One Medical deal gives it access to my most personal info

For the better part of a decade, One Medical has been my primary care provider. It’s convenient, with locations around the Bay Area, and I love being able to schedule a same-day physical or get a quick referral to a specialist.

A doctor knows a lot about me. In addition to years of clinic visits and virtual chats, I use the mobile app to record my blood pressure and resting heart rate, check my lab results, and renew prescriptions as needed. For this, I pay a membership fee of $199 per year.

But I never considered the possibility that Amazon might one day own One Medical.

The same company that sends me countless boxes every week, gives me my Kindle with book recommendations and my smart TV with movie suggestions, tells my kids the weather forecast when they call Alexa, and offers Prime discounts when I shop at Whole Foods is about to provide my medical services and own the portals that contain my most sensitive information.

I’m not the only person who had this deeply troubling thought on Thursday after waking up to the news that Amazon had agreed to buy One Medical for about $3.9 billion. At $18 a share, Amazon is paying a 77% premium to where the primary care company was valued a day ago.

As one member tweeted, “After a largely positive experience with One Medical, I canceled my membership today. I don’t trust Amazon to act in good faith with my health information.”

Founded in 2007 and based in San Francisco, One Medical offers clinical services in 16 U.S. markets, with three more coming soon, according to its website. At the end of last year, the company had 736,000 members.

Amazon did little to assuage my fears with the announcement of the purchase. The company said nothing to offer One Medical customers any comfort, and there was no conference call to discuss the acquisition, as is customary with many large transactions. Closing the deal will require regulatory approvals.

In response to an inquiry for this story, Amazon provided the minimum level of assurance that it will comply with government regulations, under the Health Insurance Portability and Accountability Act (HIPAA), that limit how the company can use protected information health information, or PHI. This includes all personally identifiable information, as well as medical history, laboratory test results and other health data.

“As required by law, Amazon will never share personal health information of One Medical customers outside of One Medical for purposes of advertising or marketing other Amazon products and services without the customer’s express permission,” an Amazon spokesperson said in a statement. an email. “If the deal closes, the HIPAA-protected health information of One Medical customers will be handled separately from all other Amazon businesses, as required by law.”

In other words, everything One Medical knows about me is supposed to stay in that protected silo. Whatever profile Amazon has built on me and my family, from our shopping habits and travel preferences to the shows we watch together on the weekends, won’t mix with my health data.

Regardless of the laws, Amazon will have to work hard to convince consumers — and potential politicians — that its intentions are pure and its main goal is to help “dramatically improve the health care experience over the next several years.” next,” as Neil Lindsay leads Amazon Health Services. said the news release announcing the deal.

After all, along with its giant retail and cloud divisions, Amazon has built a very profitable advertising business that generated over $31 billion in revenue last year and grew 58%. Most of that money comes from brands paying big bucks to promote their products on Amazon properties, where competition for eyeballs is getting more expensive.

Amazon controls roughly 13% of the US online advertising market, behind only Google and Facebook, according to Insider Intelligence.

“I don’t think there’s anything Amazon can do to get people to trust the company with their health care information,” said Caitlin Seeley George, campaign director for Fight for the Future, an advocacy group. focused on technology and digital rights.

Seeley George said in an email that the issue of health privacy is especially important after the Supreme Court overturned Roe v. Wade, which ended the constitutional right to an abortion. Some decisions related to reproductive health, which until recently were protected by law, can now be considered potentially illegal.

Amazon has already restricted sales of emergency contraceptive pills after demand surged following the Supreme Court ruling. And Google said it will work to quickly delete location history for people who go to abortion sites.

“The push forward in health care raises some serious red flags, especially in the post-Roe reality where people’s data can be used to criminalize their reproductive health care decisions,” said Seeley George.

Seeley George also questions whether, outside of HIPAA regulations, Amazon could open a fertility or mental health tracking app and collect information that “could be used to create assumptions about an individual that could be used against them.”

Amazon already has a health tracker called Halo that collects information such as body fat percentage, activity levels and sleep.

Techno-optimists are likely to scoff at such cynicism. The status quo in health care is deplorable. The systems are old and don’t talk to each other, billing is extremely opaque and complicated, and medical care is prohibitively expensive.

Amazon has been pushing into the health space for years, recognizing the system’s many flaws and inefficiencies and trying to provide better care to its massive employee base, which jumped to 1.6 million last year from 1.3 million in 2020.

Amazon bought online pharmacy PillPack in 2018 for $750 million and launched Amazon Pharmacy two years later. The company has invested in a telehealth service called Amazon Care, which was launched as a pilot for some employees in 2019 and is now available for other employers to offer as a service to their staff.

Deena Shakir, a partner at venture firm Lux Capital and an investor in numerous health tech startups, noted that for Amazon, this is not their “first rodeo in healthcare.”

“Amazon is very aware of how to handle HIPAA considerations and has experience in multiple products with this,” Shakir wrote in an email. This type of deal “should encourage additional partnerships between larger companies and major health technology players,” she wrote.

Shakir’s firm is an investor in Carbon Health, which provides primary care and urgent care facilities in 16 states. The company serves about 1.1 million patients and, compared to One Medical, typically targets a less affluent demographic.

Carbon Health CEO Eren Bali agrees with Shakir that Amazon is deeply limited in how it can use data. Compared to other big tech companies like Facebook and Google, he says Amazon gets a fair amount of trust from consumers.

But Bali understands why there might be concern. Healthcare companies have large amounts of personal data, including Social Security numbers, driver’s license numbers and insurance cards on top of all the health information in their systems. Patients are much more willing to hand over personal information to doctors and nurses than to other types of service providers.

And while there are strict rules about how that data can be used, consumers may reasonably wonder what happens if a company like Amazon were to break the rules.

“Unfortunately there are no strong technical solutions to implement data access, which is a big weakness,” Bali said in an interview. Whether patients should worry about it is a “personal decision,” he said.

Bali is generally positive about Amazon’s jump into the space. When Amazon makes a big announcement signaling its arrival in an old market with large operators, existing players find themselves forced to act to avoid extinction, Bali said.

He cited Amazon’s acquisition of PillPack as an example. While Amazon has struggled to gain traction in the pharmacy business, the entry has prompted companies like Walgreens and Walmart to bolster their digital offerings in ways that are beneficial to consumers, Bali said. The One Medical deal could similarly drive improved products and services in the primary care world.

“Big companies usually don’t feel threatened by small startups,” Bali said. “But they are really threatened by Amazon.”

— CNBC’s Annie Palmer contributed to this report.

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