Buzzy, venture-backed startups and big tech companies that have promised to disrupt health care are indeed doing so — including by shuttering services that early adopter patients may have come to rely on.
Following its deal to acquire primary care tech company One Medical, Amazon announced it was ending its own virtual- and in-person health service Amazon Care, which covers 40,000 patients, by the end of the year. Telehealth prescription company Cerebral, which used pandemic-era regulatory flexibility to virtually treat mental health conditions like ADHD, has largely halted controlled substance prescriptions in light of scrutiny from federal and state regulators. Dozens of other health tech companies are cutting back their staff or shuttering business lines, doubting sustained demand from consumers and employers.
While some companies say they’re helping patients find care elsewhere, the churn could disrupt patients who lack other options for in-person care or prescribers where they live, who can’t afford other services, or who lose their health records in the shuffle between providers, experts tell STAT.
“Failure can be good, but just acknowledge that when we break things or when we fail fast in health care, we are leaving a person’s health on the other end of the line,” said Brian Hasselfeld, senior medical director for digital health and innovation for Johns Hopkins Medicine and a practicing internist and pediatrician.
Amazon told STAT that customer service teams, clinicians, and care coordinators were available to help existing patients throughout the year to help them transition, and that it would share patient records upon request. Cerebral, which launched its ADHD treatment program in 2021, is no longer writing prescriptions for controlled substances for new patients; patients with established prescriptions can continue to get them until mid-October. The company did not share more specific details on its plan for transitioning those patients to other clinicians.
Hasselfeld said patients signing up for employer-based and direct-to-consumer health services might expect more continuity, and companies could do a better job communicating those risks to patients, Hasselfeld said.
“If I have a recurring grocery store I go to, and they decide to not sell something, I can simply move to the next grocery store,” he said. “Unfortunately in a direct-to-consumer [health] model, there is often not the partnership between a consumer-patient and a medical professional to help weigh those risks and benefits.”
Patients might need to weigh the benefits of convenient, on-demand, and largely virtual care against the risk of losing it very suddenly. “They have to think about, ‘Am I engaging in this health care transactionally, am I OK if this is a temporary relationship?’” Hasselfeld said.
The confusion is also bleeding into their expectations for traditional brick-and-mortar health care, which still faces licensing and reimbursement hurdles that make it harder to treat patients virtually. Primed by direct-to-consumer services boasting continuous text-messaging and video visits with clinicians, patients are increasingly expecting traditional health care providers to be accessible digitally. “The last thing you want is a patient to have a spiking, acute urgent health care question, and for them to be surprised about what they can and cannot access,” said Hasselfeld. “Avoiding surprise is priority.”
Michael Maniaci, a physician who leads Mayo Clinic’s home-based care program, is optimistic about the innovation unfolding in virtual care, including participation by upstart providers. But he said he’s also concerned that for-profit companies that dodge in and out of patients’ lives may ultimately undermine quality and trigger a backlash.
“The fear is somebody comes in for the wrong reasons and messes things up, to where the government says, ‘We don’t think this is a good idea because of bad outcomes,’” Maniaci said. “CMS won’t back us up, commercial payers won’t back us up. Regulatory and law changes can’t happen because the wrong players are there.”
Some of this disruption is inevitable and necessary to generate new, more convenient services for patients, said Duke law professor Barak Richman. “Nobody is advocating to cement the status quo in place and there is a great need to experiment with new technologies and delivery systems … some of these experiments will work and some of them won’t,” he said. “The balance is that we have been wed to stability, and not wed enough to changes and improvements, and innovation.”