Amazon, please deliver Health Care Prime

Here is a letter to Amazon CEO Jeff Bezos from a loyal employee, as imagined by non-employee

Dear Mr. Bezos,

I was excited to read about the partnership among Amazon, Berkshire Hathaway and JPMorgan to create a new health care thing. I say “thing” because no one knows what you’re cooking up. As a result, I’m tempted to take this blank slate and write my own wishes on it.

Few of us customers of health care ever get consulted about what we want to pay for and what we don’t. And few employers have stepped forward like you propose to do and acted like real customers. You have the purse strings, so pay for what matters. It’s about time that employers flexed their muscles.

As a loyal employee of your company, I’d like to tell you how I’d fill that blank slate. And know that I prize my Amazon Prime membership and believe that you care what your customers think. So, please consider the desires of your employees as you shape something creative and disruptive in health care.

1. Don’t allow health care providers and insurers to spend money on things I don’t care about, such as billboards, canned TV commercials featuring happy patients, Super Bowl ads or an army of middlemen who plan and process and complicate my life. You hate waste. So do your employees.

2. Please spend money on things I do care about: access to a doula when I’m pregnant, access to a care manager if I have a chronic illness, behavioral health services, pharmacy consultations, exercise classes, massages, care navigators

and health coaches.

3. Please guide me to the best doctor or surgical team when I need one. I don’t care if they’re “in network” or “out of network.” I’m willing to travel. I actually want to save money for both of us, so send me where the costs are reasonable, the outcomes are exceptional and medical errors are minimal. Do your own measurement of customer satisfaction and quality of care. Just send me to the best of the best.

4. Make useful new technologies available as they are proven worthy. Also, please pay for (or even design) a health care system that does not take 17 years to adopt best practices once they are revealed through credible scientific research. Find me doctors and teams who believe in the scientific method and know how to implement change.

5. Customize my care. I’m unique, as we all are, in many ways. Use big data and artificial intelligence — maybe even an accurate, comprehensive electronic health record if you can create one — to determine how to ease my pain and discomfort and address unwelcome symptoms. Help me change my behavior or my environment so that I’m healthier. I’d like to avoid drugs and surgeries if possible. Keep me out of the hospital if you can! I’ll be healthier, and you’ll save money.

6. Please make the necessary connections to wrap my care around me, rather than have me bouncing around to a bevy of specialists when I’m hurting. Your engineers know how to do this, and you can find good models from other countries. But when my lower back is screaming, I don’t want to flop from orthopedist, to physiatrist, to physical therapist, to those guys who give steroid shots.

7. Do not pay for preventable errors or unnecessary treatments, tests and medications. Just say no. You have the force of money on your side. This includes a careful reconsideration of the health care workforce. Why pay for expensive specialty care when a midwife or technician or even a community health worker will do? And don’t pay any members of a surgical team if they ever do a wrong-site surgery. It’s inexcusable. Just take them off your list.

8. Reveal what my care will cost me — after you bundle my services and bargain for the best possible price — so that every little pill and phone call and crutch is not billed separately and exorbitantly. Promise me: no surprises, no frustration, no anger. Just like when I order a toaster from you.

9. Do what you do best: Bring services and products to me. You can do it. Why not have mobile emergency rooms and surgical suites? Surgeons can operate remotely. You can equip these floating units with the latest technologies and welltrained technicians. They even can drive themselves. And, soon, we’ll have incision-free surgeries. Also, why not dispense my drugs? Send out your little drones or something. Don’t overload me with more drugs than I need or want. Do you know how many expired tubes of little pills I toss out each year? They go into our water systems. Total waste! You can do better.

10. Advise me on how to manage my health, how to select a doctor or primarycare source and how to give health care providers good feedback. And give me options! — while making clear their relative value and downsides. Are there generic drugs as good as the ones I’ve been prescribed? Should mom consider hospice? You understand “choice architecture” better than anyone. Just please don’t push unnecessary commercial products and services on me, given your power to do so. Remove temptation and keep your sales interests separate from your health care system. If you’re going to do any nudging, do it to improve the quality of service for those whose health care you subsidize.

11. And let’s exchange information regularly — on Kindle, video, e-mail, whatever. You know how to do this. Let me see what others have said about my conditions or services or new medications. Track and monitor how Amazon and I, together, are meeting my needs and managing my health, and how well providers and services are doing so, too. I’m hungry for information.

Thank you for listening. It’s about time someone did, even if I wasn’t asked. Signed, Loyal employee of Amazon

Karen Wolk Feinstein is president and CEO of the Pittsburgh Regional Health Initiative (prhi.org).