As Amazon and the rest of Big Tech push into the health care industry, privacy advocates worry what they’ll do once they can add people’s most sensitive information to the already mammoth trove of data they hold.
Joana Gaia, a professor from the University at Buffalo’s School of Management, sees some upside.
Let’s say you’re looking to eat healthier, you’re an Amazon customer and you’re receiving your health care through One Medical, a primary care provider with offices in Seattle that could soon come under Amazon’s umbrella. You told your provider about your diet and, at some point, agreed to let Amazon use some of your personal data to advertise products you might be interested in.
That agreement could, hypothetically, help you score a discount on organic kale.
“If Amazon has information about your health habits, they can say, ‘Hey take these vitamins or here’s a coupon for Whole Foods to try organic kale,’ ” Gaia said. “The benefits are huge if you think about it from this standpoint.”
On the other side of the equation, privacy advocates worry about whether companies like Amazon are collecting that data without users’ consent — and how it could be used to make predictions about users that might not be true.
But for Gaia, that innocuous bit of data-powered commerce illustrates what platforms like Amazon are supposed to do for retail customers, what health care providers are supposed to do for patients and what a combination of the two could do together: use information to provide a better service.
Amazon acts as a “bridge between consumers and whoever else,” Gaia said. Lately, the company is aiming to connect its platform with the health care industry, from kale to pharmaceuticals to telehealth.
Amazon has been eyeing different parts of the health care industry for years, launching its own health care venture with the goal of lowering costs, setting up coronavirus testing centers and opening a digital drugstore. Amazon Web Services, the company’s cloud computing arm, already helps manage data and tech infrastructure for health care providers and health insurance companies.
In July, Amazon took another step forward when it announced plans to acquire One Medical, a primary care provider that serves more than 760,000 people nationwide. The $3.9 billion acquisition is still subject to regulatory review, but both companies say it will “transform health care.”
“We think health care is high on the list of experiences that need reinvention,” Neil Lindsay, senior vice president of Amazon Health Services, said in a statement announcing the acquisition.
A lot of groups — from health care systems to insurance providers to startup founders — have made similarly ambitious statements about upending an industry known for high costs, long waits and general confusion. But as tech giants like Amazon, Google and Apple turn their attention to health care, industry experts and privacy advocates worry about how companies accustomed to monetizing data will handle patients’ most sensitive information.
For Amazon — a retailer, tech provider, device manufacturer and advertiser — those concerns are amplified.
“Amazon already has so much data on us — they know many of our purchases online, what we read on Kindle, what we watch on Amazon Prime. Adding health information to this adds an additional piece to the puzzle,” said Louiza Kalokairinou, a postdoctoral fellow at the University of Pennsylvania’s department of medical ethics and health policy.
Taken together, that data can paint a picture of a person, Kalokairinou said. Companies could then use that picture for targeted advertising or to make assumptions about a group of people based on demographics or geography, leading to changes in insurance coverage and rates.
“There are already concerns about our everyday data,” Kalokairinou said. “And then when you add sensitive data on top of that, this enhances all those concerns.
“The more you collect about specific people, the more you’re able to predict behavior.”
Apps, acquisitions and privacy regulations
Amazon has said it will follow privacy regulations meant to protect individuals’ health care data, and the information won’t be used for other purposes — like advertising or marketing Amazon products — without users’ consent.
“Nothing about this transaction” changes Amazon or One Medical’s obligation to comply with the Health Insurance Portability and Accountability Act, or HIPAA, an Amazon spokesperson said.
“Both One Medical and Amazon have stringent policies protecting customer privacy in accordance with HIPAA and all applicable privacy laws and regulations,” the spokesperson said. “We will retain our focus on this as we continue to grow our health care businesses.”
For Amazon, those policies are nothing new and the stakes are already high. Health care providers, insurance companies and IT professionals already use Amazon Web Services to process health information.
“Rest assured, they’d lose most of their AWS health care business if they ever did something that was against HIPAA or against expectations,” said Jonathan Weiner, a professor of health policy and management at Johns Hopkins University.
The health care data that companies can and do collect, buy and sell must be aggregated and anonymized, meaning it should be impossible to pick out one individual from a set of statistics and match that up with other defining characteristics.
But existing regulations don’t cover all the data that comprises an individual’s digital profile: buying vitamins online, tracking nutrition on a mobile app. Collecting heart rate trends on a wearable device.
In that gray area, the combination of e-commerce retailer and health care platform can raise additional concerns.
Weiner put it in terms of subscribing to a cooking magazine.
Magazines have long sold their subscription lists to retailers looking to reach customers with particular interests. “Amazon does the same thing,” Weiner said, “but the cooking magazine doesn’t also have my medications and doesn’t also have my doctor data and … electronic medical data maybe sitting on AWS.”
Amazon says it does not use the same practices.
For some patients, the stakes around protecting their private medical data are now higher in light of the Supreme Court’s decision overturning Roe v. Wade, removing constitutional protections for abortion access. In some states where abortions could be banned or restricted, authorities looking to prosecute pregnant people who receive the procedure could use data collected by Big Tech.
In response, some tech companies have started taking steps to better protect information. Google said it would automatically erase location information about users who visit abortion clinics or other places that could trigger legal problems.
More broadly, consumers and the health care industry overall are weighing privacy concerns against the benefits of sharing more data across more platforms.
A device like Alexa could help provide consistent instruction for behavioral therapies for children with autism. A pharmacy connected to the device could let consumers refill a prescription with a voice command and have their pills at their doorstep within hours. If one specialist prescribes you a blood thinner and all your health care data is connected, your nutritionist will know to tell you can’t eat grapefruit.
“When the rubber hits the road, we all are willing to give up our privacy for better care and better outcomes for ourselves,” Gaia from the University at Buffalo said.
About 81% of adults in a 2020 survey from The Pew Charitable Trusts, a nonprofit, said they supported data-sharing and increased access to health information for patients and providers. Four in 10 respondents said the pandemic made them more likely to support data sharing. But, the percentage of people who said they had “serious privacy concerns” more than doubled when they learned federal privacy protections don’t extend to all apps.
Amazon as a health care company
Amazon has spent the last several years chipping away at parts of the health care system to, it says, help create better outcomes.
“We see lots of opportunity to both improve the quality of the experience and give people back valuable time in their day,” Lindsay, from Amazon Health Services, wrote in a statement. “We love inventing to make what should be easy easier and we want to be one of the companies that helps dramatically improve the health care experience over the next several years.”
In 2018, it bought online pharmacy PillPack and later opened its own online drugstore. It operates a PillPack facility in Kent, where workers fill prescription orders and ship off completed packages.
The same year, Amazon formed a venture with JPMorgan Chase and Berkshire Hathaway called Haven, intending to overhaul employee health care and improve costs. Haven dissolved quietly in 2021.
In 2020, Amazon unveiled Halo, a wearable wristband that monitors sleep and activity.
“We are using Amazon’s deep expertise in artificial intelligence and machine learning to offer customers a new way to discover, adopt and maintain personalized wellness habits,” Dr. Maulik Majmudar, principal medical officer for Amazon Halo, said in a statement.
After piloting a health care service with its own Seattle-area employees, Amazon launched Amazon Care to employers nationwide in 2021. It is also partnering with telemedicine provider Teladoc Health to start a voice-activated virtual care program through its Echo devices.
Amid the pandemic, Amazon launched its own testing program for front-line employees at the company.
On AWS, it hopes to create partnerships with other health care tech companies to build “a more seamless connection between patients, payers and providers, to humanize the patient experience,” it wrote in a March blog post.
Now, Amazon’s acquisition of One Medical will add physical office space to its portfolio of health care products. As of March, One Medical had 188 medical offices in 25 markets, including Seattle, according to a recent earnings report. One Medical offers patients a combination of in-person and virtual services available through a $199 annual membership, and works with more than 8,000 companies to provide its health benefits to employees.
The acquisition represents “entrepreneurial innovations in the delivery of care,” said Wayne Winegarden, a business and economics fellow from the Pacific Research Institute, a think tank that advocates for a free market and limited government. “We’re looking toward experimenting with new ways of providing primary care services, which is what we desperately need.”
Amazon’s capital and expertise could help raise One Medical’s current subscription-based plan from a $199 membership to a $500-plan that offers the best primary care service around, Winegarden said. Or it could ultimately help change the way medical professionals use electronic health records. That way a patient never has to tell a doctor they are allergic to penicillin; their health records will do it for them.
Or, it might not work.
“Maybe they’ll be coming up with a model, and they’ll be able to integrate it and it will work well, maybe they won’t,” Winegarden said. “I think it’s possible they don’t necessarily add value. From my perspective, a health care economist perspective, that’s fine. We learn from failures.”
It’s been difficult to bring innovation to health care in part because the industry — and the patient information it works with — is highly regulated, Winegarden said.
Amazon’s acquisition of One Medical is still subject to regulatory approval and critics have already called for regulators to block the deal, arguing it endangers privacy and allows the company to gain a foothold in another major sector.
In a letter asking the Federal Trade Commission to investigate the acquisition, Sen. Amy Klobuchar, D-Minn., said the proposal could “result in the accumulation of highly sensitive personal health data in the hands of an already data-intensive company.”
She also raised concerns about stifling competition since Amazon has its own pharmacy and could offer preference to vendors that offer other services through its platform.
If the deal does go through, current One Medical members shouldn’t have to worry about their data, Weiner from Hopkins said. One Medical CEO Amir Dan Rubin will remain in his role, Amazon is already used to operating in the highly regulated health care space and HIPAA will still act as a safeguard.
But, Weiner recommended, read the fine print if Amazon offers a 30% discount to fill prescriptions through its pharmacy. Those lengthy agreements are where users could sign away what privacy they have left.
This story has been updated to include additional comment from Amazon. An earlier version of this story also misstated the name of the University at Buffalo.