Amazon is considering opening its own primary health care clinics for employees at its Seattle headquarters, CNBC reported on Thursday, becoming the latest in a series of major US companies pursuing innovative approaches to health care outside the traditional group insurance model. Two people familiar with the confidential discussions told CNBC that the company was planning to start with a pilot clinic for a select group of employees later this year, then expand the program in 2019:
Amazon was previously looking to outsource its clinics and brought vendors in to pitch their services. After numerous rounds of discussions, Amazon ultimately decided to develop clinics internally, one of the people said. Providers including Crossover Health and One Medical offer on-site or nearby services for other companies, including those in the technology sector. …
Amazon started its effort by hiring primary care experts, beginning last year with Christine Henningsgaard, who was previously vice president of operations at One Medical. In January, the company brought in Martin Levine from Iora Health, a primary care group with clinics in Seattle.
If Amazon moves ahead with this plan, it will be pursuing a similar path to Apple, which announced earlier this year that it was establishing a network of health clinics for its employees in and around its headquarters in Cupertino, California. To staff this initiative, Apple has since hired a number of employees away from the provider that operates some of its on-site clinics in other locations, along with a variety of wellness professionals and “care navigators” to help guide patients in choosing the appropriate care for their health needs.
Earlier this year, Apple announced that it was establishing a network of clinics near its headquarters in Cupertino, California to provide primary health care services to its employees in Santa Clara County. The AC Wellness program has been on a hiring spree since then, bringing more than 40 health professionals on board, CNBC reports, citing a LinkedIn search. The hires include a number of former employees of Crossover Health, which used to operate Apple’s onsite clinics in the Bay Area and still runs them elsewhere, and which Apple had considered acquiring before deciding to design its own clinics instead. In keeping with the name of the initiative, these early hires indicate that AC Wellness is going to be more than just a medical clinic, suggesting a more holistic focus on wellbeing and helping employees maintain healthy lifestyles:
Most of the team hired so far aren’t doctors. In fact, the hires skew toward wellness professionals like nutritionists, exercise specialists and nurse practitioners. A lot of the hires have a background in alternative or functional medicine and there’s even a “wellness lead” — Jennifer Gibson, a former head of coaching at Vida Health, a health-tech start-up. Gibson, according to her profile, is passionate about things like nutrition, stress management and smoking cessation, which aren’t always offered at primary care practices.
The company has also brought on at least a half dozen “care navigators,” who don’t have medical degrees but do have a background in directing patients to the most appropriate care. In some cases, that might involve a followup conversation with a specialist or a lifestyle change that might alleviate the problem on its own. That could reduce costs as these navigators can better ensure that Apple employees and their dependents aren’t getting unnecessary care.
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Large US employers, particularly tech companies, have been vocal advocates of transgender rights and acceptance in recent years. Beyond public statements and activism, however, these organizations are also looking at ways to make their HR policies more inclusive of their transgender employees. Fast Company’s Lydia Dishman observed recently that major companies are doing making more of an effort to be trans-inclusive, particularly in terms of ensuring that their benefit plans cover gender-affirming health care:
The Human Rights Campaign, a leading advocacy group, announced last year that over 450 major U.S. employers now have policies to support employees through the transitioning process. Separate research from the International Foundation of Employee Benefit Plans (IFEBP) found that these numbers are inching up throughout the U.S. workforce. Twenty-two percent of the nearly 600 HR professionals surveyed said their health plans cover gender confirmation procedures, up from 8% in 2016; a quarter provide mental-health counseling pre- and/or post-surgery, up from 11% two years ago; and 24% cover prescription drug therapy, up from 9% over the same period.
However, these benefits are more likely to be found at large employers like Intel, with workforces in the tens of thousands, than at smaller ones; IFEBP found that only 10% of companies with fewer than 50 employees offer trans-friendly health benefits, up from 4% in 2016.
By way of example, Dishman looks at Intel, which introduced coverage for all gender confirmation procedures, following standards set by the World Professional Association for Transgender Health (WPATH), in 2016, with no maximum lifetime benefit; and Amazon, which began offering unlimited coverage for trans medical care in 2015. Starbucks announced late last month that it had updated its health insurance policy, with help from WPATH, to cover a wider range of procedures that insurers often label cosmetic and refuse to cover but that trans people and their health providers consider essential to their transition process:
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Amazon, Berkshire Hathaway, and JPMorgan Chase made headlines—and sent health insurance stocks into a tailspin—when they announced in January that they had partnered to form an independent nonprofit organization dedicated to finding ways of providing health care to their employees at a lower cost. However, Kathryn Mayer at Employee Benefit News flags a new report from venture capital firm Venrock in which healthcare experts say that this partnership is unlikely to have as immediate or dramatic an impact as its founders might expect:
Of the 300 healthcare professionals, employers, investors and academics surveyed by Venrock, 73% said that the Amazon, Berkshire Hathaway and JPMorgan effort was going to take a lot longer than expected and endure many obstacles. Meanwhile, 25% said the companies “have no idea what they’re getting into.” There are a number of reasons for the industry’s skepticism, say Venrock partners Bryan Roberts and Bob Kocher.
“[One is that] many new entrants have sought to dramatically improve healthcare for many years and nearly all have failed to produce any material impact. Remember Google Health and HealthVault?,” Roberts says. “While these are all large, successful companies, they do not have any real market power in healthcare, where all leverage is locally driven.” Meanwhile, Kocher notes, the companies haven’t yet formed a leadership team.
January’s announcement reflected the pressure many US employers of all sizes are feeling as rising health care costs force many of them to shift more of these expenses onto their employees. Businesses are bracing for a further spike in costs next year, as Congress has declined to take action to stabilize the individual health insurance marketplace established by the Affordable Care Act, potentially paving the way for premium hikes of as much as 30 percent. Higher expected costs for insurers mean higher prices for group insurance customers (mainly employers) as well as individuals.
Last Thursday, the Wall Street Journal reported that Walmart was in talks to acquire the health insurance company Humana, currently valued at around $37 billion, raising the prospect of another merger with transformative implications for the benefits industry. Both companies are keeping mum about the possible deal, though Bloomberg heard from a person familiar with the talks that the most likely outcome was a closer partnership between the retailer and the insurer, which already collaborate on providing prescription drugs for US senior citizens insured through Medicare (Humana is the second-largest provider of government-supported private Medicare Advantage plans in the US).
Either way, a closer partnership between these giants could have some major implications for the US health insurance market, especially in combination with the other changes that are going on. The pharmacy chain CVS announced in December that it had agreed to purchase the insurer Aetna for $69 billion as part of an effort to transform its 9,700 retail drug stores into “health care supermarkets” complete with wellness clinics for preventive care (That merger was approved by shareholders last month but has yet to pass muster with antitrust regulators in the Justice Department).
A similar move by Walmart would be groundbreaking, given the big-box retailer’s massive presence throughout the US. Even a deal to provide health care for Walmart’s 1.5 million US employees would be significant. Walmart becoming a health care provider would make a big difference, Tracy Watts, senior partner at Mercer, tells Employee Benefit News reporter Kathryn Mayer:
“I would think whatever happens with the deal, Walmart would leverage its relationship with Humana to provide primary care or extend convenience care to its employees in addition to the general public,” Watts says. She also predicts the retailer will leverage its onsite care locations to provide a convenient, cost-effective way for employees and others to receive basic treatments. “For employees to get healthcare from Walmart in those rural locations can be a really good thing,” she says.
Apple is in the process of establishing a network of clinics near its California headquarters to provide primary health care services to its employees, CNBC reports:
This new primary care group — a group of clinical staff that is run independently from Apple but is dedicated to Apple employees — will initially only serve Apple’s employees in Santa Clara County, where its headquarters are located. Initially, it has two clinics in the county. Development appears to be well underway.
The initiative, called AC Wellness, will “offer a unique concierge-like healthcare experience for employees and their dependents,” according to its website. In addition to health care professionals, AC Wellness is hiring designers and analysts to help build and implement a preventive and behavioral health program, according to CNBC.
Part of the rationale for this project is undoubtedly to better manage health care costs at Apple, which has thousands of employees in California and 123,000 worldwide. The clinics appear to have a secondary purpose, however, as proving grounds for Apple’s consumer-facing health products:
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Amazon, Berkshire Hathaway and JPMorgan Chase have announced a partnership to establish a nonprofit entity dedicated to lowering health care costs for their employees, the Washington Post reports:
The independent company would be jointly led by executives from all three companies and would be focused on technology that could increase transparency and simplify health care, according to the joint announcement. It will be free from the need to deliver a profit. … Few details were available about the new initiative, described as in the initial planning stages. The announcement comes amid anticipation that Amazon could disrupt health care as it has in other industries — sending tremors through companies that make and supply prescription drugs.
The announcement sent health care stocks tumbling, Bloomberg adds, affecting several major pharmacy benefit managers, health insurance companies, and biotechnology firms. While the details of the partnership are still sketchy, it is expected to focus on technological solutions, data sharing, and its participants’ bargaining power as large employers. The initiative may also expand beyond these three companies in the future: