The news behind Amazon Care — the digital retail giant’s telehealth pilot program for its employees — is not the technology. The news is that Jeff Bezos’ company, and others like it, don’t need anyone’s permission to start building and paying for their own parallel health care systems, little by little.
The trick will be whether Amazon can go beyond this pilot and build something that provides more of the things we need from health care without blowing everything up.
If you want to see a playbook for what’s next, take a look at the strangler fig. This plant grows by wrapping itself around a tree, growing down from the branches or up from the roots. It can eventually encase the tree, leaving it to die, with the strangler fig remaining in place.
Giant companies like banks and insurance firms are using this strategy to get off the legacy information technology systems they depend on but which are holding them back in a digital world. Most are trying to follow a strategy popularized by software thinker Martin Fowler after he saw strangler figs in Australia. This approach builds small software applications around the outside of a company’s IT infrastructure and gradually migrates functions off the legacy system.
If Amazon replaces the existing health care system bit by bit, and employees of self-insured companies migrate to this new digital health system, do we all get to come along? Why can’t the current health system that most of us non-Amazon employees depend on do the same thing Amazon is attempting to do?
The existing health care system doesn’t have to be replaced by something growing around it on the outside. The technology exists for it to go digital.
As early as 2001, U.S. physicians performed surgery on a patient in France using robotics and high-speed fiber optic cables. It’s not the technology that Amazon has that’s allowed it to start Amazon Care. It’s the company’s economic autonomy from health insurance and wrangling over reimbursement.
The existing health care system is stalled by questions about how do we pay physicians who provide virtual care outside of their practices, and how do we pay hospitals for that care? How do we ensure the care meets proper standards if it is happening someplace else?
If a U.S. physician can perform surgery on a patient in France, can physicians in India — who make a lot less than U.S. physicians — perform procedures on American patients? We already see this dynamic in medical tourism championed by the likes of digital lifestyle advocate Tim Ferriss.
How to Be a Medical Tourist – Time for a Thailand Visit? http://su.pr/2BAyDv
— Tim Ferriss (@tferriss) June 5, 2009
U.S. doctors want to be paid for telehealth the same way they’re paid for in-person care, and they don’t want care shifted to low-cost centers like factory and software workers have experienced. Doctors want to be paid the same as they are now, and live where their patients live. They don’t want care to be off-shored to surgeons in Bulgaria, India, or the Philippines.
So far, payers, providers, and Medicare aren’t getting very far with telehealth. Each can veto a move it doesn’t like by someone else. Like legacy IT systems at big companies, everything is siloed and doesn’t work together well. It just keeps stumbling on.
But because Amazon self-funds its employees’ health insurance, it’s like its own country. The company can start just on this one aspect of care: clinics for routine care. But what if Amazon or Apple or Google decides to build a more comprehensive telehealth platform for self-insured companies? What if those companies secede from the existing health care system after they’ve replicated enough of the old system to migrate away from it? Can they do that?
IT teams at giant corporations know that the strangler fig approach doesn’t go as smoothly as it’s pitched by enterprise software vendors. When you start adding cloud-based tools to the existing legacy system, the exponential complexity can crash it. To solve this, IT engineers have created systems to buffer the existing system from the changes taking place outside of it. This is sometimes called a wrap or a load balancer. It’s a layer in which data from the existing system and the new one can be organized so the two systems can talk to each other without falling apart.
Amazon is going to need to think about this, and so are the rest of us. If, after the pilot, Amazon Care moves outside of the protected environment of the company, what systems will be in place to keep it and the health care system we already have from collapsing? Technology might solve some of this problem, but the health care system equivalent to load balancing and wraps will be the organizations and companies in which providers, payers, and tech companies come together, talk about what’s ahead, and strike agreements.
Amazon Care is a wake-up call for providers, payers, and employers. Telehealth is not just about video chats with your doctor or wearable fitness trackers. It’s a new operating system for health, and big technology companies are not going to wait for everyone else to figure it out. It’s not enough to sit back and wait for Amazon to envelop the existing health system with its strangler fig. And unless providers, payers, and companies that can help them proactively become part of the solution, it’s going to go badly.
Vik Panda leads U.S. operations for Dreem, a sleep health company based in France.