Where Amazon is heading in health after the Amazon Care failure

Chalk up another failure in health care for Amazon, one of the ultimate market disruptors.

First, its much-hyped effort with JPMorgan and Berkshire Hathaway to reform health care, Haven, ended its short life.

Now, Amazon Care, its effort to tackle telemedicine and primary care for the employer market on a national basis – which Amazon itself trumpeted as gaining more and more clients – is being shut down.
Is that all the proof we needed of what many people have said over the years: health care is just harder to disrupt than most industries?

Maybe not, though maybe it is a signal of a change in the approach to how Amazon will attempt to gobble up more health industry market share. The shutdown of Amazon Care may come back to a simple choice that companies, especially those with a lot of cash, have to make when it comes to breaking into new markets: build or buy?

For some health-care industry watchers, it’s no surprise that Amazon Care is going away as a stand-alone entity. When Amazon made the decision in July to acquire primary care company One Medical, which does what Amazon Care was hoping to ultimately do on a national basis, it was the writing on the wall that something was going to change. And for a cash-rich company looking for opportunities to buy into a stock market that had pushed down the value of recently public health companies – One Medical had traded as high as $58 in 2021 and Amazon announced plans to buy it for $18 a share – Amazon may have been more opportunistic than anything else in plotting the next stage of its future in health.

Buying into a market where it wants more share and where it requires a physical presence isn’t new to Amazon, nor is being opportunistic in the timing. As Amazon’s acquisition of Whole Foods reaches the five-year mark, it’s worth remembering that Amazon’s shares went up in value as much on the day it announced the acquisition of Whole Foods as the purchase price for the then-troubled high-end grocer.

“It’s not surprising they’re shutting it down,” said Sari Kaganoff, general manager of consulting at Rock Health, which invests as a VC in health start-ups and has a health advisory and research arm. “Their vision always was to have a primary care integrated solution and now it will have a better solution than what they could build,” Kaganoff said.

It was a little surprising, maybe, that Amazon announced the shutdown before the One Medical deal even closed, but One Medical has many more markets, many more offices and many more companies that are clients than Amazon ever did (it had to boast about signing up Whole Foods, which it owns, as a client for Amazon Care). Maybe also surprising: it didn’t wait to rebrand One Medical as part of Amazon Care. PillPack, its acquisition in the pharmacy space, still has a brand but is now folded within Amazon Pharmacy.

By Amazon’s own account, Amazon Care was a failure, at least in the terms conveyed in the internal memo provided to the press about the shuttering. There’s no doubt it struggled with the problem of building up an in-person care component nationwide, staffing up in a sector where it has limited history, and getting corporate customers to sign on. While telemedicine is a nice have, it’s not a full health-care solution, and Amazon would have had to ramp up investment considerably to build a true national hybrid health-care practice with sites and physicians and clinics.

In the end, let’s say Amazon Care was a test run for a business, and once Amazon learned enough to know what it wanted in the long-term, it bought the better company at a time when its value was depressed.

“I don’t think they failed, because One Medical is great,” Kaganoff said.

Amazon learned a lesson that has influenced the fortunes of many health disruptors in recent years: it’s hard to make a stand-alone startup work in the sector — even if you’re one of the richest companies in the world — consolidation is increasingly the way to go.

“Amazon Care was no different than any other stand-alone health startup in terms of needing to be consolidated,” Kaganoff said. “They played around with it a bit,” she added, enough to know their ambitions remain validated on the market, but just not the way there.

“One of the ways we’ve worked towards this vision for the past several years has been with our urgent and primary care service offering, Amazon Care. During that time, we’ve gathered and listened to extensive feedback from our enterprise customers and their employees, and evolved the service to continuously improve the experience for customers. However, despite these efforts, we’ve determined that Amazon Care isn’t the right long-term solution for our enterprise customers,” the internal memo said.

While Amazon’s health-care efforts in recent years have been associated with direct battles to unseat recent health disruptors (e.g., Amazon Care vs. Teladoc), Wall Street analysts have said the market should worry more about Amazon making a string of acquisitions that speak to broader aims.

That’s what seems to be happening.

Amazon isn’t done yet pushing its cash around in buying more in health-care, with recent headlines reporting it is among bidders for Signify Health, which has an overlap with the Iora Health business of One Medical, focused on a more complicated, Medicare-centric market than standard national care practices. 

It’s clear Amazon still plans to be a formidable player in the health-care space. It can leverage its ability to personalize its offerings, connect to its pharmacy, and ultimately pose a threat to many other retail giants aiming to upend healthcare. Walmart acquired telehealth company MeMD in 2021; CVS, which already offers telemedicine through a deal with American Well, is another rumored bidder for Signify; and Walgreens has VillageMD and is opening up hundreds of offices in markets around the country.

That retail disruption is only going to grow, for a bottom-line reason. When you look at the share of wallet, from consumers to employers, the health-care market is a big part of spending. Amazon is already in almost every chunk of the wallet, maybe not banking (though it does have credit cards).

What’s the biggest chunk of the market they are not in?

“It’s healthcare, and they already have so many things consumer-health oriented, it just makes sense to go big in health care,” Kaganoff said.

When Haven — which disbanded after three years — debuted to much fanfare, people thought the combined might of Berkshire Hathaway, JPMorgan and Amazon could result in a significant driving down of costs throughout the health-care system that Warren Buffett has called a tapeworm on the national economy.

And that’s still part of the story. Anything Amazon does is partially about driving down cost and driving up efficiency. “Better care at a lower cost,” is what Cano Health CEO Marlow Hernandez told CNBC last week is the paradigm shift for all players in the space.

Amazon’s consumer internet business may be the ultimate in transactional disruptors, but the transactional system of health care is under threat and people don’t want to treat it like just another form of retail. “What patients have been demanding is that integrated platform where they can build relationships and no longer be a number,” Hernandez said.

That’s referred to as value-based care — and maybe it is a sign of just how messed up the U.S. health-care system is that “value” for patient is a novel idea — and it is leading to a lot of consolidation. Hernandez projects the primary care market will grow from $1.8 trillion to $3.7 trillion by 2030.

And that speaks to the underlying aim for any big company like Amazon and its rivals.

“I think it’s just market share,” Kaganoff said.

The end of Amazon Care did seem abrupt. But as Amazon moves from primary care, into more complicated care, and potentially even chronic care – and combines pharmacy and over-the-counter medication with all its offerings – everyone from private health start-ups to Teladoc to retail competitors and health-care incumbents should continue to worry. Amazon Care’s failure may have come at a cost and may have come as a surprise, even to some within Amazon, but what the company ultimately is buying and building off may still make it the stronger disruptor.