Changes at Amazon-owned health services cause alarm among patients, employees

The Washington Post

By Caroline O’Donovan

February 28, 2024

Elderly patients used to take cooking classes and do puzzles at Iora Health clinics, which also paid for taxi rides so they wouldn’t miss appointments.

The late-night phone calls, free transportation and ability to text with clinical staff helped pull Deborah Wood of Kennesaw, Ga., out of a spiraling health crisis, she said. But since Amazon bought Iora parent company One Medical and rebranded it as One Medical Seniors, appointments have gotten 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.

The changes for senior patients like Wood highlight Amazon’s recent effort 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 across Amazon Pharmacy and One Medical and announced a corporate restructuring. Current and former employees say the move reignited concerns that the e-commerce giant would start prioritizing profits over patients.

“Having a [doctor] who can coordinate your health care and is willing to do so on a personal basis was very important to me,” Wood, 69, said. “And I really feel like that is completely gone, and I feel like it happened overnight.”

One Medical CEO Trent Green said the company remains “independent of Amazon leadership” and any changes are unrelated to the acquisition.

Amazon has long had health-care ambitions, but it has struggled to make them a reality. In 2020, it tried to improve health-care systems in partnership with JPMorgan Chase and Berkshire Hathaway in a since-shuttered venture called Haven. More recently, it spun up virtual and in-home health clinic Amazon Care, which it hoped to sell as a workplace benefit, but shut it down in 2022 as it struggled to attract customers.

Amazon built its empire in part through big acquisitions. It is also known for its frugality, a core principle that dictates that employees “accomplish more with less.” When buying companies, Amazon has historically looked for good deals, and allowed its acquisition targets to operate independently while it observes and gathers data. Only then does it gradually begin molding those companies, like it did with Whole Foods and the gaming platform Twitch.

Today, Amazon’s health-care offerings include Amazon Clinic, an online-only offering for common ailments that works with third-party medical providers; Amazon Pharmacy, which it grew out of PillPack, a start-up that the company acquired for $1 billion in 2018; and One Medical, the concierge primary-care clinic with a $199 annual membership fee that appeals to young, healthy, urban patients comfortable booking 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 integrate these businesses, stocking One Medical waiting rooms with Amazon Pharmacy fliers, creating a program that allows One Medical doctors free consultations with Amazon pharmacists, and offering Amazon Prime subscribers One Medical memberships at a 50 percent discount.

Employees say they were shocked to learn that the consolidation would also involve the elimination of a few hundred jobs in February. Some of the roles eliminated were in departments that overlapped with Amazon’s existing resources in its marketing, recruiting and financial departments, employees said.But One Medical-specific jobs including front desk staff, office managers, health coaches, behavioral health specialists and a pediatrician were also cut, 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,” which allowed “in-office teams to focus on providing care to members,” said Green, who replaced Amir Dan Rubin as chief executive in September.

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

Green’s email to staff also said that One Medical would be introducing a regional general manager role. After reading the email, a One Medical doctor, who spoke on the condition of anonymity to protect his job, said he was concerned that a new operations role is “an easy answer to any profitability question [that] can pretty rapidly turn a well-paced and humane job to a factory-style rat race.”

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

Heartbroken patients

When Wood, the Georgia patient, felt her heart racing and her blood pressure plummeting one night, she picked up the phone and called the Iora clinic. A medical professional picked up and told her what medicine to take. “They called me back every 30 minutes to make sure I was okay,” she said. “It was outstanding.”

But since Iora became One Medical Seniors, Wood said she’s begun to see changes very quickly. “I’m an Amazon patient now,” she said. Wood, who suffers from congestive heart failure and chronic kidney disease, said her calls are now routed to a call center on the other side of the country, and getting a call back can take days.

Iora Health was founded in 2010 on the premise that spending more on a patient upfront would produce savings in the long run. The hot coffee, cozy fireplaces and free rides were more than perks — they were meant to ensure patients were consistent about their health care. A cab ride might cost the company $10, but an ambulance ride following a 911 call cost a lot more, the thinking went.

“Iora’s philosophy with the rides was that even though transportation is so expensive, having patients in the hospital is even more expensive. We’d rather pay for transportation to and from appointments to hopefully eliminate those hospitalizations. It made a little more financial sense that way,” said a former Iora and One Medical employee in Seattle, who was laid off and spoke on the condition of anonymity to protect their career.

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

“In the last six to eight months, it really became a numbers game again,” the former employee said.

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

Jaymee Blackbourn, a health coach specializing in treating seniors who worked at One Medical over two years, said in a LinkedIn post that being laid off left her “heart broken,” including for “the patients whose health care and well-being is directly impacted by these decisions.” She did not respond to a request for comment.

Since its inception, Iora’s focus was serving lower-income and chronically ill older adults on Medicare. Thanks in part to a federal program called ACO Reach that focuses on improving health equity for underserved populations, it has been a successful business: In 2022, more than half of One Medical’s revenue came from Medicare payments. As the U.S. population ages, that business opportunity is only getting bigger.

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

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

‘Everything has changed’

As Amazon pursues its ambitious health-care expansion, one of its biggest challenges and opportunities is scaling One Medical. To get on that path, it started offering a 50 percent discount to 300 million Prime members in November.

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

To deal with the influx of telehealth patients, Amazon started sending inbound messages through a central call center called Mission Control, former employees said. The company is also training an artificially intelligent chatbot to triage incoming patient messages and deal with administrative queries, employees said.

After some front desk roles were eliminated in the layoffs, Mission Control was initially flooded with the additional calls, according to employee Slack messages seen by The Post.

One Medical said it wasn’t overwhelmed and that the centralized system is improving response time. Amazon declined to confirm its AI plans for One Medical but said it is always investing in technology that can reduce the time health-care providers spend on administrative tasks.

One of the former Iora employees said it was difficult to see her clinic — which once had a staff of 20 — cut down to five people, and to see patients “being pushed out to virtual services.”

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