Amazon's telehealth gold rush

The collision of health care and technology.

Mar 30, 2022 View in browser   By Emily Birnbaum The Big Idea AMAZON'S TELEHEALTH MOVES: With little fanfare, Amazon recently launched its most significant foray into clinical health yet: the expansion of its Amazon Care telehealth service nationwide and in-person care services to more than 20 cities this year. Meanwhile, the tech giant inked a partnership with Teladoc , one of the largest telehealth providers in the country, which will allow people to access its services through their Alexa devices. Amazon has been pushing into the health care space for years, starting with its wearable health device, Halo and pharmacy services with its PillPack acquisition. But this latest move signals that the company is getting serious about its role in the rapidly expanding telehealth industry, which could grow to a $20 billion sector over the next five years. Amazon is among many nontraditional health care businesses to make inroads into virtual care, joining Verizon, Dollar General, Best Buy and more. Idris Adjerid, a Virginia Tech professor focused on business information technology, said Amazon's "ability to integrate" its health offerings into its other popular products like Alexa will provide a competitive advantage in an increasingly crowded industry. The policy implications are enormous , prompting privacy and antitrust advocates to watch Amazon's moves with trepidation. After all, it has a reputation for leveraging its dominance in other areas, like e-commerce, to take over new markets, sometimes at the expense of user privacy. "They are effectively a data business," said Adjerid. "And there's a big concern about how they could leverage that data when it comes to health." For example, some experts are concerned that Amazon could use the patient information it collects to target them with e-commerce recommendations. Most of Amazon's telehealth and in-person offerings are likely covered by HIPAA, experts told Future Pulse. Amazon has tapped third-party teams of clinicians with family medicine backgrounds to help patients who use the Amazon Care service. The clinicians' involvement means that patients' information will likely be covered by health data privacy regulations. But some of Amazon's other offerings, such as its partnership with Teladoc, might fall into a gray area. In a statement, Amazon spokesperson Julia Lawless said the company designed the Teladoc on Alexa experience with customer privacy in mind. "Amazon cannot access, record, or store the content of your conversations with Teladoc," Lawless said. "Alexa only logs that a call took place, not what health information was discussed during the call. Any protected health information you share with Teladoc will be handled pursuant to HIPAA and Teladoc's Notice of Privacy Practices." A sign is seen outside of an Amazon Go store at the Amazon.com Inc. headquarters on May 20, 2021 in Seattle, Washington. | David Ryder/Getty Images Progressive antitrust advocates like Stacy Mitchell, co-director of the Institute for Local Self-Reliance, said that if Amazon gains a foothold across the market, from pharmacy to direct patient care to wearable health devices, there's a risk that it could use that power to disadvantage the people and businesses that rely on them, potentially violating antitrust law. "They're losing all kinds of money" on their health care ventures, Mitchell pointed out — something it can do because of the hundreds of billions of dollars it earns in e-commerce and cloud computing, "gravy" that Amazon's rivals don't have access to. Welcome back to Future Pulse, where we explore the convergence of health care and technology. Share your news and feedback: @_BenLeonard_, @birnbaum_e.   SUBSCRIBE TO NATIONAL SECURITY DAILY : Keep up with the latest critical developments from Ukraine and across Europe in our daily newsletter, National Security Daily. The Russian invasion of Ukraine could disrupt the established world order and result in a refugee crisis, increased cyberattacks, rising energy costs and additional disruption to global supply chains. Go inside the top national security and foreign-policymaking shops for insight on the global threats faced by the U.S. and its allies and what actions world leaders are taking to address them. Subscribe today.     Tweet of the Week Krishna Komanduri, MD, FASTCT @drkomandur: "I'm always amazed at the paper intake form experience. Take a seat please. Clipboard. Pen. Then semi-relevant and sometimes redundant questions. And then someone manually takes this info and does what to it? It all reflects a bygone era and is ripe for improvement." Washington Watch A GRIM CYBER THREAT: Amid the Biden administration's warnings about potential Russian cyber threats, the U.S. is facing a disturbing reality: It might have too many targets to defend them all, POLITICO's Maggie Miller reports. The health care sector is among the long roster of crucial infrastructure, including banks, energy suppliers and food manufacturers that hackers have victimized in recent years. Cybersecurity experts fear attacks on the energy and finance industries, but they say the health care sector also is an attractive target for cybercriminals. The sensitive information held by health care organizations can be valuable because of its endurance: Patients can get a new credit card and cancel the old one if it's hacked, but they can't similarly start fresh with their medical history. Health care organizations frequently have weak cybersecurity budgets. But their focus on the Covid-19 pandemic has left them even more vulnerable to the recent hacking surge. "Our organizations are continuously being probed and scanned from Russia, China, Iran and North Korea thousands of times a day, literally, whether it's a small critical access hospital or the largest systems," John Riggi, the national adviser for cybersecurity and risk at the American Hospital Association, said last month. Experts expect that the likelihood of a direct attack on U.S. health care infrastructure would increase if more countries get drawn into the war in Ukraine or if sanctions further debilitate Russia. EX-GOOGLE CEO AND BIDEN'S SCIENCE OFFICE: Eric Schmidt, the former CEO of Google, has exerted what staffers call an unusual level of influence in President Joe Biden's science office, POLITICO's Alex Thompson reports. More than a dozen officials in the 140-person White House Office of Science and Technology Policy have been associates of Schmidt. And his charity arm, Schmidt Futures, indirectly paid two science office employees' salaries. That included six weeks' salary for the office's chief of staff, Marc Aidinoff. Schmidt Futures paying the staff salaries raised "significant" ethical concerns, given Schmidt's financial interests in areas overlapping with the office's responsibilities, according to the science office's then-general counsel, Rachel Wallace, in internal emails obtained by POLITICO. Schmidt serves on the boards of a number of tech companies, including some that focus on artificial intelligence. The office is in charge of setting priorities for the U.S.' $1.4 trillion-plus annual spending on health and science. A spokesperson for the office disputed the notion that the office's work dovetailed with Schmidt's priorities. "You're trying to tell a story of agency capture — that one philanthropy has influence over policy outcomes," the spokesperson said in a statement. "And yet, OSTP is executing on an aggressive agenda to protect the civil rights of all Americans impacted by algorithmic discrimination in the use of artificial intelligence and automated systems." Ideas Lab INTERNET ACCESS AND COVID DEATH RATES: Areas with limited internet access had higher Covid-19 death rates, particularly in urban areas, a study published recently in JAMA Network Open found. Researchers from the University of Chicago studied data from more than 3,100 counties across the U.S. during the first year of the pandemic, between January 2020 and February 2021 — before vaccines were widely available. Across all types of communities — rural, urban and suburban — death rates were significantly higher in areas with less internet access. "More awareness is needed about the essential asset of technological access to reliable information, remote work, schooling opportunities, resource purchasing, and/or social community," the researchers wrote. "Populations with limited internet access … are often excluded in pandemic research." The study didn't explicitly mention telehealth, but the findings suggest that access to health information influenced Covid-19 outcomes, potentially via access to virtual care or reliable online health information. The findings also bolster the case for advocates pushing to expand broadband access. The Next Cures AI TO PREDICT HEART ATTACKS? Cedars-Sinai researchers developed artificial intelligence to make predicting patients' heart attack risk much simpler, a new study published in the Lancet Digital Health found. Researchers say the technology can accurately predict which patients would have a heart attack within five years based on the plaque in their arteries. Current technology uses 3D images of the heart to identify how much arteries have narrowed — which increases heart attack risk — but lacks an automated way to quantify the plaque in the images. "When it is measured, it takes an expert at least 25 to 30 minutes, but now we can use this program to quantify plaque from CTA images in five to six seconds," said Damini Dey, senior author of the study and director of the quantitative image analysis lab in the Biomedical Imaging Research Institute at Cedars-Sinai. The study used images from nearly 1,200 people in Australia, the U.S., Germany, Scotland and Japan between 2010 and 2019. Dey said the findings could allow clinicians to predict heart attack risk, though more research is needed. Zooming out: AI has long been hyped in health care but has had limited success. Imaging has been one area where it's shown the most promise. What We're Clicking Workers at digital health startups Cerebral and Done told The Wall Street Journal they felt pressure to prescribe stimulants amid eased pandemic prescribing rules. Racial minority health apps seem to be a "step in the right direction," Udani Samarasekera argues in the Lancet Digital Health. Digital health is the latest iteration of "medicine's knowledge problem," Charlotte Grinberg writes in a STAT opinion piece.   DON'T MISS POLITICO'S INAUGURAL HEALTH CARE SUMMIT ON 3/31: Join POLITICO for a discussion with health care providers, policymakers, federal regulators, patient representatives, and industry leaders to better understand the latest policy and industry solutions in place as we enter year three of the pandemic. Panelists will discuss the latest proposals to overcome long-standing health care challenges in the U.S., such as expanding access to care, affordability, and prescription drug prices. REGISTER HERE.       Follow us

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