Amazon is entering healthcare. And, of course, this news should lead us to believe that many of the industry’s most vexing problems are on the verge of being solved. Sigh. Of course, they are.
Recently Forbes published a three-part series entitled ‘Here’s How Amazon Could Disrupt Health Care’, that isolates five key criteria Amazon might leverage from its retail experience and use in healthcare.
Comprehensive customer records: Sure, the corollary to healthcare is that we can now presume that Amazon will deliver comprehensive medical records to patients. The jury is out on whether this can be accomplished. And perhaps, more germanely, whether we need another player in this space attempting a solution when others are already working on it. This is not something new nor something that we don’t know is a problem. But the problem is not simply one of ‘comprehensiveness’. It is not simply a problem of collecting and aggregating data. It is a problem of ensuring that the data leads to continuity and coordination of care. It’s not just a matter of knowing the personal history of every prescription or diagnosis but, rather, transferring that information seamlessly through the care coordination pathway.
Personalised content and user experience: The idea in this Forbes piece is that we can aggregate data from multiple sources and create a dashboard that helps the patient and the clinician move towards the ever-elusive goal of ‘better care’. This is a noble idea and one that everyone supports. But the foundational elements upon which this idea is built rely upon patient-reported outcomes, user-generated content and platforms (ie apps) that have proven not to be useful at changing behaviour in the long run for lots of people.
Price transparency and choice: This topic is a book unto itself. Sadly, the Forbes article does not add to the thinking on the topic either. It tells us what we know: that lack of price/cost transparency is choking our system, and everyone is worse off because of it. The article’s position is that it would be great if we had intelligent assistance in making choices about medications and treatment options. There is no argument there. It would be lovely. For Amazon to provide this service to patients we would need to know the real price (not the list price) of every drug and device on the market. We would need to know the level of rebate provided by the manufacturer and we would need to know silly little things like the retail, wholesale and PBM markups. Not to mention that we’d need to know how the algorithm was able to recommend a specific treatment or medication while simultaneously controlling for variables like socioeconomic status and baseline comorbidities.
Quality reviews: The upshot is that there is a mountain of quality data out there. And this data, in the hands of patients, can help them make choices about their healthcare. The analogy used is that of product reviews on Amazon. Wouldn’t it be great if we had something similar for healthcare, the article opines? First, we would need to risk-adjust all the data so that people know that the better-rated hospitals and the better-rated doctors are not simply seeing healthier patients. And, in parallel, we would need to ensure that every hospital was using the same system and that the metrics were truly meaningful measures of quality. Since health literacy is a massive issue, we would also need to make sure that patients could actually understand and interpret the information in order to make informed decisions.
Stellar execution and customer satisfaction: The Forbes article does an immensely under-whelming job at addressing this issue. The article states that Amazon has ranked best in customer satisfaction for 16 of the last 17 years and that it would be amazing if healthcare customer satisfaction rose to Amazon-like levels. Thank you. Noted. Let’s forget that defining customer satisfaction is difficult in any environment, leave aside one where your life literally depends on it. Assume we can agree on a healthcare definition of customer satisfaction that touches on the intersection of low cost, timely access, optimal outcomes and high quality of life. How exactly do you measure it? Do you ask all patients after every visit to every doctor about their experience? Do you take a cross section of, say, 100,000 interactions and extrapolate? Do you ask doctors, nurses, pharmacists and every other single allied healthcare practitioner about their satisfaction as well, since they too are customers of a sort? And doesn’t satisfaction of any kind depend on one’s own goals and objectives?
’Cadabra’. That is what Amazon was called before it was called ‘Amazon’. As in ‘abracadabra’ which is an incantation used as a magic word in stage magic tricks. If Amazon can pull this off, this might be its greatest trick of all.