2020 Predictions for Amazon, Haven, Google, Apple

Editor's Note: Since we first published this article, Amazon launched an employee health clinic called Amazon Care, a virtual clinic for Seattle-based employees and their families that lets people video chat and text with healthcare professionals. We look forward to seeing how the below predictions hold up over time as more company announcements come to light.

When you consider big healthcare companies – their roots, their capabilities, and what they’re known for – they’re ultimately successful because they make things that were once hard, very easy. On that note, allow me to dust off my crystal ball to predict what will happen next in healthcare for Amazon, Haven, Google, and Apple.

Prediction 1: “Amazon will still need care delivery experts – just like they needed book wholesalers 25 years ago.” 

What’s the first thing you bought on Amazon? Maybe a new frying pan, a pair of sneakers, or some items you bought before your first daughter was born. Amazon doesn’t just keep that data – they mine it and use it to make predictions. Since the first Amazon book sale from Jeff Bezos’ garage in 1995, the 600 million products sold on Amazon pinpoint where someone was in their life and what they needed and wanted at different times. The first time I bought things related to being a new mom on Amazon, they knew, “Okay, she’s either a new mom or she’s buying for a new mom in her life.” That tees up a whole other set of choices. From a consumer perspective, Amazon’s single value proposition is customization and personalization – I can get exactly what I want, because Amazon is mining decades of data about the previous choices I’ve made to understand who I am and why I made those choices in the first place.

Amazon’s early hook was, “We have every single title in the world!” – which didn’t play to the average Barnes & Noble consumer, but to the rare book collector or the researcher. And they leveraged some pretty old-fashioned things, like a book club. The original Amazon Recommends was like, “Hey, I read this book. I loved it. Let’s talk about it together.” Look at wholesalers and what Amazon did to the economics of the bookselling industry. Instead of a chain where book publishers distribute to book retailers and you only get certain titles in certain places, it’s all on one platform. In short, Amazon edged out booksellers.

Now if you run that play in healthcare, it has significant implications for squeezing costs out of healthcare’s supply chain. (We’re seeing this already with hospital supplies and generics drugs.) Regarding, say, Amazon’s PillPack acquisition, maybe they’ll begin doing that with low acuity, standard procedures – like at-home strep throat tests. That lets them play more in care delivery. Once a dad trusts them to figure out if his child has strep throat, you can see them start to extend consumer trust deeper into healthcare through other ways. They’ve got a whole set of assets – like Alexa – that can do some care delivery in the home, or at least care management. They can set up an ecosystem for a cardiac patient, a diabetic, the hypertensive – you name it – with all the regular nudges, prompts, and reminders they need. They will curate based on cost, because we still don’t understand quality signals. For big procedures and major life events, you’re still going to the main hospital in your market. But they will start taking apart the value chain by focusing on, say, patients who need regular supplies and guidance, and take that revenue (and profit) from incumbents in healthcare. 

Amazon and PillPack’s capability could then enable them to mine data around adherence and compliance and feed it to the care management function I mentioned above, to help patients stay on track with their care plan. 

To the extent Amazon gets PillPack customers on their generic drug delivery, consider how they can either market and sell, or tap into Alexa’s care management side. They’ll still need care delivery experts – just like they needed book wholesalers 25 years ago.  But if you consider them as the Valkyrie-judging winners and losers, they may not be judging based on what you or I would want to judge the winner on.

Amazon has developed a robust dataset of insights about all of us, like what recommendations you respond to versus ignore. It’s a continuous loop for them about how you make choices as a consumer. Incumbents need to build that or buy it.

Predictions 2: “Expect some interesting Haven products that aren’t necessarily a threat to insurers.”

Haven, announced over two years ago, brings assets from Amazon, Berkshire Hathaway, and JP Morgan Chase. Amazon has warehouse fulfillment workers and software coding technologists. Berkshire Hathaway has entities like Geico, which taught an entire consumer generation how to think about things like car insurance. Chase has bank tellers and investment bankers, and since it’s already working in healthcare payments, it really understands the economic and financial realities of many US consumers who view healthcare as a luxury item they can’t always purchase (or sometimes refuse to purchase at all).

Haven’s employees run the spectrum of the US economy. Once you’ve figured out how to offer prevention and treatment across this diverse employee population, you’ve basically cracked it for much of the US population. Because they’re in the employer seat, they may try to link together data sets that are disparate today to produce better insight. For example, they can tell things like career trajectory. Is this person a go-getter or do they have a laid-back career approach? And, they can tell how people respond to stimuli. When an employee gets a security and compliance email to complete a training module, do they do it that day? Or on the third reminder? I assume they can even enhance employees’ psychographic profiles, like how quickly they complete required tasks. (HIPAA training, anyone?) Or even what foods their employees buy from the company cafeteria. Although not everyone goes to the cafeteria for lunch, when they do, do they get sushi or salad, and how often? Culling this data to create a rich, textured profile of people’s habits and their claims data can tell us what drives healthier behaviors and reveal why people choose not to get healthcare.

Expect some interesting Haven products that aren’t necessarily a threat to insurers today. Like a credit card to finance healthcare expenses. Unlike an insurance company, Chase hypothetically could ask consumers a lot of health status questions to predict how their debt level may relate to their health, what kind of a credit rating they have and, therefore, what kind of a credit limit they want to offer them.