Amazon employees. The reason I say concierge is because they will come to you.

They'll come to you in your office. They'll come to you in your home, and they will see you. They'll do it via telehealth. They will dispatch a nurse or doctor if it's required after the telehealth visit to get a closer look. They will send their medications. Directly to your home. If you get sick in certain diagnosis, they will send you to a provider, some of top tier providers in the country that they have signed deals with.

I actually wrote it for my blog. They picked it up and it's called How Amazon Can Have a Prime Impact on Healthcare. Essentially, this article describes exactly what they're doing and it says that they are able to bridge the gap. Amazon's able to bridge the gap between the, the digital and the virtual world and the physical world.

They're able to not only, uh, engage you on the digital platforms, but they're able, also able to engage you, uh, physically wherever you live in the country. I was talking to Mike McSherry, the CEO of Zel, and we were talking about, there's just this concept of how digital has impacted. Our healthcare delivery and I, I threw out this concept, which I've talked about a couple times, which is essentially how would the vaccination program had gone if they had just given it to CVS, Amazon and Walmart.

And even if they had just given it to Amazon, I think it would've been highly efficient, delivered directly to your home, and it would've been done very orderly and whatnot. They would've figured out how to do the freezers in the various locations that they needed to do because they just get logistics.

They have a ton of information on me and most of the people in the United States, 'cause we all shop at Amazon and they know how to reach us. They know our current address. They know how to contact us via text and other ways. If we allow them to do that. So they're a company that's very adept at reaching into our home, at reaching us where we live and providing services to us.

And so that's the danger here. The danger to health systems is they're adept at the very thing we are trying to get good at. They're adept at reaching people, at understanding people, at having a whole person profile. What are these people buying? Uh, what kind of books do they read? Most of us have taken a significant amount of our shopping online recently.

They really have that, that whole person profile, which as we know. Only 20% of health is actually healthcare related. The rest of it is related to what we eat and the decisions we make and where we live and the education we have. And so Amazon has a more complete picture of the individual and therefore has a leg up with regard to information and utilizing that information on a couple different levels.

One of them is in this article I talk about that I believe their end game. Is as an insurance provider, so they are going to essentially stand up these programs in hopes of going direct to employers. I don't think this is a direct to consumer play. In any way, shape, or form, I think they're gonna go to employers and say, look, we have this service.

We're doing it for our employees in all 50 states. So they immediately become a national player and we can deliver it for you. You know that model that you've been asking for for years from the insurance carriers. From healthcare providers that they've been unable to deliver to you, we're ready to deliver that.

We're gonna do virtual first, virtual visit first, but if the virtual visit doesn't work, we're not gonna make you come into our office and sit in our waiting room. We're gonna send somebody out to your location, concierge level service. And by the way. Uh, it's going to include all the prescriptions, all the medications, and therefore they're capturing so much of, of the revenue that is out there.

And, and then you move beyond that and you say, look, we've negotiated deals with, fill in the blank, with, uh, city of Hope, which they have negotiated deal with, with Mayo with. You know, fill in the blank. They're gonna negotiate deals with the academic medical centers around the country and say, look, we're gonna filter people into your locations on certain diagnosis, and then it really is gonna be about quality and cost, because they're gonna control the.

Activities of the consumer of these employer programs in order to drive costs out of the system, and that's what I want as an employer. I want them to drive costs outta the system, provide an exceptional experience for my employees, and deliver a higher level and higher quality. Of care for my employees.

But right now it's impacting anywhere where there's a significant Amazon employee base. Right? So if you look at Seattle, for example. Seattle's a great case study of what's happening. Now, I don't have any insider information on this, but if you look at it and you say, look, the competition for Providence has got gotten pretty heated at this point.

You have Kaiser there. You have Amazon taking all their employees and doing this Amazon care model, and potentially Amazon who is standing up the physical aspect of this in the state of Washington going to, I don't know, Boeing and others. And and saying, look, we can provide this level of care and health systems haven't been able to do that to date.

And that is what represents the biggest challenge. And it's not only from Amazon. Just to be real clear, there are other entrants in this space that we have to, uh, consider and be concerned about. Clearly, Optum is a significant player in this space. We have, um, CVS, we have Walmart, you know, Kaiser can't be underestimated.

And then you have Amazon, and I think those are the national players to keep an eye on right now. Right? So Optum, CVS, Walmart, Kaiser, and Amazon. And then there's gonna be interesting partnerships that sort of come out of this. You're gonna see Cigna partner. You're gonna see partnerships start to happen between health systems as they start to put up defenses against the onslaught, really, of these players.

And let's be clear, they're not gonna stand up hospitals, they're never gonna stand up hospitals. That business is not going away. But what they are going to do is they're gonna start controlling as much of the dollars that get spent in the hospitals as possible. And that represents a significant challenge for health systems.

This is probably not a pick me up, and it really wasn't meant to be a pick. Pick me up. It's meant to lay it out. What's going on here? Optum continues to expand and now you have Amazon taking their . Amazon care out to all 50 states, which is a precursor to out to the market. And you have Walmart pulling back a little bit, but you have CVS pushing forward a little bit and I think it's going to be interesting to watch.

I. The the so what for this is you have to fine tune your digital initiatives. You have to, uh, fine tune your ability to manage costs and manage risk because you have to figure out a way not to get dis mediad from the patient and from the consumer. Health systems have to figure out how to develop that relationship.

That one-on-one relationship where they. Are managing the care from the first phone call to the last event, and, and, and that's gonna require a significant amount of digital tools. It's going to require a significant amount of technology. It's gonna require a significant amount of new skills, designed thinking, and the ability to create care journeys and not only imagine the care journeys, but make them a reality on top of

Platforms and that's gonna require us to think beyond the EHR. We are going to have to tap into other technologies and bring those together seamlessly. The EHR is one aspect. CRM is another aspect. We've gotta a, as well as all the other health data that exists out there, we've gotta figure out how to bring that in, create that whole person profile, and move forward on this.

I realize this is a little longer than I usually go. Just got me going on a rant. Thought I'd, uh, share what I wrote, I don't know, four, a little over four years ago. It's interesting to see it now coming to fruition, and it's interesting to, to just imagine what the impact of this is going to be on healthcare as a whole.

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