Assessing the Biggest Disruptors in Healthcare

A new American Hospital Association report takes a closer look at the biggest challengers to healthcare's status quo, and challenges traditional providers to be innovative to survive in a competitive primary care market.

The primary care landscape, which accounts for some $260 billion in annual healthcare spending, is ripe for transformation. The growth of direct-to-consumer telehealth and the retail healthcare industry are putting traditional providers on notice: Embrace innovation or fade away as consumers take their healthcare elsewhere.

To understand how to offer primary care in this chaotic landscape, healthcare leaders might do best to look at how disruptors are entering the space. That's the gist of a report from the American Hospital Association, which cites a Bain & Company analysis that indicates 30% of that primary care market could be owned by those non-traditional providers within seven years.

The AHA's "Health Care Disruption: 2023 Outlook" examines how seven of the biggest disruptors--Amazon, CVS Health, UnitedHealth Group, the Walgreens Boots Alliance, and Walmart, and tech companies Apple and Google/Alphabet—has staked their claim in primary care, and used that platform to expand.

"The nation’s largest retail, payer and tech disruptors once again invested billions of dollars in healthcare in 2022, continuing to build out their visions to transform the field," the report notes.  "In the short term, these moves helped the companies grab market share in primary care, concierge medicine, virtual care, in-home medical services and elsewhere."

"In many cases, the investments helped companies broaden their footprints as they continue to integrate their expanding vertical healthcare operations in areas like pharmacy benefits management, behavioral health, care coordination, diagnostics and therapeutics, and health information technology," the report continues.

It points out that these disruptors are seeing success by addressing pain points and gaps in healthcare that traditional, fee-for-service providers have failed to correct. And in the future, healthcare will continue to see these innovative care models that focus on value-based care by, among other things, offering multi-disciplinary services that address specific consumer concerns at the time, place, and modality that they prefer.

The Disruptors

Amazon may be the biggest of the disruptors, with its proposed purchase of One Medical, pending a review by the US Federal Trade Commission, poised to dramatically shake up the primary care field. But the online giant is also expanding its pharmacy base with RxPass, and boosting diagnostics, therapeutics and disease management capabilities.

But this path forward isn't assured, or easy. The failure of the company's virtual primary care platform, Amazon Care, is still fresh, and the One Medical partnership is still under review. Critics also question whether Amazon can forge partnerships with health systems and scale its primary care service to stay on par with competitors like Walgreens and CVS.

CVS Health, meanwhile, is laying the groundwork to be the biggest primary care provider, capped off by the recent acquisition of Oak Street Health. The company has also picked up Signify Health and is investing heavily in virtual care and digital health, through both its HealthHUB locations and innovative start-ups and early-stage tech companies. With more than 10,000 retail pharmacies in the US and Puerto Rico, as well as 1,000 MinuteClinics, it's poised to continue growth.

But will the company's reach exceed its grasp? Critics wonder if it's growing too fast, and not laying the right groundwork through partnerships with providers and payers. Management's goal to facilitate 65 billion healthcare transactions by 2030 is a lofty promise.

UnitedHealth Group, which includes Optum, is the one familiar face in the crowd, with a background in the payer market. The company has made a huge push toward diversification, topped off by the $8 billion merger with Change Healthcare this past year and investments in digital health, care coordination and remote patient monitoring capabilities. Now it's focused on value-based care, including an ACO partnership with Walmart, a partnership with HealthEdge and the acquisition of Imperium Health.

And while value-based care is at the top of everyone's to-do list, no one has figured out how to make it work just yet. UnitedHealth Group will have to integrate all of these new partners and programs while also convincing its physicians and members to embrace VBC.

Walgreens Boots Alliance's growth is yet to come, but the company has laid the ground work with its partnership with primary care provider VillageMD and home care company CareCentrix and the acquisition of Summit Health. The company is now poised to expand its presence in the US with co-located primary care practices alongside its pharmacy network, while building out a home healthcare platform.

The big question is whether Walgreens Boots can compete with the likes of Amazon and Walmart and meet its ambitious growth plans. This is uncharted territory for the company, and the best-laid plans don’t always come to fruition.

Walmart, meanwhile, is building on an established base as the nation's largest retailer by adding virtual care, a discount drug platform and even an EHR. The company is betting on its brand and its pharmacies to establish long-term healthcare partnerships, which will be augmented by telehealth services, health centers and enhanced value-based care partnerships. The key to its growth is in creating partnerships with consumers.

But the name and the network won't automatically lead to success. Walmart still has to deliver the kind of healthcare experience that will make customers come back again and again. Like the others, it will have to scale accordingly, and hope it has the resources to support its vision.

Alongside the five retail giants are two technology firms, Apple and Google/Alphabet.

While Apple won't be competing for primary care, the company is aggressively expanding its healthcare platform through devices with the Apple Watch and iPhone, giving payers, providers and researchers new opportunities to connect with the consumer. As Apple continues on this path, it will need to make sure that connection is safe and reliable. The information collected by those devices and used by both consumers and providers has to accurate, meaningful and protected, as well as easy to gather and disseminate.

To expand from that platform, Apple will need to look for other ways to monetize that relationship beyond device sales.

Google/Alphabet has that platform, and will be investing heavily in AI technology and hardware to make healthcare data accessible and easy to use. The company is actively courting the pharma market and investing in technology that enables healthcare organizations to focus on health equity, value-based care and patient engagement. It's also partnering with health systems to tackle specific pain points like radiology support and patient flow.

The question for Google/Alphabet will be whether it can "own" the consumer's healthcare journey and monetize those interactions. Some wonder if the company will expand to include direct care or prescription drugs.

How Can Healthcare Organizations Fit In?

The AHA report concludes with four questions that every healthcare organization should ask:

1. Do we have an omnichannel presence that provides the convenience, access, transparency, pricing and other information and services that patients want?
2. Are there partnership opportunities with any of the Big 5 companies transforming primary care?
3. How can we leverage our strength in established trust and rapport with existing patients to use our outpatient, clinic and virtual services for routine and nonemergent care?
4. How can we partner with big tech firms around research, data sharing, etc., to improve care?

The implication is clear. Healthcare organizations can't continue with a business-as-usual approach. Consumers are more in control of their healthcare expenses and decisions, and they have the ability to shop around. Likewise, payers and self-insured businesses are looking for better ways to deliver and track healthcare, with the goal of cutting out the tremendous amount of waste that the industry has been supporting for years.

In order to keep up with the disruptors, they may have to be the disruptors.