Health Technology
Article | September 12, 2023
In 2021, the introduction of Amazon Care marked the first time a prominent technology firm stepped into the healthcare services industry. The fact that Amazon filed paperwork to offer care in multiple states without much fanfare is intriguing. In March 2021, the company confirmed the details of its new services, announcing that it would be delivering the services through an independent private medical practice called Care Medical.
The move may signify another diversification for Amazon, but what does it mean for the healthcare services landscape?
The Highlights of Amazon Care’s Services
Home healthcare
Amazon announced that it would be participating in an advocacy group for home healthcare. The Moving Health at Home initiative aims to transform how policymakers view the home as a site to deliver clinical services. Amazon Care may be riding on the trend for home care that has been evolving in the form of remote patient monitoring for post-acute care management and chronic care.
Employer-oriented offering
Amazon Care aims to become a workplace benefit partner for employers. One of the pain points it is directly addressing is the challenge of runaway inflation that increases healthcare costs.
Virtual care simplified
The most significant offering that Amazon Care plans to lead with is virtual care that promises to reduce wait times for quality patient care to under 60 seconds. It also includes the option to access 24-hour care services through messaging and video calling. In addition, it eliminates unnecessary traveling and long wait times by delivering care in the comfort of the patient’s home.
The Path Ahead
Amazon is known for introducing a slew of initiatives in the health and fitness sector, like the Halo wearables, a data management product called Amazon Health Lake, and a healthcare delivery system called Haven, which doubled over in 2021 after a three-year run. However, the tech juggernaut is not about to stop attempting to disrupt healthcare services. Only time will tell whether Amazon Care finally proves to be a feather in Amazon’s healthcare cap or another ambitious project that bites the dust.
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Healthtech Security
Article | November 29, 2023
The fall is a time of renewals and choices. It is also a time of so called “open enrolment” for health plans. It is the one time of year we can study and learn about the options offered through employers or government sponsored plans. Individuals and small business owners alike are also are faced with a myriad of choices with confusing and often contradictory language promising lower premiums with higher out of pocket costs for covered services subject to deductibles. What does it even mean anymore when your monthly premiums exceed your pay check and you still have to pay for your colonoscopy or your insulin? Where is it all going?
Let’s imagine you twist your ankle playing basketball. You might go to an urgent care, receive an X-ray, probably be examined by a non-physician, and then referred to your primary care, who can’t see you for a few weeks but eventually sends you to an orthopaedic who takes another X-ray and treats your injury. Weeks have passed, multiple visits, time out of work, and co-pays, not to mention the out-of-pocket fees associated with imaging and perhaps a $100 ace bandage. What stops you from going straight to the ankle specialist in the first place? First, we have become conditioned to follow the directions dictated by the insurance companies, even when restrictions are not in place, patients have been convinced that stepping out of line will make all insurance promises null and void resulting in catastrophic bills and financial ruin. Second, the doctors and their office staffs have been conditioned to deny entry to any patient who does not have the proper referral, authorization, or identification. There are dire consequences for both if the insurance rules are not followed and fear keeps both sides aligned.
The past two decades have seen an explosion of healthcare costs. Health insurance has become the single biggest line item second only to payroll for most businesses. It is no coincidence that as the government increased its role as payor with state subsidies, the prices have gone up. Much like college tuitions, when loans are easy to obtain and guaranteed by federal support, there is little to deter those in charge from increasing the price. After all, everyone is doing it, it must be OK, and even if students end up in debt, it will be repaid because they have received the value of a great education. Right? But unlike higher education, healthcare is a necessity. We cannot avoid it, and there needs to be a reliable mechanism in place to guarantee access.
Ironically, as charges and prices have continued to escalate, payments to doctors have diminished. Why medicine is the only service industry where there is no transparency is truly astounding, especially since the there has been no increase in so called “reimbursements” for decades. As physicians, we have been complicit, being fully aware of the discrepancies between what is charged and what a patient’s insurance will pay. Even as patients began to have higher deductibles, and therefore higher out of pocket expenses, we continued to follow the rules, asking insurance permission to collect payment from the patient. It is not surprising that bad debt accounts for over 50% of most account receivables and why over 70% of doctors are now employed by hospital networks or private equity, who not only go after patients, but benefit from the repricing that occurs when insurers pay a negotiated amount as opposed to the charge. In other words, we pay more not just for less, but for nothing.
But what if we twisted our ankle and went directly to that specialist and paid out of pocket a transparent price? What would it take for that to happen? Not much, the cost of care is predictable, and because payments have always been decreasing, most physicians have learned to be economical. Plus, out of pocket costs are capped by federal law, so no patient is really responsible for catastrophic bills. Charges inflate to cover overhead, but if payments were guaranteed and immediate, then the cost of doing business goes down. Add technologies like telemedicine to a practice and you have increased patient access to a doctor without adding more personnel. Direct pay doctors are emerging all over the country and have consistently offered better access and more affordable care. The bar is also being set by independent surgery centers and imaging centers who offer better outcomes at lower costs. Perhaps motivated by prohibitive pricing, better options have emerged that have moved patients away from expensive operating rooms to safe, office-based procedures. Even cutting-edge cancer therapies can be delivered at home, preserving more of the healthcare dollar for medical care rather than the complex system built to manage it.
Competition and choice inevitably drive prices, but in a monolithic system the price is not negotiated, but instead it is set by only a few, in this case the big insurers. Small businesses cannot compete when bigger companies come to town. Eventually, the local hardware store gives way to a national brand, and the consumer is left with fewer choices and eventually higher prices. Amazon disrupted this equation by creating a marketplace for individual buyers and sellers. The convenience of finding a trusted brand, no longer available locally, is irresistible and the reason why we became loyal consumers. Healthcare is no different. Trust exists implicitly between a physician and patient, because it is an authentic, empathetic, and logical relationship. Trust does not exist between a patient and their insurer, on the contrary it is an unsympathetic business relationship without transparency or consistency. Few doubt the insurance company’s top priority is the premium, not the patient. Creating a direct relationship between the doctor and patient is a common-sense approach that serves both stakeholders well, and requires merely a fair and affordable price. But do doctors have the capability or the will to do it and if so, can the rest of the system follow?
Never in the history of modern medicine have physicians been more dissatisfied. US healthcare used to lead the world in innovation and outcomes, now we struggle to break the top thirty. We may have the most brilliant doctors and scientists with access to the best resources, but the need to maximize profits while catering to special interests, be they commercial or political, has led us to favour certain therapies over others despite marginal proven benefits. Doctors have little autonomy and less authority; prescribed treatments are routinely denied by insurance companies without a second thought or appropriate peer review. In fact, insurers even renamed us “providers”, a term used to by Nazis when referring to Jewish doctors to devalue them professionally. Over 56% of physicians are burned out, nearly all report moral injury and as hospitals have systematically replaced doctors with non-physicians with limited training, we have watched the standard of care deteriorate. It is no wonder we have witnessed the single biggest loss in life expectancy since WWII. The prognosis is grim, but there are solutions.
We need to reinvent healthcare by removing the middleman. We don’t have to set the price, but we can make it transparent so patients can decide for themselves if it is worth the inconvenience, the delay, and the co-pay to use insurance or just pay directly. Health savings accounts are tax deferred and can cover an out-of-pocket maximum in just a couple of years. Paying for care means there are no surprise bills or out of network costs, because there are essentially no networks and therefore no need to follow restrictions. You’d be hard pressed to find a doctor or hospital unwilling to accept an immediate cash payment, especially when it costs nothing more than the service provided. There are no billing cycles, or claims to prepare, no up coding, or authorizations. Doctors free to care for patients, patients treated individually and not subject to protocols designed to maximize charges. There are literally thousands of direct pay primary care and specialists now available all over the country and they are building alliances with likeminded people providing imaging, ancillary services, surgery centers, and prescriptions all at fair market prices. More and more employers are moving toward medical cost sharing plans that not only lower the cost of care but the cost of administration. Even the biggest payor, namely the government, sees the benefit of price transparency and is piloting models of direct contracting.
We will always need coverage for those unexpected events, emergencies, or hospital-based services, but all the rest - doctor visits, screening tests, and outpatient procedures - are easily affordable. After all, do we use our car insurance to pay for an oil change? If we did, the cost would be prohibitive and few of us would drive. But health insurers have lost our trust, they no longer cover necessary services and no longer honour contracts with physicians or patients. It is time to offer another option and let the patients and doctors get back to the real business of medicine.
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Health Technology, Digital Healthcare
Article | July 14, 2023
Over the past twenty-five years most businesses have been revolutionized by the easy availability of cloud and mobile-based computing systems. These technologies have placed power and access into the hands of employees and customers, which in turn has created huge shifts in how transactions get done. Now the companies with the highest market value are both the drivers of and beneficiaries of this transition, notably Apple, Facebook, Amazon and Alphabet (Google), as well as their international rivals like Samsung, Baidu, Tencent and Alibaba. Everyone uses their products every day, and the impact on our lives have been remarkable. Of course, this also impacts how businesses of all types are organized. Underpinning this transformation has been a change from enterprise-specific software to generic cloud-based services—sometimes called SMAC (Social/Sensors/Mobile/Analytics/Cloud). Applications such as data storage, sales management, email and the hardware they ran on were put into enterprises during the 80s and 90s in the client-server era (dominated by Intel and Microsoft). These have now migrated to cloud-based, on-demand services.
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Article | August 27, 2021
Do you know a friend or loved one who suffers from fear, anxiety, and depression and do not know what to do to help them?
It can be frustrating to watch someone you know struggle with their mental health and not be able to do anything to relieve their suffering.
With this in mind, here are seven ways to help the person cope in these kinds of situations.
1. Learn as much as you can in managing anxiety and depression: There are many books and information that will educate you on how to successfully overcome fear and anxiety. Share this information with the individual who is struggling with their fears. The key is to get your friend to understand how important it is to seek some guidance when it comes to their mental health.
2. Be understanding and patient with the person struggling with their fears: Maintaining depression and anxiety can be difficult for the individual so do not add more problems than what is already there. Do not get into arguments with your friend who may be having a difficult time with their anxieties. Make an effort to listen to the person rather than making judgements.
3. Talk to the person instead of talking at them: It is important not to lecture the individual who’s having a hard time with anxiety and depression. Talk to the person about their issues without being rude. Most people will listen if you approach them in a proper manner. Remember to treat others the way you would want to be treated if you were the one who was struggling.
4. Ask for some ideas: Seek advice from a professional who can assist the person you know with their mental health issues. A counsellor can give you some ideas on how to overcome anxiety, fear, and depression. Getting help from a therapist is the number one priority in getting the individual to do something about their problems.
5. Find out why the person won’t get assistance: Address the issues on why he or she will not seek treatment. Many people who are struggling are fearful and frustrated. Try to find out the reasons why your friend won’t get the help they need and then try to find the ways that will overcome their resistance of seeking some guidance.
6. Remind the person on the consequences of not getting help: Another way to convince the individual who is struggling with fear and depression is to tell them what may happen if they don’t get some counselling. Anxiety and depression can make things worse and usually won’t go away by themselves.
7. You can’t manage your mental health all by yourself: A person’s fears and anxieties can be difficult to manage and more than likely he or she will need some help. Many people think that they can overcome their mental health problems on their own. This is a mistake. The individual should admit they have a problem and then seek treatment to get their life back on track.
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