By Jackie Kimmell, contributing editor
What are Amazon, Apple, Google, and the other Big Tech companies up to in health care? Here are the five stories you should know about the moves they've made in the past month—and how they could impact the health care industry.
1) Apple moves three steps deeper into medical research
At Apple's big September 10th event, most of the country was focused on hearing more about the latest iPhones. But the company also announced significant health care news: It will facilitate and take part in three major medical studies through its new Research app.
The first study, in partnership with the Harvard T.H. Chan School of Public Health and NIH's National Institute of Environmental Health Sciences (NIEHS), will look at menstrual cycles and gynecological conditions to inform risk assessments and screenings for conditions like polycystic ovary syndrome (PCOS), infertility, osteoporosis, menopause, and pregnancy. The second, in partnership with Brigham and Women's Hospital and the American Heart Association, will assess how metrics like heart rate and walking pace relate to hospitalizations, falls, quality of life, and heart health. The third study will work with the University of Michigan to collect data on everyday sound exposure and discover how it impacts hearing. The data will be shared with the World Health Organization (WHO) for its Make Listening Safe initiative.
The moves are a clear sign that Apple saw large value in its Apple Heart Study, its first foray into medical research. With that study, COO Jeff Williams said Apple found that it "could positively impact medical research in ways that help patients today and that make contributions that will benefit future generations." Williams added that the new moves "[carry] our commitment to health even further by engaging with participants on a larger scale than ever before." But while part of Apple's motivation is surely benevolent—to democratize how medical research is conducted by facilitating it through a free app—the studies also offer tremendous commercial potential. All of them tap into new or planned applications of the Apple Watch and Apple's electronic health record (EHR) capabilities—thus clearly aiming to make Apple's tools indispensable to efforts at the forefront of medical research. Pushing growth of the Apple Watch will become particularly important as it becomes the company's main growth engine amid dwindling iPhone sales.
2) Google announces landmark partnership with Mayo Clinic
Google and Mayo Clinic on September 10th announced a 10-year strategic partnership to use the tech giant's cloud to store patient data and develop products that Mayo says "will redefine how health care is delivered." Under the partnership, Mayo aims to further develop technology using AI as well as machine learning, data analytics, and advanced cloud computing. Using Google's cloud storage system will allow it to expand its data storage capacity tenfold. It will also let the organizations more easily connect disparate datasets—like genetic, socioeconomic, and clinical data—to inform greater patient insights.
With the deal, Mayo will gain greater access to Google's talent and resources. Google plans to open an office in Mayo's home of Rochester, Minnesota, so that Google engineers can work closely with Mayo clinicians and other staff.
Google, on the other hand, will gain access to the troves of patient data it needs to train cutting-edge algorithms to read EHRs and identify medical conditions. However, it will only have access to this data in a de-identified manner and only for specific projects, according to Mayo's CIO Chris Ross. He explained, "We own the keys to the data. It's Mayo-controlled private data that we keep on behalf of our patients. Google doesn't have any right or ability to get to [that] data." This distinction is important as Google was sued over another data-sharing arrangement with the University of Chicago Medical Center in June (although both parties say the case is without merit).
The partnership is a major win for the tech giant, providing them unparalleled access to one of the top health systems in the country. Sundar Pichai, CEO of Google, said that the partnership presents "an extraordinary opportunity to develop services that will significantly improve lives." It also proves just how far Google has gone in the industry since their last partnership with Mayo, which focused on improving the quality of health-related results on the company's search engine.
3) Reports of employer strife beset Apple's health efforts
While Apple has been making strides in advancing its health ambitions (see above), reports say that the health arm of the company has been facing many high-profile departures due to divergent ideas about the company's ambitions and a reportedly toxic work culture. One central rift seems to be whether Apple will continue pursuing wellness and prevention efforts, mainly those focused on people who are generally healthy, or whether they will take on more ambitious projects with a broader reach. For instance, some employees allegedly wanted to take a more aggressive approach to managing chronic diseases, introduce a telemedicine service, or try to move into revenue cycle with the goal of simplifying insurer payments. Others reportedly wanted to expand Apple's subsidiary AC Wellness, which currently provides health services to Apple employees, to producing products or software for clinicians.
Another key split has been over the company's approach to transparency. While the company has historically been secretive about its business strategy and new products—and its health care products have been no exception—some employees allegedly argued that health care necessitates a new approach. Apple's recent pivot to high profile, well-publicized clinical trials with major industry stakeholders may prove to be a fundamental shift in this direction.
Some of the more recent high-profile departures, include the head of AC Wellness and several former Apple Health directors. Some returned to other areas of the company, while some left for other major industry players like Anthem, the Gates Foundation, and Google. Regardless, the departures likely won't prove too disruptive for the company, which still has a seemingly endless supply of talent and which sees tremendous earning potential in the industry. It does, however, illustrate the pain points inherent when non-industry players jump headfirst into the unendingly complex and established health care field.
4) Amazon's PillPack faces many new obstacles after PBM battle
After a loud and messy dispute over access to patient data, Amazon-owned PillPack is facing serious new challenges. The dispute arose after Surescripts, an e-prescription technology company owned by CVS Caremark, Express Scripts, and Medco Health Solutions, discovered PillPack was gaining access to its database through a third-party vendor. Surescripts cut off the vendor from accessing its data, claimed fraud, and reported the matter to the FBI.
The fight could prove lethal for PillPack's core business model, which is centered on creating a streamlined, customer-friendly experience by automatically getting the patient's medication history and handling all of the administrative hassles associated with managing multiple medications. But without access to Surescripts' database, the media reports that PillPack has to either rely on the patient to remember the medications they are taking (which patients often forget or get incorrect), or call the patient's doctor (which presents a large burden for the company).
These developments will likely delay Amazon's efforts to break into the $500 billion pharmacy market, especially as competitors like CVS launch similar same-day drug delivery programs.
5) Fitbit tries to push more premium services—starting with hundreds of thousands of Singapore residents
Fitbit in late August announced a deal with the government of Singapore to provide hundreds of thousands of free Fitbits to the country's residents. The free Fitbits come with a catch, however: users will have to sign up for the device's $10 per month premium service (which offers personalized guidance and one-on-one health coaching).
Singapore is trying to use technology to make its population of 5.6 million healthier, in particular by lowering rates of diabetes and heart disease. The deal with Fitbit could reach up to one million people, or 20% of the country's population, Fitbit CEO James Park said. It was apparently the result of a "highly competitive" bidding process that also included Apple.
For Fitbit, the deal is emblematic of a business shift toward extracting more revenue from existing users, rather than trying to sell more devices. The shift makes sense; the company's stock price has fallen over 50% in the past year as competitors such as Apple and Garmin grow their share of the wearables market. But it also demonstrates another company betting on the consumer trend of greater personalization. Fitbit, like consumer DNA company 23andMe and many others, are betting that consumers are willing to pay a premium for services that not only collect their data—but also translate what that data means just for them.