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Changes at Amazon-owned healthcare services worry patients, employees

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Elderly patients took cooking classes and solved puzzles at Iora Health clinics, which also paid for taxi fares so they didn’t miss appointments.

Late-night phone calls, free transportation and the ability to text with clinical staff helped Deborah Wood, of Kennesaw, Ga., emerge from a worsening health crisis, she said. she declared. But since Amazon bought Iora’s parent company, One Medical, and renamed it One Medical Seniors, appointments have become shorter, clinical staff have lost their jobs and some of the unique offerings have disappeared, patients and former employees told The Washington Post in interviews.

Changes for senior patients like wood emphasize Amazon’s recent efforts to consolidate its telehealth, pharmacy and primary care services following its $3 billion acquisition of One Medical in 2022. Earlier this month, Amazon laid off hundreds of employees at Amazon Pharmacy and One Medical and announced a restructuring of the company. Current and former employees say the move has reignited concerns that the e-commerce giant is starting to prioritize profits over patients.

“Having a (doctor) who could coordinate your health care and was willing to do so on a personal basis was very important to me,” Wood, 69, said. “And I really feel like it’s completely gone, and I feel like it happened overnight.

Trent Green, Medical’s CEO, said the company remains “independent of Amazon’s management” and that any changes are unrelated to the acquisition.

Amazon has long had healthcare ambitions, but has struggled to realize them. In 2020, he attempted to improve health systems in partnership with JPMorgan Chase and Berkshire Hathaway in a now-shuttered company called Haven. Most recently, she created the Amazon Care virtual and home health clinic, which she hoped to sell as a workplace benefit, but close it in 2022 as it struggled to attract customers.

Amazon built its empire in part through big acquisitions. She is also known for her frugality, a core principle that employees “accomplish more with less.” When purchasing companies, Amazon has always looked for bargains and allowed its acquisition targets to operate independently while observing and collecting data. Only then did he gradually begin to shape these companies, as he did with Whole Foods and the gaming platform Twitch.

Today, Amazon’s healthcare offerings include Amazon Clinic, an online-only offering for common ailments that works with third-party medical providers; Amazon Pharmacy, spun off from PillPack, a startup the company acquired for $1 billion in 2018; and One Medical, the concierge primary care clinic with an annual fee of $199 that appeals to young, healthy, urban patients comfortable making appointments and talking to doctors via an app.

(Amazon founder Jeff Bezos owns The Washington Post.)

Over the past few months, Amazon has worked to onboard these companies, stocking One Medical waiting rooms with Amazon Pharmacy flyers, creating a program that allows One Medical doctors to consult with One Medical pharmacists for free. Amazon and offering Amazon Prime subscribers One Medical memberships at a 50% discount. .

Employees say they were shocked to learn that the consolidation would also result in the loss of a few hundred jobs in February. Some of the removed roles were for departments that overlapped with Amazon’s existing resources. In its marketing, recruiting and financial departments, employees said. But jobs specific to One Medical, including front desk staff, office managers, health coaches, behavioral health specialists and a pediatrician, were also eliminated, according to current and former employees.

The changes to One Medical “reduced administrative tasks for care teams and increased the number of appointments available to members,” allowing “in-office teams to focus on providing care to members,” said Green, who replaced Amir Dan Rubin as general manager. in September.

“The changes we are making today will position One Medical for sustained, long-term success,” read a February email to Green’s staff, which was seen by The Post. “They will help us reposition our resources so that we can continue to provide high-quality, affordable care to a growing number of members and help us leverage the resources available to Amazon to further integrate our operations and benefit from efficiency. combined.”

Green’s email to staff also stated that One Medical would introduce a regional general manager role. After reading the email, a One Medical doctor, who spoke on condition of anonymity to protect his job, said he was concerned that a new operational role was “an easy answer to any question of profitability (which) can quite quickly turn from a well-paced, humane job to a factory-style frantic race.

One Medical said regional general managers would work in partnership with regional medical directors who report to clinical management.

When Wood, the Georgia patient, felt her heart racing and her blood pressure drop one night, she picked up the phone and called the Iora Clinic. A health professional came to tell him what medication to take. “They called me back every 30 minutes to make sure I was OK,” she said. “It was exceptional.”

But since Iora became One Medical Seniors, Wood said she started seeing changes very quickly. “I’m now a patient of Amazon,” she said. Wood, who suffers from congestive heart failure and chronic kidney disease, said his calls are now routed to a call center halfway across the country and a call back can take days.

Iora Health was founded in 2010 on the principle that spending more on a patient up front would save money in the long run. The hot coffee, cozy fireplaces, and free rides were more than perks: They were meant to ensure that patients were consistent in their health care. A taxi ride might cost the company $10, but an ambulance ride after a 911 call cost much more, it was thought.

“Iora’s philosophy with the rides was that although transportation is very expensive, taking patients to the hospital costs even more. We prefer to pay for transportation to and from appointments to hopefully eliminate these hospitalizations. It made a little more financial sense,” said a former employee of Iora and One Medical in Seattle, who was laid off and spoke on condition of anonymity to protect his career.

As Iora moved to One Medical Seniors, former employees at other locations said standard appointments went from an hour to just 30 minutes, health coaches no longer assisted doctors throughout long appointments and that in-person mental health check-ins with behavioral health specialists were replaced. with virtual tours. The number of patients doctors were expected to see per day gradually increased, from six or seven to more than a dozen, the Seattle-based former employee said.

“Over the last six to eight months, it’s really become about the numbers again,” the former employee said.

One Medical said it began shortening appointments before the Amazon acquisition and that patients are now screened in advance by a centralized team to save time on office administrative tasks. The company said using a call center improved response times and patient care, and helped patients find transportation options to get to their appointments with insurance or local agencies.

Jaymee Blackbourn, a health coach specializing in treating seniors who worked at One Medical for two years, said in a LinkedIn post that her termination left her “heartbroken,” including for “patients whose health care and well-being are directly affected.” by these decisions. She did not respond to a request for comment.

Since its inception, Iora’s goal has been to serve low-income and chronically ill seniors on Medicare. Thanks in part to a federal program called ACO Reach that focuses on improving health equity for underserved populations, this company has seen success: in 2022, more than half of One Medical’s revenue came from Medicare payments. As the U.S. population ages, these business opportunities only continue to grow.

But changes Amazon is making to its senior health care business suggest it may not seize that opportunity, according to two former executives familiar with the company’s strategy. High-risk populations pose a challenge for the retail giant, which lacks deep healthcare experience, especially compared to One Medical’s privately insured patients, who tend to be healthier, younger and better off financially, the sources said.

One Medical said it plans to continue providing value-based care to at-risk patients, and although a few sites near San Francisco no longer participate in the special Medicare program for underserved communities, other sites are still active members.

‘Everything changed’

As Amazon continues its ambitious expansion into healthcare, one of its biggest challenges and opportunities is growing One Medical. To get started on this path, it started offering a 50% discount to 300 million Prime members in November.

But One Medical has fewer than 200 physical clinics in just two dozen mostly urban locations, meaning some Prime members who become One Medical patients will only be able to access the service virtually.

To cope with the influx of telehealth patients, Amazon began sending inbound messages through a central call center called Mission Control, former employees said. The company also trains an artificially intelligent chatbot to sort incoming patient messages and handle administrative queries, employees said.

After some reception positions were eliminated in the layoffs, Mission Control was initially inundated with additional calls, according to employee Slack messages seen by The Post.

One Medical said it is not overwhelmed and the centralized system improves response time. Amazon declined to confirm its AI plans for One Medical, but said it is still investing in technology that can reduce the time healthcare providers spend on administrative tasks.

One of Iora’s former employees said it was difficult to see her clinic – which once had 20 employees – reduced to five people, and to see patients “being pushed to virtual services”.

Amazon “tried to assure us that not much would change,” she said. “But fast forward to today and everything has changed.”

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