“…what would it look like if Amazon CEO Jeff Bezos took the helm of a major integrated (health care) delivery system?”

“Big Silicon Valley companies have often competed for talent with specialized skills, like expertise in artificial intelligence or trendy new programming languages.

Now they’re competing for heart doctors.

Apple hired Dr. Alexis Beatty, a cardiologist, to its growing health team in July, according to a LinkedIn search. Amazon hired Dr. Maulik Majmudar, also a cardiologist, the following month. Alphabet’s life sciences company Verily named Dr. Jessica Mega as its chief medical officer almost three years ago. Mega, of course, is a cardiologist…

Apple’s smartwatch now includes an electrocardiogram, which can detect heart rhythm irregularities. Verily’s study watch, which is designed for clinical trial research, also tracks heart rate and heart rhythm, and it’s doing a lot of work in chronic disease management. Another Alphabet team, Google Fit, worked closely with the American Heart Association for its design revamp. Amazon’s plans in cardiology are less clear, but the company does have a secretive research and development team that is working on a variety of health projects under the leadership of an electrical engineer — former Google X employee Babak Parviz.

So the more likely explanation is that tech companies are interested in health care, and they have all come to the conclusion that cardiology should be an early (if not initial) target.

Here’s why….” (A)

“…. The question now is how far will Amazon, the master disrupter, take this?”

The answer: very far, it’s safe to assume. Anyone who continues to think of Amazon as just a very big digital retailer needs to think again. The company has repeatedly shown that it has the capabilities, the patience and the deep pockets to disrupt industry after industry. Healthcare is no exception. There are at least three reasons to believe Amazon is has a good shot. First, as one of the largest private employers in the United States, Amazon would reap huge financial benefits from lowering the high cost of healthcare in this country. Second, the numerous inefficiencies of the healthcare system present enticing avenues for Amazon to explore, and as CEO Jeff Bezos has famously stated, “Your margin is my opportunity.” Finally, healthcare is just the kind of big, complex problem that Bezos likes to sink his teeth into. An unabashed “Star Trek” fan with a utopian view of the future, Bezos has always aspired “to boldly go where no one has gone before.” Bezos strongly believes that Amazon has a role to play in making things better.

As Amazon turns its focus to healthcare, we believe there are four potential points of entry, with increasing levels of complexity from simple product distribution. Durable medical equipment and medical supplies. Mail-order and retail pharmacy. Pharmacy benefit manager. AI powered telemedicine, diagnostics or in-home healthcare.  (B)

“To get to their next trillion dollars, Apple and Amazon are realizing that they can’t ignore opportunities in the health sector. But to get that right, they need to focus on the things they’re good at.

Amazon is focusing on its area of expertise: the supply chain. The company bought PillPack, an internet pharmacy, and it has a grocery delivery business through Whole Foods. It is also working with two other employers, J.P. Morgan and Berkshire Hathaway, on an initiative to reduce health care costs…

But these are just the things that we know about. Undoubtedly, Apple and Amazon, which both have a strong focus on research and development, are thinking about new health-focused hardware and software products for the next decade. And where better to try them out than by talking to their doctors and garnering feedback from real patients (incidentally, their own workers)? It makes a lot of sense, health experts say, especially for tech companies that are notoriously obsessed with secrecy.

“If Amazon and Apple had considered these clinics for internal use only, they would have likely outsourced to any of the number of clinics that offer on-site clinic services,” said Nikhil Krishnan, a health-focused analyst with CB Insights, a market research firm. “The fact that Apple and Amazon are testing it in-house means they want to test the model with employees, iterate, and eventually release this product to their respective customers.”

Weinberg from the Bay Area Council Economic Institute has seen tech companies try and fail to get into health care, if they assume there’s a simple tech solution.

Health care is “devilishly complicated,” he says. In his experience, those that do succeed will be richly rewarded, while having an opportunity to make a difference. And one of the best ways to get there, says Weinberg, is to get into the business of both patient care and population health management, which includes tools to keep a population of patients as healthy as possible.” (C)

“The healthcare initiative formed by Amazon.com Inc. (AMZN – Get Report) , Berkshire Hathaway Inc. (BRK.A – Get Report) and JPMorgan Chase & Co. (JPM – Get Report) made a “bold statement” with its appointment of Comcast Corp. (CMCSA – Get Report) alum Jack Stoddard as chief operating officer, according to Leerink Partners LLC analyst Ana Gupte.

The venture is “reaffirming its commitment to upending the way consumers access healthcare in an increasing digital ecosystem,” Gupte wrote in a Wednesday, Sept. 5, note. “We believe the Stoddard hire clearly shows that [the venture] is looking to own the digital front door to healthcare.”

Stoddard, who was most recently general manager of digital health at Comcast, started his new role this month, according to his LinkedIn profile. CNBC first reported on Stoddard’s appointment on Tuesday.

The news follows the hiring of Atul Gawande, a surgeon, public health researcher and a staff writer for The New Yorker, as CEO of the healthcare initiative effective July 9. Amazon, Berkshire and JPMorgan unveiled their partnership in January, saying they’ve banded together to address healthcare for their U.S. workers…

Comcast could offer a blueprint for what Stoddard might aim to do at the Amazon-Berkshire-JPMorgan venture, Gupte wrote.

“As noted in a recent New York Times article, Comcast has been at the forefront of health insurance innovation,” she wrote. “Instead of pushing the financial burden to employees via high-deductible health plans (as nearly 50% of large employers have), Comcast has focused on lowering costs by partnering with innovative tech-enabled companies to improve employee engagement (Accolade), care management (Grand Rounds which provides second opinions) and telehealth (Dr. On Demand).””  (D)

“Amazon’s increased presence in healthcare has caught the attention of many hospital and health system leaders who are vested in a healthcare model that is at risk of being disrupted. So far the company has considered a number of patient-centered initiatives, but what would it look like if Amazon CEO Jeff Bezos took the helm of a major integrated delivery system?..

Healthcare leaders stand to learn a lot by examining Mr. Bezos’ approach toward processes. A good process serves the provider so they can serve the customer, but one of the most dangerous epidemics gripping our industry is that we have stopped focusing on the outcomes of our processes. Mr. Bezos refers to this fallacy as “managing by proxy.” If patients complain about an undesirable outcome, the first thing many clinical leaders do is defend the process that drove the outcome, so long as they followed protocol. Instead of swearing by adherence to protocol, we should examine the process itself to see if it can be improved. Do we own the process or does it own us? If Mr. Bezos ran my health system, he would be constantly reevaluating our processes not by cost optimization or operational efficiency, but by the true value that they bring directly to our patients and members…

Anyone familiar with the number of individuals and organizations that orchestrate the payment and delivery of care knows that misalignment is a troubling reality within our industry. Healthcare is extremely siloed, but Mr. Bezos has made his fortune by streamlining efficiency among numerous players to deliver the best product as quickly as possible. I believe Mr. Bezos would take innovative steps to challenge healthcare’s misalignment and integrate the model to create efficiency and savings for our patients and members.  His long-term view of success would drive Sentara’s development into a system fully aligned to maximize the value to our consumers.  Under his watch, Sentara would rapidly become the first, most convenient choice for our patients and members for all their healthcare needs.”  (E)

“Out of all the technology giants with ambitions in healthcare, hospital executives have overwhelmingly put their faith in Amazon, according to a new survey.

A full 59% of executives say Amazon will have the biggest impact, according to the survey by Reaction Data. Respondents cited resources available to the retail and technology behemoth…

 “Amazon has a huge market they can use to distribute materials. They are already a household name and the users are not specific to Apple or Android,” one CEO said.

About 80% of survey respondents were from the C-suite, including chief nursing officers, chief financial officers and chief information officers.

While Amazon alone may be generating significant excitement in boardrooms, a previous survey by HealthEdge shows consumers are largely skeptical about Amazon’s partnership with JPMorgan and Berkshire Hathaway.

Amazon’s push into healthcare “has been a shot across the bow for the entire industry,” Rita Numerof, Ph.D., president of Numerof & Associates told FierceHealthcare. The company’s consistent and deliberate investments indicate they are serious about making substantial changes within the industry.

“Amazon is known for its relentless focus on the consumer and its ability to use data systematically to identify and meet unmet needs in an accessible manner,” she said. “Unfortunately, access, consumer engagement, and segmentation haven’t been the hallmark of healthcare delivery.” (F)

“Amazon, JPMorgan and Berkshire Hathaway’s buzzy partnership over their employee healthcare announced in January caught plenty of other large employers’ attention.

Sure, it could just end up being just another purchasing coalition.

But if it actually takes advantage of the breadth of Amazon’s connection with consumers? That could stand to truly—pardon the overused term—”disrupt” healthcare for employers, said National Business Group on Health President and CEO Brian Marcotte.

“If they begin to leverage Amazon’s footprint within the home, their relationship with the consumer, their customer obsession … the customer loyalty they have, and begin to leverage their ability,” Marcotte said, it could change everything.

“One of the challenges in healthcare is employees don’t touch the system with enough frequency in order for it to be routine, in order for them to be sophisticated consumers,” added Marcotte. Amazon and other online shopping platforms are routine, he said.

“When I look at this coming together, the opportunity is how do you leverage their platform to reach people in a more natural way, in a more frequent way then we reach them today,” he said.”  (G)

“Former Cleveland Clinic CEO Toby Cosgrove said healthcare’s potential innovators need to have one key trait—persistence.

The industry is resistant to change, he said, so new ideas aren’t likely to be met with a warm reception. Instead, expect colleagues to push back.

“Don’t expect everyone to love [your ideas]—they’ll hate it,” he said. “Don’t get discouraged when your ideas aren’t immediately embraced.” ..

While the innovative examples provided by Cosgrove himself are on the clinical side, he said what keeps him up at night, and where there’s the greatest room for future growth, is cost and new tech.

“We are under tremendous pressure in the United States…about the cost of healthcare,” he said.

In innovation, cost and technology are likely to go hand-in-hand, he said. Cleveland Clinic, for example, has 2,000 employees involved in revenue cycle management, he said. Artificial intelligence could streamline that process significantly, cutting costs and improving efficiency.

Another area ripe for future innovation is leadership development. Healthcare needs administrators and often has to train people internally for top roles. Cosgrove said he didn’t really have a grasp on what a CEO does at the time he took over the Cleveland Clinic.

But strong leadership, once it’s built, can serve as a catalyst for further innovation in the ranks and sets the tone that trying new things is valued, he said.

“It’s amazing how leadership…just cascades down through the rest of the organization,” Cosgrove said. (H)

Jeff Bezos gave a master class on life and business onstage in Washington last night, with this keeper advice: “All of my best decisions in business and in life have been made with heart, intuition, guts, … not analysis.”

“If you can make a decision with analysis, you should do so. But it turns out in life that your most important decisions are always made with instinct and intuition.”

“Everything I have ever done has started small,” Bezos added, drawing laughter at the 32nd anniversary dinner of the Economic Club of Washington, D.C.:

“Amazon [now with 500,000 employees] … started with five people.”

“It’s hard to remember for you guys, but for me it’s like yesterday I was driving the packages to the post office myself, and hoping one day we could afford a forklift.”..

Turning to business best practices, Bezos said he sets his first meeting at 10 a.m.:

“I go to bed early and I get up early. I like to putter in the morning. So I like to read the newspaper. I like to have coffee. I like have breakfast with my kids before they go to school.”

“I do my high-IQ meetings before lunch. Like anything that’s going to be really mentally challenging, that’s a 10 o’clock meeting. And by 5 p.m., I’m like, ‘I can’t think about that today. Let’s try this again tomorrow at 10 a.m.'”

Bezos said he gets eight hours of sleep:

“I prioritize it. … I think better. I have more energy. My mood is better.”

“As a senior executive, you get paid to make a small number of high-quality decisions. Your job is not to make thousands of decisions every day.”

“Is that really worth it if the quality of those decisions might be lower because you’re tired or grouchy?”

“All of our senior executives operate the same way I do. They work in the future, they live in the future.”

“Right now, I’m working on a quarter that’s going to reveal itself in 2021 sometime.”

“If I make, like, three good decisions a day, that’s enough.”

“Warren Buffett says he’s good if he makes three good decisions a year.” [Laughter]. (I)

“Online retail giant Amazon is set to sell medical devices straight to consumers in a partnership with Arcadia Group, a consultancy with a history of partnering with big brand retailers such as Walmart Pharmacy to sell exclusive medical devices.” (J)

“CVS Health CEO Larry Merlo doesn’t want to leave any room for Amazon to disrupt the pharmacy benefits industry, according to CNBC.

Mr. Merlo, whose company won Justice Department approval to move forward with its $69 billion acquisition of Aetna Oct. 10, said he is more concerned with meeting customer needs than fearful off disruptors.

“So that’s what we focus on as an organization, with the goal being: Don’t leave any white space for Amazon to disrupt,” Mr. Merlo said.” (K)

“But Amazon has yet to provide any indication it’s entering the business of providing face-to-face healthcare to patients, which is increasingly the strategy being pursued by traditional drugstore chains.

Walgreens, which operates 9,800 drugstores in all 50 U.S. states, is testing myriad healthcare partnerships and this summer launched a digital marketplace that links its customers to medical care providers and their prices beyond services inside the drugstores. And CVS Health is touting its relationships with medical care providers and the potential to add more healthcare services once its acquisition of the health insurance giant Aetna is completed in coming weeks.

The strategies unfolding at CVS, Walgreens and Walmart are designed to stress the patient connection beyond the ability to order something online and have it delivered overnight or within hours. Though they don’t mention Amazon when they discuss their strategies, it’s clear they want to fill their emptying retail space with healthcare services and don’t see Amazon as a threat.” (L)

“Netflix co-founder and California resident Marc Randolph says Dallas is his favorite place in the world.

Randolph’s emotional connection to the city stems from a meeting he had with Blockbuster executives in its downtown Renaissance Tower when they were Goliaths of the video industry, and Netflix a lowly David.

With Netflix struggling to stay financially viable, Randolph and co-founder Reed Hastings tried to set up a meeting with Blockbuster executives to see whether there was any interest in buying their company.

But Netflix, at a little more than 2 years old, had less than 100 employees while Blockbuster had 60,000, so getting a meeting at all had been like pulling teeth, Randolph recalls.

“We sent emails, we tried calling, and not a peep — nothing,” he said.

Finally, Randolph and Hastings were invited to Blockbuster headquarters at Renaissance Tower. Underdressed because of the short notice, and seemingly without much leverage, the men offered to sell Netflix for $50 million.

“The meeting went downhill very quickly after that,” Randolph said.

The men returned to California without a deal — and as determined as ever to best Blockbuster.

A “miraculous” combination of no late fees, personalized rental queues automatically ordering the next DVD for customers, and a new subscription revenue model ultimately turned the company around, Randolph said, and Netflix never looked back, even as its success began to depend more and more on video streaming. It now has 130 million paying customers.

Meanwhile, Blockbuster has one remaining store in the United States, in Bend, Oregon.” (M)

“Here are seven ways Google is tackling healthcare today: HIPAA compliance; Online search; Clinical documentation; AI; Genomics research; Application Programming Interfaces; Consumer health.” (N)

“Google, Amazon, insurers and credit card companies have long been able to tell whether you vote, own a dog, spent time in prison or drive a rusty 1997 Chevrolet. Now, that type of information is starting to pop up in front of doctors when you walk into their examination rooms.

A small but fast-growing number of technology companies, including data brokers LexisNexis and Acxiom, sell health care providers detailed analyses of their patients, incorporating criminal records, online purchasing histories, retail loyalty programs and voter registration data…

The medical profession increasingly recognizes that it needs to be aware of how socioeconomic context — the buzz phrase is “social determinants of health” — is vital to a patient’s whole health. The flip side of benevolent concern, however, could be pigeonholing or invasions of privacy.

There are few safeguards on how such outside information can be used within the health system. The algorithms that companies use to classify some patients as “high risk” are rarely made public, so patients may not know their purchasing history or lifestyle could catapult them into a higher-risk strata. For every health plan that uses algorithms to predict substance abuse and help patients get treatment, there could be one that turns patients away when it learns they have.” (O)

“Geisinger President and CEO David Feinberg will reportedly lead health strategy at Google. The move comes after he turned down a high-profile job earlier this year leading the Amazon-Berkshire Hathaway-J.P. Morgan healthcare venture.

Feinberg will be tasked with pulling together and coordinating health initiatives across Google’s properties such as Google Brain, Nest home automation and Google Fit, according to CNBC. He’ll report to Google’s artificial intelligence head Jeff Dean but will work closely with CEO Sundar Pichai…

Feinberg will have a lot to work with. Google, through parent company Alphabet and life sciences arm Verily, has been relatively secretive about explicit healthcare ambitions, but there’s clear interest in the space. The tech giant has invested in methods to help stop the spread of infectious diseases, voice technology to help doctors as well as patients and numerous AI projects. Google-owned connected home device company Nest has also shown health sector ambitions.” (P)

“Sean Parker, the tech billionaire and cancer research philanthropist, may be a product of a Silicon Valley tech giant — but he’s skeptical about the impact those companies will have as they increasingly make a play in medicine.

“I just don’t think the innovations that are going to drive this revolution in health care and discovery are going to come out of Amazon or Google,”…

While coders face their own formidable challenges, Parker said, “tech people coming from tech to biology so dramatically underestimate the complexity of the human body. It’s not designed by us. It doesn’t work in ways that make sense.”” (Q)

“HERE COMES AMAZON: The tech giants keep on trampling into medicine. Seattle tech giant Amazon announced Wednesday it’s got a new machine learning service — called Amazon Comprehend Medical — intended to help the health care sector understand free text contained in medical records.

Amazon says the information will be useful for clinical decision support, revenue cycle management, clinical trials, and population health, and will potentially save lots of clerical work stemming from the need to tag or structure prose.

“We’re able to completely, automatically look inside medical language and identify patient details,” including diagnoses, treatments, dosage and strengths, “with incredibly high accuracy,” Amazon exec Matt Wood told the Wall Street Journal.” (R)

“Amazon Web Services, the company’s cloud business, announced last week that three of its most popular services — Amazon Translate, Amazon Comprehend and Amazon Transcribe — are now HIPAA-eligible. That brings to six the number of HIPAA-eligible AWS machine learning services in its catalog of offerings. The other three are Amazon Polly, Amazon SageMaker and Amazon Rekognition.” (S)

“Technology is rapidly changing the healthcare industry: surgeries are microscopic, patients have virtual appointments, doctors offer 3D visualizations on medical scans and more. But while these advancements in patient care are happening on the front lines, there seems to be a gridlock in the healthcare supply chain industry behind the scenes. Hours are wasted each day on ordering supplies and inventory is not always in stock, which leads to delayed procedures, higher costs, and ultimately, a negative impact on patients…

Imagine the scenario: on one side of the hospital, doctors perform surgeries with robots, while on the other side — either the loading dock or a supply room — procurement teams manually check spreadsheets to ensure their inventory is in stock. As budgets get smaller and executives face more pressure to bring costs down, the need to reduce both the time and money spent on outdated inventory management processes is more pressing than ever.

And while change can be complicated, there is no denying that there are a number of ways healthcare leaders — whether at a hospital or doctor’s office — can spend less time on procurement and more time on care.” (T)

“Amazon’s potential foray into healthcare has already caused players in the space to scramble and reevaluate their core competencies.” (U))

“…Dr. David Feinberg, the Geisinger CEO turned Google healthcare leader..

Because Geisinger also insures the patients it serves, there’s a built-in financial incentive to keep people healthy and out of the hospital. Dr. Feinberg took that notion one step further in his opening remarks: “I run a health system and we have about 13 or so hospitals, and I think my job is to close every one of them.”

The alternative? As he told it, bring healthcare to the people instead of bringing people to care providers.

“I think a lot of patients could be managed better at home,” he said. “We look at our highest utilizers, our sickest patients (and) we show up at their house in two cars, because we can’t all fit in one car. We got a nurse, a palliative care nurse, a community health worker, a pharmacist, a doc. We say, hi sir or ma’am, we’re here to take care of you, and our goal is that you never go in the hospital again and we know you’ve been hospitalized 12 times in the last year. Let’s clean out the medicine cabinet. Let’s make sure the house is safe. Oh, you have a bunch of appointments that are hard for you to get to? We’ll do them through telemedicine right now at the kitchen table. We just completely eliminate the need for those folks to ever go in the hospital again.”” (V)

“Amazon made headlines this year — especially as it leaped further into the healthcare arena. While there has been speculation about Amazon’s entry into the industry for years, announcements by the e-commerce giant in 2018 make it clear that it’s planning to make a big splash in healthcare. 

Here’s a breakdown of Amazon’s healthcare ventures, acquisitions, hiring trends and product developments reported by Becker’s Hospital Review.” (W)

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