Is Amazon Primed to Take on a Bigger Role in Healthcare in 2022?

Amazon is poised to continue its 2022 expansion in more than just e-commerce sales. It’s about to become the largest U.S. carrier for delivery services. Yes, larger than the U.S. Postal Service, UPS and FedEx. That may sound unrelated to healthcare, but it really isn’t. That infrastructure is helping Amazon deliver their own branded PCR COVID-19 tests. It’s helping them deliver pharmaceuticals through PillPack. And it may help them become an even bigger player in the home health arena.

With Amazon, “their movement is large, but it’s also really long,” says Robin Gaster, a visiting scholar at George Washington University Institute for Public Policy and the author of “Behemoth, Amazon Rising: Power and Seduction in the Age of Amazon.” Amazon observers such as Gaster expect Amazon’s current healthcare endeavors to grow this year but don’t anticipate a big, splashy announcement for a new service or product. The moves into healthcare are likely to be more subtle, with entry into new markets for current offerings, or an expansion in capabilities.

Here are three areas to watch in 2022:

1. Amazon Care’s embrace

One of Amazon’s main healthcare moves right now is primary care. Just as Amazon built Amazon Web Services for its own data storage use and then commercialized it, the company is positioning itself to do the same thing with Amazon Care. “They build something for themselves and then sell it to others,” Gaster notes.

Amazon Care rolled out in 2019 as a service for the company’s Seattle employees, followed by an expansion to its Washington state employees in 2020. Last year Amazon extended virtual care to its employees in all 50 states. This year, employees in 20 major U.S. cities can access in-person healthcare services, including home or office visits, plus telehealth.

With low reimbursement rates to providers and few procedures to bill for, primary care has long been a problematic area for American healthcare and its providers. Primary care is, in theory, a bargain, partly because preventive services can reduce the utilization of expensive acute care. But it is also hard to please the patients who want convenience and affordability. This presents an opportunity for Amazon, as the “customers” are not especially well treated in primary care, Gaster says. “It’s a place where Amazon’s focus on the customer could pay big dividends.”

In 2022, Amazon may start turning healthcare into an engagement vehicle to make employees happier while improving health outcomes and potentially shaving costs for employers. With the pilot venture and national expansion under its belt, Amazon Care signed up fitness company Precor, its first outside employer client, in May 2021. The app-based primary and urgent care was offered to a subset of Precor’s Washington state employees. The hospitality company Hilton signed on next, in November 2021. All U.S. staff members enrolled in the corporate health plan will receive this benefit in 2022, including texting services, virtual healthcare visits and house calls, depending
on the location.

2. Remote diagnostics

Although Amazon did not try to draw a lot of attention to its entry into COVID-19 testing, the company began offering PCR tests online in 2021. “I thought it would be antigen tests, but it makes more sense for PCR, as it lays into their logistics infrastructure,” says Tom Kiesau, leader of digital health at The Chartis Group, a healthcare advisory firm. “Amazon has the logistics to easily drop the test off and pick it up again, bypassing the clinic setting,” adds Kiesau, “and they have the data infrastructure to quickly share the results faster than many other organizations.”

The Amazon Halo isn’t new, but it may gain capabilities in the next few years to make it more of a player. The diagnostic tool and fitness tracker caters to that relatively narrow niche of quantified-self adopters — people who enjoy monitoring their activity levels, heart rate, sleep, body fat percentage and vocal tone, which can be analyzed for signs of stress. Consumers may find some of these functions useful, notes Kiesau, but “I don’t necessarily see a direct (patient) benefit” at this point. It needs more capabilities to create good value, he says.

Those additional diagnostic capabilities might be tools to manage diabetes and heart disease, and to do it more effectively than it’s done now. “Those are the diseases that are bankrupting the health system,” says Gaster. If Amazon can find ways to significantly reduce the costs by lowering testing costs and making tracking more effective, clinicians could perhaps intervene earlier and head off hospitalizations and other kinds of expensive healthcare.

3. In the home

Alexa, Amazon’s virtual digital assistant, already has a library of advice for breastfeeding, first aid and issues including improving medication management and adherence. But this year Alexa will continue making inroads in the home setting, particularly for the older population. Amazon sees Alexa as the hub of home care with the potential for knitting together an at-home care model comprising family members, clinicians and expert caregivers as well as the people needing care, many of whom are seniors.

In October, Amazon announced that Alexa Smart Properties would be used at senior living providers such as Atria Senior Living and Eskaton and at hospitals such as Boston Children’s Hospital, Cedars-Sinai, Houston Methodist Hospital and Baycare Health System. They will use Alexa to connect residents and patients, providing information and entertainment. Amazon is banking on the Echo devices making caregivers more efficient with the Drop In feature, which allows others to connect with residents or patients without having to enter the room. “With the Drop In capability, if I’m a health system, I can have a virtual entry point into almost every patient home,” Kiesau says. Patients talking to their local clinicians may be more comfortable with the service. For now, Amazon is just in charge of the logistics, with the clinical expertise left to the healthcare organizations. It will be interesting to see whether Amazon moves into the care portion in the future.

Alexa Smart Properties complements Amazon Together, a subscription service allowing loved ones to remotely check on older adults or those needing monitoring. “It’s a pretty smart solution to a growing problem,” Gaster notes, with so many parents living away from their grown children. The tool allows those given access to monitor the person’s activities and potential falls, and to call for assistance when needed. It solves a problem, as “there’s an extreme shortage of nurses and people to work in home and congregate care,” Gaster says.

Amazon may move more into services and supportive care for patients with medical issues. In 2021, Penn State started offering supportive care to those with metastatic breast cancer, with Amazon Echo Show answering questions about symptoms such as pain, fatigue, sleep and mental health issues. It shares evidence-based interventions including cognitive behavioral therapy and guided meditation. Tools like this can help extend healthcare services into the home while freeing up clinician and staff time, and still provide value to patients.

The 2021 American Rescue Plan provided additional funding for home care for seniors and those with disabilities, and Amazon Care, Intermountain Healthcare and Ascension joined forces to form a healthcare coalition called Moving Health Home to advocate for expanding home-based clinical care. Kiesau said he was surprised to see two established healthcare provider groups partner with Amazon Care. However, the complexity of deploying a hospital-at-home solution involves distributed logistics, nursing, respiratory therapy, devices, lab studies, phlebotomy and devices.

“There’s so much getting moved around,” he says, and it’s hard enough for hospitals to track it in their own facilities, let alone tracking it across a metropolitan area. “Amazon is pretty good at doing that. On my phone I can see where my package is on a map and it’s telling me, based on the driver’s projection, when (it’s) going to get there.” That ability and technology ecosystem make Amazon a logical choice as a partner in a home-based care program.

AWS and data

In mid-2021, Amazon launched Amazon HealthLake as a general service. The company already stored data through its AWS service, but previewed this service in 2020. Amazon HealthLake gives healthcare organizations a HIPAA-compliant service for analytics and visibility of both individual and overall patient populations.

"This is a place where their technology and pretty insatiable thirst for data can come into play because they can provide services potentially at the top end of the healthcare system on the data side, all the way from managing clinical trials way down to patient data," notes Gaster. Through data, Amazon can gain or retain an edge with integration capacities helpful in providing services and acquiring data for and from partners. “In the world of machine learning and artificial intelligence, the one with the most data wins,” says Gaster.

During a preview period, several customers used Amazon HealthLake for different purposes. Rush University Medical Center used it to address health inequities in its COVID-19 response, to better understand how the organization was caring for patients with the disease. The center also extracted information from the medical records on the patients medications, previous conditions and diagnoses to provide more comprehensive information to providers. Cortica used the service to better track the progress of patients with autism. And CureMatch used it to help provide clinical decision support to oncologists for personalized cancer treatment options. With increased access to healthcare organizations in 2022, one can expect the use cases to expand.

The end of Haven

Amazon starts a lot of pilot schemes. Not all of them have taken flight. The Haven healthcare venture, which Amazon, JPMorgan Chase and Berkshire Hathaway formed, shut down in early 2021. Although some in business said Haven failed because it’s difficult to disrupt healthcare, Kiesau has a different take. “One partner (Amazon) realized it didn’t need the other two partners,” he explains. JPMorgan Chase and Berkshire Hathaway make more sense as Amazon clients, he says.

“Amazon pressed the accelerator owning this space,” and using the Amazon Care infrastructure it was creating for its own employees, the company is now selling it to others. It is notable, says Kiesau, that Amazon is using a more aggressive, disruptive approach than typical employee health programs.

In Gaster’s opinion, Amazon jumped ship from the Haven partnership because the project didn’t move fast enough, not because it failed. The company expanded its rollout of Amazon Care quickly after that. “Amazon tends to repurpose things they abandon,” he says.

In 2022, Amazon will likely continue building out offerings around care areas such as joint orthopedic management, pain management and sleep tracking, all with well-
established implications for other health issues, Kiesau says. The company may also partner with traditional healthcare providers to bring about a more comprehensive version of in-person care. Amazon may provide the infrastructure alone, or they may take over the wellness area.

“There’s not convincing evidence that Amazon knows how to do services, but it’s absolutely coming because Amazon needs the revenues,” Gaster says. That may not all occur in 2022, but “it’s emerging slowly out of the mist.”

Deborah Abrams Kaplan is a freelance writer who covers medical and practice management topics.