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Our Take: Amazon achieves goal of rolling out virtual health services nationwide, plans to expand in-person care

Feb 14, 2022

Amazon Care’s virtual health services are now available throughout the U.S., Amazon revealed last week, and the company says it will expand in-person care services to more than 20 additional cities this year.

When Amazon Care began as a pilot in September 2019, it was a virtual health clinic for employees and their families living in the Seattle area. Users could have a digital chat or video visit with a clinician, and those needing additional care could request a home visit by a nurse, who could perform screenings, immunizations, blood draws, and other basic services.

Not quite a year ago, Amazon announced that it would be expanding Amazon Care’s telehealth services not only to all of its own employees across the U.S., but also to those of other employers, starting with companies in Washington state. At the same time, Amazon said it would expand the home visit component of Amazon Care to Baltimore, Washington, D.C., and other cities in the northern Virginia market, where Amazon is building its second headquarters.

In addition to the cities noted above, Amazon Care’s in-person services are currently available in Arlington, Austin, Boston, Dallas, and Los Angeles. This year’s expansion will target cities in other major metropolitan areas such as Chicago, Miami, New York City, and San Francisco.

“Patients are tired of a health care system that doesn’t put them first. Our patient-centric service is changing that, one visit at a time,” said Kristen Helton, Amazon Care’s director. “We’ve brought our on-demand urgent and primary care services to patients nationwide. As we grow the service, we’ll continue to work with our customers to address their needs.”

Our Take: Virtual primary care seems to be the hot ticket in health care these days, spurred in no small part by the pandemic. The rise of telehealth as a means of delivering preventive and primary care has been nothing short of meteoric.

Payers and self-insured employers have jumped on the bandwagon, developing virtual-first health plans that emphasize — and in some cases require — the use of online visits as the initial point of contact for nonemergency care. If warranted, the plan member’s online physician can make a referral to another in-network physician for in-person care.

Most virtual-first plans offer substantially lower premiums, along with $0 copays for virtual primary care services. Many offer additional services, such as chronic care management, mental and behavioral health care, and health coaches who work with members to develop and achieve personal health goals.

Even Teladoc Health, one of the top telehealth companies, announced in November that it was partnering with Trustmark Health Benefits to launch a health plan design called myVirtualCare Access for self-funded employers. Naturally, the plan design features Teladoc’s primary care service, Primary360. Trustmark serves as the third-party administrator.

Each announcement of a new virtual primary care offering touts the potential to redefine, revolutionize, or transform the future of health care. But while there are known advantages associated with virtual care (e.g., convenience, cost savings, greater efficiencies, and possibly even better access to care — though not in many rural and lower socioeconomic communities, where internet access can be a problem), there are also potential disadvantages.

For example, primary care physicians (PCPs) can identify signs and symptoms of chronic and debilitating illnesses ranging from depression to Parkinson’s disease during office visits. As some critics have pointed out, those signs and symptoms may not be as noticeable during a virtual visit as they are in person.

On the other hand, for people who skip routine care because they don’t have a PCP, virtual care could prove to be beneficial. Easy access to an online physician, along with a care team that can assist them with other health care services, might encourage them to seek preventive and routine care.

A study published Dec. 16, 2019, in JAMA Internal Medicine found that 25% of U.S. adults did not have an identified source of primary care in 2015. Among those in their 30s, the proportion was even higher, at 36%.

Not surprisingly, a Kaiser Family Foundation analysis of health-related disparities in 2020 found that the lack of a PCP was more prevalent among minorities and men, with 42% of Hispanic men indicating they did not have a PCP.

There are potential downsides associated with virtual-first health plans, too. As Drs. David Whitehead and Ateev Mehrotra noted in a JAMA Viewpoint article published on Nov. 22, 2021, those “likely to embrace a virtual-first product will be younger and more highly educated people who, on average, use the health care system the least. By preferentially enrolling healthier people and therefore having enrollees with lower health care expenditures, the plan can be profitable regardless of whether the plan leads to improved care.”

We all know what happens when health plans can cherry-pick healthier enrollees: Medicare or Medicaid ends up providing coverage for a greater proportion of sicker people who use more, and more expensive, health care services.

It’s clear that many of the industry’s top stakeholders believe the demand for virtual care will persist beyond the pandemic, even though we’ve seen it drop off between surges. Amazon is betting on virtual care in a big way as the company continues to grow Amazon Care’s “unique hybrid care offering.”

What makes Amazon Care “unique” is that the in-person component is delivered in the patient’s home or office. Amazon says this combination of “the best of virtual care with a new approach to in-person care” will make it possible for patients to “build lasting relationships with their health care providers over time.”

Of course, in doing so, patients will also be building a lasting relationship with Amazon … and Amazon Pharmacy, as well.

What else you need to know
Pfizer’s COVID-19 vaccine is the highest-selling pharmaceutical ever, having generated $36.8 billion in sales last year. Of that total, $7.8 billion were U.S. sales. According to Endpoint News, Pfizer currently controls approximately 70% of the COVID-19 vaccine market in the U.S. and Europe. In its recent earnings report, the company raised its 2022 revenue guidance for the vaccine, marketed as Comirnaty, to approximately $32 billion and issued 2022 initial revenue guidance for Paxlovid — the recently approved oral COVID-19 treatment — of approximately $22 billion.

Sanofi is ditching the Pasteur and Genzyme names associated with the company’s vaccine and specialty care business units, bringing them under the Sanofi umbrella. The company is also revamping its brand identity with a new logo. The Paris-based pharmaceutical firm unveiled the changes earlier this month, stating in a press release that the new brand brings the company’s “diverse history together in a single common identity for the first time.” Sanofi also said it would trim its workforce by an estimated 6,000 positions before year-end and terminate several early to midstage clinical programs. A company spokesperson told Endpoint News that the job cuts include about 3,200 employees who will transition to Euroapi, the spinoff of Sanofi’s European drug ingredients business planned for this year.

Biogen received a civil investigative demand from the Federal Trade Commission and an inquiry from the Securities and Exchange Commission (SEC) for information pertaining to Aduhelm (adulimumab), the company’s controversial drug for Alzheimer’s disease. Biogen disclosed the two investigations in a Form 10-K filed with the SEC earlier this month, stating that the requested information is related to “health care sites” and the drug’s approval and marketing.

Ascension and Labcorp signed a collaborative agreement under which Labcorp will manage Ascension’s hospital-based laboratories in 10 states. Labcorp will also purchase certain assets of Ascension’s outreach laboratory business. The agreement gives the Catholic health system’s clinicians and patients access to Labcorp’s diagnostics and at-home test collection services. Ascension’s physicians and patients will also have additional access to clinical trials, as well as new therapies and treatment options, through Labcorp Drug Development, the company’s contract research business. The agreement is expected to close in the first half of this year; specific terms were not disclosed.

Sutter Health is the defendant in an antitrust federal jury trial that began last week. Northern California’s largest health system is accused of engaging in “all-or-nothing” contracting practices that caused fully insured health plans to pay more for health care services. To cover the increased costs, the health plans raised plan members’ premiums, affecting least hundreds of thousands of consumers. Plaintiffs in the class-action lawsuit, which include individuals and employers, are seeking compensation for the overcharges as well as a court order prohibiting Sutter Health from engaging in the alleged anticompetitive practices. In 2019, the health system agreed to pay $575 million to settle a similar lawsuit brought by workers unions and self-funded employers.

What we’re reading

Mount Sinai, Providence and 21 other systems share their social media strategies. Becker’s Health IT, 2.10.22 

What else we’re reading

Putting the Rabbit in the Hat: A Memoir, by Brian Cox.

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