February 27, 2024

Amazon has embarked on a mission to help tackle chronic disease. It’s a growing epidemic that is only getting worse, due in large part to a healthcare delivery system that is buckling under the weight of its own failures. As the e-commerce retail giant continues its foray into disrupting a fundamentally broken system, it is conceptualizing new approaches aimed at becoming more patient-centered.

Amazon recently rolled out its Health Condition Programs, the aim of which is to increase consumer use of digital health benefits that help people manage specific chronic health conditions. These benefits are offered through individual and employer-sponsored health plans, but they often go unused. Amazon is partnering with digital healthcare companies, starting with Omada Health, to advance this effort. Like other Amazon health services, it is not only making primary care more convenient, accessible, and affordable, but just as importantly, meeting patient-consumers right where they are–in this case, online.

“When customers are shopping for health-related products on Amazon, we can surface these additional health care benefits to them to provide even more support in improving their health, at no additional cost,” said Amazon’s vice president of healthcare. While it’s still too early to assess the impact of this service, it’s an example of what patient-centered innovation designed to improve outcomes might look like.

Across the U.S., chronic disease is spiraling out of control. Nearly half of the U.S. population has at least one chronic condition and 40% of adults suffer from two or more. Hypertension, high cholesterol and diabetes are among the top maladies afflicting older Americans. So, who is responsible for this crisis?

There are multiple factors that can lead to chronic conditions–poor lifestyle choices, genetic predisposition to disease, lack of access to nutritious foods, and other social determinants of health. But as I’ve explained, even though patients are ultimately responsible for their behavior and lifestyle choices, they can often benefit from assistance from providers and other healthcare stakeholders–many of whom have not stepped up to the plate.

Most healthcare stakeholders say they want “better health outcomes at lower cost,” and have been under increasing pressure in recent years to improve quality and deliver care in new ways. But, the journey to population health management has been slow and difficult.

As I’ve covered extensively, both in this column and in my book, Bringing Value to Healthcare, the main impediment has been fee-for-service payment. It is a model that has created perverse incentives. Healthcare providers have gotten paid more when they’ve delivered more diagnostic tests and procedures to patients than may be medically necessary. They have not gotten paid for prevention and better health outcomes. They are also incentivized when referring patients to specialists (in the same healthcare system, of course) for additional consultation and treatment. The underlying flaw with this system is that it does not reward efforts that would improve quality or prevent unnecessary utilization, like chronic disease management for diabetics to reduce emergency room visits for low-blood-sugar reactions. In turn, increased utilization, with no linkage to outcomes, has led to both higher healthcare costs and a deterioration in the quality of patient care. The ripple effect does not stop there.

For many doctors, particularly primary care physicians, this has become increasingly problematic because the really good ones are penalized for spending the time needed to get an accurate diagnosis. Many of these physicians, fed up fighting insurance companies over paltry reimbursement for an extended visit are leaving the profession in greater numbers. As for patients, they have fallen further through the system’s cracks.

When Covid-19 arrived in early 2020, it quickly became clear that those in underserved communities, particularly those with chronic health conditions paid the highest price. The great tragedy is that the suffering could have been mitigated if the healthcare delivery apparatus had been set up to provide low-cost opportunities that encourage those with chronic conditions to better manage them.

The disproportionate price paid by such communities was in part a legacy of fee-for-service thinking–a mindset that seeks to maximize the value of the current transaction, disregarding other interventions that would improve health outcomes longer term. The fallout wasn’t limited to underserved communities, though. As I’ve argued repeatedly, fee-for-service became a huge liability when the worst health crisis in more than 100 years came knocking. It was simply folly to believe the health of any population can be independent of its most at-risk segment. Unfortunately, that lesson was not learned and health outcomes have continued to worsen.

According to a recent Gallup survey, more than 38% of U.S. adults are classified as obese, a percentage which has risen sharply since the onset of the pandemic. Those diagnosed with diabetes by a clinician reached 13.6% last year, which is “a new high” for Gallup since it began tracking this data in 2008. And, not surprisingly, healthy eating habits have declined from 51.7% in 2019 to 46.7% in 2023, with produce consumption seeing an even steeper drop. These alarming statistics don’t bode well for an unhealthy nation, especially when you consider findings that 25% of Americans have either skipped or postponed getting needed care in the past year, due in part to health care costs which continue to skyrocket. And, as patients shoulder more of the financial burden, these outcomes are likely to get worse.

Amazon’s new chronic disease management initiative will not cure all healthcare ills, but it is an example of an innovative solution to long-standing problems. Amazon has successfully disrupted other industries; it’s certainly on the path to do that in healthcare. The question that remains is: what more will it take to get through to the captains who are rearranging the deck chairs on a sinking ship? Continued consolidation in the face of downward reimbursement pressure is not the solution.

Given the healthcare delivery outlook for the foreseeable future, unfortunately quite a lot is needed to change the direction of traditional healthcare delivery organizations. The inability to conceptualize and then implement a fundamentally different business model will continue to put these organizations at risk. And it is the patient-consumer who is footing the bill and not getting needed services.

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