As Amazon builds out its healthcare business and expands its reach into hybrid primary care, pharmacy operations and virtual care, there are promising opportunities to integrate these services to offer a better healthcare experience.
A year after its big-ticket acquisition of One Medical, Amazon's pharmacy business is piloting a program to provide pharmacy consultations to One Medical primary care providers with a specific focus on high-risk and complex patients among the older senior population. The pilot started in the fourth quarter of last year, executives said.
"This is a pilot program that I think is pioneering and doesn't exist nearly enough in outpatient care, especially high-risk patients who are frequently at risk for readmission because they have multiple chronic diseases that require multiple medications," Vin Gupta, M.D., Amazon Pharmacy's chief medical officer, said during an interview.
The Amazon Pharmacy pilot program focuses on One Medical Seniors, which was previously called Iora Health, a program for patients over the age of 65. One Medical bought Iora Health and its 46 senior-focused clinics for $2.1 billion in 2021, before the Amazon deal.
"These are patients who would otherwise qualify for home hospital services if they were cared for in a traditional health system," Gupta said.
Through the pilot program, One Medical providers can request pharmacy consultations for a patient's medical regimen, especially for those on multiple chronic medications, to review medication interactions or to de-prescribe. The pilot program aims to improve patient care and reduce fall risks that may result from drug-drug interactions, Gupta said.
"In some cases, they're looking for opportunities to change dosing. These are things that are very common and that we do all the time in the inpatient world that allow for value-based, high-quality, low-cost care. That is not common enough in the outpatient world. I don't think it exists at scale," he said.
In hospital settings, it's common for providers to get pharmacy consultation services for patients, but those services typically don't exist in the outpatient setting where its needed for patients with complex conditions and complicated medication regimes.
"We were hearing from our One Medical Seniors providers, who focus on that geriatric population, those at high risk of readmission, that they would benefit from the type of pharmacy counseling support that I, as an inpatient provider, received all the time," he said. "You talk to any outpatient provider and there is no sort of a helpline that they can call to get pharmacy counseling support and yet, throughout training and in the four walls of any hospital, that is exactly what we are used to receiving, that close interface between provider and pharmacist."
This presents an opportunity for Amazon Pharmacy to fill that gap and enable clinical pharmacists to "practice at the top of their education," Gupta said.
Amazon’s $3.9 billion acquisition of One Medical made big waves when it was announced in July 2022, signaling that the online retailer had bold ambitions to expand its reach in healthcare. One Medical now falls under the Amazon Health umbrella, which includes Amazon Clinic and Amazon Pharmacy.
The One Medical deal expanded Amazon's reach into primary care as it now officially operates 220 clinics in 29 metropolitan areas. The deal also gives Amazon rapid access to the lucrative employer market as One Medical works with more than 8,500 companies and has a trove of member health data.
Launched in 2007, One Medical operates as a membership-based, tech-integrated, consumer-focused primary care platform offering care at brick-and-mortar clinics as well as near-site and work-site care along with virtual health services.
Amazon Pharmacy launched four years ago in 2020 after the company acquired PillPack in 2018. Amazon Pharmacy has largely been focused on price transparency and affordability of branded and generic drugs. Amazon rolled out RxPass, a prescription drug subscription for Prime members and it launched drone delivery for prescription medication orders with the service initially taking flight in College Station, Texas.
Building on its One Medical deal, in November, Amazon rolled out a new One Medical for Prime membership, including 24/7 virtual care, for $9 per month, or $99 a year.
During interviews on the sidelines of the HLTH 2023 conference in Las Vegas last fall, Amazon Health executives said they were looking at ways to combine One Medical's expertise in patient care with Amazon's tech capabilities to scale up integrated primary care and dramatically improve both the patient and provider experiences.
The biggest potential for Amazon Health and One Medical to "move the needle" in healthcare is to leverage its care model combined with tech to tackle the burden of chronic diseases in the U.S., Andrew Diamond, M.D., Ph.D., One Medical's chief medical officer, told Fierce Healthcare last fall.
Gupta said the pilot program is getting strong uptake from One Medical Seniors providers and continues to grow.
"The feedback [from providers] has been overwhelmingly positive when it comes to this provider support, directly and indirectly, impacting clinical care, enabling value-based care in a framework for One Medical Seniors that is an at-risk model where we're doing everything we can to keep these patients at home and healthy and to lower the risk of readmission," he said. "To me, this is pioneering something that is very prevalent in some parts of the U.S. healthcare system, but not nearly enough where it's needed the most, which, in my opinion, is this high-risk population that is just gone back home and we need to help keep this population at home to the greatest extent possible."
Amazon Pharmacy is piloting this program as more health systems invest in hospital-at-home programs to move medical services from the four walls of hospitals to patients' homes. Often, these health systems are partnering with companies like Best Buy Health to provide the tech and logistics support for these programs.
"This is a care paradigm that is going to become, I think, much more common where you have high-risk patients needing multidisciplinary care and that's where we feel like there are growth opportunities potentially as well," Gupta said.
Amazon also is exploring opportunities to use generative AI to automate pharmacists' workflows and reduce administrative burdens, which gives them more time to focus on patient care and "practice at the top of their license," noted Alexandre Alves, senior principal engineer at Amazon Pharmacy, during the interview.
Amazon Health executives also exploring opportunities to leverage Amazon's deep tech expertise to build more advanced predictive models to identify patients at high risk of a serious health event and intervene earlier by sending "nudges" or other digital engagements.
Through the Amazon Pharmacy pilot program, providers focus on senior patients identified as being at higher risk for hospital readmissions or at risk for complications due to their medical regimes.
"We could provide this service more broadly and some of our providers within One Medical clinics caring for the general patient population have said they would love to have pharmacy counseling support. And, I understand that, because what provider wouldn't want to have a helpline for the pharmacist? But we only have so many in the way of human capital to deploy for the service, and we're trying to target where we think they can have the greatest value," Gupta said.
He added, "What these pharmacists do is incredible. It is really multidisciplinary top-of-education pharmacy practice where they're looking at complicated regimens and opportunities for de-prescribing. This is something that is needed for the One Medical Seniors and their high-risk patient population, but there's a broader need across the country."
As the program continues, Amazon Pharmacy and One Medical leaders want to track clinical outcomes such as reducing fall risk and hospital readmissions.
"I think we're going to be able to look longitudinally at outcomes like, can we reduce fall risk, and what are benchmarks that we can compare for this high risk-cohort? We would certainly want to look at metrics that evaluate this service and multidisciplinary care and reducing the risk of readmission," Gupta said. "We also want to look at, do the providers feel like this is a valuable use of their time?
Amid growing levels of physician burnout and as clinicians focu on spending more time with patients, this type of pharmacy consultation service is proving, in its early days, to be valuable to One Medical Seniors providers, Gupta noted.
"How many people talk about value based care? To me, this is the very definition of a service that aims to really enhance the value of care at the lowest cost possible, especially as One Medical Seniors assumes full risk of that patient's care," he said. "We're looking at clinical impact over the medium-term but in the near term, we're evaluating whether providers find it valuable."