Vin Gupta, MD, MPA, a pulmonologist and Air Force veteran, is the chief medical officer of Amazon Pharmacy. He was hired by Amazon in January of 2020 and is helping lead the company’s efforts to grow his presence in healthcare. Medical economics sat down with Gupta at the HIMSS23 conference in Chicago to discuss the latest trends in healthcare and what Amazon’s growing presence in the industry means for physicians.
Medical Economics: Where Is All the Healthcare Consolidation Going? Will we end up with a few big players dominating the market the same way they do in retail?
Vin Gupta, MD: I feel there are a lot of opportunities in the market. I’m stepping out of my role at Amazon for a moment, but by 2028 there will be an estimated $6 trillion in spending in the US healthcare system, but access is still a struggle, we have one in three people who are underinsured, and there are many opportunities. And this is where I feel very fortunate to be a part of Amazon, because I think we’re just one of many players, but we’re really focused on access and engagement and convenience. And so, for me, it’s not about consolidation. I think it’s about solving problems that are rampant right now, because without newcomers like ourselves and each other, I think those problems will continue to exist.
ME: So you see Amazon bringing a fresh perspective to healthcare?
VG: Absolutely. It’s really just engagement through convenience. We think we can make getting your medications to help you stay at home a lot easier. And if you’re someone who has chronic illnesses and takes multiple medications, the simplicity of free home delivery and pricing transparency at the time of prescription, self-refills and pill boxes, and other features can help. The ways we experience healthcare today are to welcome us as providers, not to engage patients. This is where I think we have an opportunity to add a fresh perspective to build engaging experiences and we know how important it is to improve outcomes.
ME: Sounds great for the patient, but what does it mean for the doctor?
VG: Let’s take the example of pharmacy coupons. I’m very optimistic about what that means for my fellow providers, which makes the point of prescribing that much more helpful for the patient, but also for the provider. Now we know if there are any problems with the information, there is an automatic application of a coupon – you don’t have to look for it, there is no administrative burden. We can have that discussion at the time of prescribing as I’m educating the patient about the pros and cons of the drug about what they can expect to actually pay out of pocket if there was a direct expense. Previously, this wasn’t the standard experience for providers. It’s usually, Hey, Doctor, at the retail pharmacy down the street, it’s too expensive, and I didn’t know that coupon existed. A 2018 study showed that 85% of these people have never taken advantage of the coupons available, so simplifying the basic experiences, I think not only helps the patient, but greatly helps the provider reduce burdens administrative. It keeps patients happier and hopefully keeps them out of the clinic and at home healthy, and I think it also reduces workflow.
ME: A big theme of HIMSS this year is AI. What does all this big data and artificial intelligence mean for the average doctor? Where does the doctor fit into all this?
VG: I am incredibly optimistic about some of the particularly broad language models that are being built that may help facilitate a differential diagnosis. We are seeing many of these applications now within the reach of trainee doctors, especially for medical education, and allow a young doctor or young nurse in training to be better resourced at home or when visiting patients for the first time. Right now, the way we test and train our interns is whether you are right or wrong. As far as continuing medical education licensing exams go, we are now entering a world where we can actually help you understand decision making in real time. Where was our point of failure in clinical decision making? Thanks to artificial intelligence, we can move to get to the root cause. Oh, they did eight steps right in this diagnostic picture, they just missed step nine, so we’ll go deeper there. Right now, it’s binary: You’re right or you’re wrong. So our ability to provide very targeted support will make better doctors across the board. It will also help where it’s nice to have an addition to say, have you thought about that? Have you thought about it? Ultimately, I hope it helps enable better long-term care.
ME: Burnout is a big problem for doctors all over the world. Do these technological solutions help? Doctors were promised that EHRs would help and have become a major contributor to burnout.
VG: I think it’s too early to tell, but I really think technology can help maximize the potential. As a clinical addition, you are seeing the announcement of the embedding of ChatGPT into Epic. I love that kind of innovation, because it helps with transcription, it helps with workflows. I think thoughtful applications of AI, whether it’s to make a doctor’s life easier like this, or for decision support, or for medical education, or for a stressed out care provider in the inner city. There are ways this will directly address burnout and make life easier for doctors and allow them to practice to their fullest license, which is vital. We have fewer MDS and DOs to care for a larger population, and by the end of this decade, one in five physicians will be over 65. And we will have fewer, in relative terms, health workers to care for them. So we need top-notch medical practice as soon as possible. I think artificial intelligence can help make that possible. But again, if we don’t collaborate and listen directly to suppliers, it won’t be as effective. We are listening a lot and collaborating with the Amazon pharmacy; it’s part of the reason we’ve had double-digit growth over the past four months, driven by partnerships. I love how open we are to these kinds of dialogues. And I think those at the forefront of AI need to as well.
ME: Administrative burdens also play a big role in burnout. It seems that AI could help with the paperwork monster that doctors are faced with on a daily basis.
VG: I think you’re already seeing some signs that AI can help streamline prior authorization, which is one of the worst experiences for physicians and ultimately downstream for patients. Across the board, I know more stakeholders are thinking about that issue, just like us. And so over time, I suspect we’ll see durable solutions where AI can solve these problems. Artificial intelligence is part of the solution. But frankly, I think it’s important to go back to basics and what we do really well at Amazon Pharmacy today. I think what we’re looking to consolidate and scale over the course of 2023 is offerings like coupons, price transparency, convenience, value selection, deliver your stuff when you expect it at home, build the foundation that we know well from our retail detail roots and applying it to the pharmacy. If we can get this right at scale, I’m excited about what it means for patients and what it will do to reduce administrative burdens. I think just what we’re doing with pharmacy coupons takes the administrative hassle out of what should be a really simple experience. And then in parallel, these innovations in AI will be useful. But we haven’t even gotten the basics on a large scale. And I think that’s where we can derive unique value from our forward-thinking technology approach coupled with our core strengths and logistics.
ME: You mentioned prior authorization. Do you think we can get to a point where we get approvals in real time?
VG: To kind of step into my role as a physician, and from what I’ve seen from the broader ecosystem on that is totally what we’re doing today as a pharmacy, I think it’s possible. I think we’re getting to the point where we can be smart enough from a software technology standpoint where it takes ICD 10 codes, it takes some understanding of what’s been experienced in the past, and combining that information into a algorithm and saying this person actually qualifies for the next step forward in therapy. It’s not hard to imagine that getting automated; it’s something we’re thinking about and we know what many of our colleagues are thinking about. I suspect over time that will be something that will be addressed.
ME: What do tech companies need to do better in healthcare?
VG: I think what we’re building is going to build trust with our patients because we can deliver the things they expect. Yet there’s a wave of digital innovation for other health services that’s meeting this moment where health messages and information are found, and there’s not a lot of trust because of what we’ve seen over the past three years. And so just the conversions of that for me, not from an Amazonian point of view but more from just being a doctor, I always wonder how patients are going to think about all these amazing tools that they have in a time where I think trust and the messaging on health was damaged. How do we ensure trust in things that work? We need to recognize that we’re starting from where maybe we weren’t in 2019. How do we make sure we don’t forget that we need to build and we need to win back the trust of a lot of patients, even with these amazing tools that we have.
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