Amazon Care user Ashley Bennett

Digital Health

Amazon Care is Coming to a City Near You

Amazon is expanding its in-person medical care service to 20 cities by the end of next year, causing many digital primary care providers to begin wondering how much disruption is on the way.

• What is Amazon Care? The service offers virtual primary care through an app, connecting users to physicians with messages and video in as little as 60 seconds. For in-person care, nurses are dispatched to patients’ homes for tests and treatment, as opposed to patients travelling to an office.

Amazon Care began as an employee-only health service for the company’s own workers, but recently opened up to other US-based employers.

In-person care was originally limited to Washington state, Washington DC, and Baltimore, but is now set to reach Philadelphia, Chicago, Dallas, and Boston in 2021 – at least according to “three people familiar with the plans” speaking to Business Insider.

• Is Amazon Care coming to your city in 2022? Yes… as long as you live in Atlanta, Denver, Detroit, Houston, Indianapolis, Kansas City, Los Angeles, Miami, Minneapolis, Nashville, Tennessee, New York, Phoenix, Pittsburgh, San Francisco, San Jose, or St. Louis.

Although the expansion announcement might seem as innocuous as a young Jeffrey Bezos telling you he’s starting to sell books on the internet, Amazon’s success in industries ranging from e-commerce to cloud computing suggests that healthcare could be next.

The $3T US healthcare market is notoriously difficult to disrupt, and Amazon Care’s unique approach of sending clinicians to patient homes is an enormous logistical problem, but that might make the company behind 2-day free shipping the best one to solve it. 

Although Amazon’s recent healthcare ventures haven’t had an industry-altering impact, the company has a long history of experimenting, learning lessons from failures, and making a better product down the road. Amazon Care might be that product.

Digital Health

Invitae Acquires Ciitizen to Make Genomics Accessible

Genetic testing leader Invitae recently acquired consumer health tech company Ciitizen for $325m, split between $125m and approximately 7m shares of Invitae stock.

While a medical genetics business and a digital record compiler share few similarities at first glance, the strategy behind the deal comes into focus when looking at the driving themes behind each company.

• Ciitizen is a patient-centric platform that enables users to organize their medical records in order to optimize their own care or contribute the data towards a different goal, such as rare disease research. CEO Anil Sethi founded Ciitizen in 2017 after having a difficult time accessing his sister’s health records while she was battling cancer. 

• Invitae is on a mission to bring comprehensive genetic information to mainstream medicine. The company is attempting to aggregate global genetic test results into a single user-friendly service that makes the information accessible to anyone with patient consent.

• Both companies share a common goal that might be better served by working together: data accessibility. Whether unstructured health records or disjointed genetic test results, each business is seeking to improve the utility of hard-to-reach data.

The Takeaway

As genomics transitions from a laboratory testing-based industry to an information industry, Invitae is aiming to develop a platform that allows patients to make use of their data. The acquisition of Ciitizen gives Invitae the ability to create a centralized hub for genomic and clinical information, a dynamic dataset with the potential to drive better research and health outcomes.

Nuance’s Patient Engagement Must-Haves

Consumer demands are shifting, and they’re looking to get more out of their digital health technology. Nuance outlines the 5 must-haves for your patient engagement strategy here.

The Wire

• Telehealth Plateau: A new Center for Connected Medicine survey of 96 health system technology managers found that June 2021 telehealth usage began stabilizing near 20% of total visits. To assess telehealth’s effectiveness, a majority of respondents focused on non-clinical metrics such as visit volumes and patient satisfaction, while only 27 measured patient outcomes. The survey also found that most health systems are planning to expand telehealth services going forward, primarily for chronic care management and behavioral health.

• Medical Emojis: As of 2020 there were 3,521 emoji in the Unicode Standard, roughly 30 of which could be considered relevant to medicine. A new JAMA Network editorial made the case that the clinical community should work toward a consensus on what iconography would best serve patients while medical emoji are still fairly new. The author encourages physicians to think of emoji as a preloaded digital set of images that work across platforms and can facilitate communication to patients, then proposes a set of 15 new emoji to better serve this goal.

• Parkinson’s Detection: npj Digital Medicine recently published a study presenting a new method for diagnosing Parkinson’s disease (PD) utilizing the study of micro-expressions, given that a prevalent symptom is hypomimia (reduced facial expressions). Researchers analyzed the facial action units from 1,812 videos of 604 individuals (61 with PD and 543 without) in which participants made three facial expressions (smiling, disgusted, surprised) followed by a neutral face. An AI-enabled classifier achieved 96% accuracy detecting PD, a potentially transformative solution for patients in need of remote diagnoses.

• Build Your Own Community: Patient engagement platform provider Belong.Life recently announced the launch of i-BELONG, a self-managed pay-as-you-go platform for health systems to build customizable communities for their patients. Opening the platform to complete customization gives organizations the flexibility to tune a community to any need, as opposed to using one of Belong’s prebuilt configurations like BelongMS for multiple sclerosis patients.

• Less is More: With the ONC recently banning information blocking, researchers from Johns Hopkins and Westpoint examined the downside of sharing detailed notes with patients in a new JAMA Oncology viewpoint. While complete transparency gives patients a clear view of their situation, the authors found that the blunt analytical tone of these notes often leads to avoidable patient confusion and anxiety. The findings are a reminder that less information is sometimes beneficial, and that the art of oncology lies in accurately conveying information while also maintaining empathy.

• Rule Change: A range of digital abortion clinics have begun to appear after the Biden administration recently placed a hold on an FDA rule that required medical abortion pills to be dispensed in-person. These digital clinics provide a more affordable path to an abortion, but UCSF reproductive health professor Carole Joffe sees a potential downside to the ease of access: if digital alternatives take a large enough share of the first-trimester visits (90% of all abortions), many brick-and-mortar clinics will have to close, leaving those in search of second-trimester procedures with nowhere to go.

• Behavior Change Apps: A recent JMIR mHealth and uHealth analysis of 60 chronic condition management apps found that average disease information quality was acceptable but few apps were effective at promoting behavior change. Common behavior change functionality included weight/diet tracking (25), stress management (23), and physical activity tracking (22). When designing mHealth apps for chronic condition management, recommendations include implementing more effective behavior change protocols, such as gamification and social proofing.

• Cityblock Capital: Medicaid healthcare provider Cityblock Health recently completed a $400m Series D capital raise ($891m total funding), giving the four-year-old company a valuation of $5.7b. Cityblock originally launched in 2017 out of Alphabet’s Sidewalk Labs, aiming to serve under-privileged communities by addressing healthcare at the neighborhood level. The company provides care to over 70k members by partnering with local organizations to help expand access to primary care, behavioral health, and social services.

• Patient Nonadherence: A new study published in the Journal of the American Geriatrics Society investigated the causes of nonadherence for oral anticoagulants among patients with atrial fibrillation. Of the 43 patients studied, 35 started their prescription but stopped, skipped, or decreased dosing. Nonadherence themes included drug costs, a perceived lack of need, and drug efficacy doubts. Researchers point to patient engagement and communication for overcoming each barrier, even cost, given that a less effective but more affordable medicine could be a better treatment path if a price conversation determines nonadherence is likely.

• Telemedicine Care Models: In a recent JAMIA article, Stanford researchers called for the development of an optimal telemedicine care model following the technology’s rapid adoption and likely staying power. According to the authors, an optimal care model must include the following components: 1) secure consults across the multidisciplinary care team 2) experience optimization and training for clinicians/patients 3) embedded quality and patient-reported outcome metrics.