OneMedical customer since well before the acquisition -- the enshittification continues.
Competitor services costing muliples of what OneMedical does keeps me in place for now; that, and getting an appointment and the experience of that appointment at a "normal" doctor's office is still the same as it's always been: scheduling is a massive PITA, and you're lucky if they aren't running at least 30 minutes behind by lunchtime.
Have you personally noticed any downgrade in your experience yet? Each year I waffle back-and-forth about whether the OneMedical membership fee is worth it, but only because I'm pretty healthy and don't get to use it much. Whenever I do, it works great: book an in-person doctor's appointment same-day/next-day in 10 minutes, get seen within 5 minutes of walking in, no need to fill out an in-take form with my complete medical history for the umpteenth time, and prescriptions and follow-up all handled seamlessly on the website.
The Amazon acquisition seemed like the best outcome we could hope for. Experience says it's unrealistic for OneMedical to remain independent forever, and Amazon has much better customer service than almost any other big company with a broad customer base. Insofar as the OneMedical experience was stellar mostly because it was being subsidized with ~$1B in VC/PE money (which is plausible to me), belt tightening was inevitable.
The two doctors I regularly saw - my primary care doctor and the one I used when she wasn't available - both left One Medical right after Amazon purchased them. Since then, it's impossible to get an MD appointment, but a flood of new physician assistants will happily see you.
I'm at an age where if I'm going to the doctor, I want a doctor. That's harder to come by.
Where are you located? I just checked for appointments with MD in San Francisco tomorrow and there were 5 different doctors available, with maybe a dozen time slots to choose from.
Have you tried https://goforward.com/ ? It's not especially cheap and they don't accept insurance, but you can do everything in the app, there is no waiting time, and the medical professionals seem passionate and competent.
I have so far had good luck with Forward, been with them for 2 years.
It is pricy, but being able to text someone at anytime and all of my basics are covered is nice. There isn't anything they can try to upsell me on since it's all included.
Have you looked for an independent Direct Primary Care doc? I use one in Wisconsin in addition to my usual PCP for routine stuff, vaccinations, lab tests, etc, and it saves me 90%+ off what I would pay with my PCP. My PCP is just essentially my catastrophic backstop now.
We considered trying OneMedical, which opened an office close to where we live. But when I looked into it, it seemed like you have to buy a subscription up-front, with no other way to try it out. We might have made the switch by now if they had made it easier to try.
I was on a gig interviewing a doctor co-op. It was similar in that it was an upfront subscription plus co-pays per visit. They had a staff of MDs, more nurse practioners, and a staff of nurses. They also had a couple of psychiatrists on staff as well. The upfront subscription was still lower than an actual insurance plan. The only downside for me that I could see in the idea was it was not available in my city.
the vast majority of people's medical needs are typical office visits. emergencies or more serious things do occur, and they mentioned something about those situations but I was not part of that interview so I didn't get that part of the details.
I doubt they're better. The Amazon of Healthcare doesn't seem like the best place for high quality doctors. but then it should be cheaper than your regular premiums and stuff.
> The costs after you susbcribe are also insane: $420 for a 15min online chat.
>
> I got the same type of appointment for something around $20 directly from Cigna. And that's with a high deductible account.
Cigna (and any insurer) is always going to charge you way more for services that they don't provide themselves, because their direct incentive is to encourage (or force) you to use the services that they provide directly instead of using independent in-network providers. Their profit margins are way higher on those (compared to in-network providers), and furthermore they have way more control to use those as a mechanism to gatekeep further specialized care. You can sort of think of it like a loss leader, but in reverse: providing those services "at-cost"[0] allows the insurer to save way more by using that virtual visit to deny you a referral to a specialist, or denying you a particular procedure, based on some clinical guideline that the insurer has decreed, when an in-network independent provider would have come to a different judgement.
Remember that, for in-network coverage, the amount that you have to pay is a somewhat arbitrary number that is entirely decided by your insurer, and has very little (if anything) to do with how much the providers on the other end are actually making. Cigna makes you pay more for independent providers because it benefits them to charge you more for those.
I'm using Cigna here because you mentioned Cigna, but to be honest, all the insurers operate like this.
[0] "cost" is a fuzzy term here; I'm being figurative
Oh, that’s interesting. The one time I had to use OneMedical services was when I was on a work trip to another state and was afraid I broke my hand after falling on the street and scraping off the entirety of my knee skin.
Scheduled a quick appt for the same day, they checked up and did the first aid stuff on the knee, and then redirected me to a radiology clinic a few blocks away for an x-ray. I just checked the billing portal, and the visit to OneMedical ended up costing me $8, while the x-ray at a radiology clinic afterwards cost me $5.
So yeah, that’s just anecdotal, but your cost of $400+ for a short online appt just doesn’t feel right. Not doubting you, but I doubt that this is a typical experience.
> We considered trying OneMedical, which opened an office close to where we live. But when I looked into it, it seemed like you have to buy a subscription up-front, with no other way to try it out. We might have made the switch by now if they had made it easier to try.
In many (most?) states, they are actually legally required to offer services to you without a subscription, but you won't be able to use the app. In other words, you have to call them like a normal doctor's office and book an appointment, and when you do, they will have to provide you the same medical care and services that they would for any other patient.
This is not specific to One Medical; it's due to laws that prohibit additional fees for medical services. In a similar vein: in many states you can use the Costco pharmacy even without a Costco membership, although you can't buy anything else while you're there.
That said, you're not really missing out. One Medical's entire shtick is that they have a slick UX and "appointments start on time" (in theory). In practice, their medical care is... let's say variable, at best. You're paying for a slick UI and convenience slapped on top of a care delivery system that's no better than what you might get elsewhere.
> For emergency services from hospitals that provide emergency services, that's true. But for virtually anything else I don't think it is.
You're thinking of a separate law, which requires emergency rooms to provide emergency medical services to all patients if they accept Medicare or are attached to a hospital which accepts Medicare. (This is one of the reasons that there's been a proliferation of standalone for-profit emergency rooms in the last several years - it's a way to bypass this requirement and serve only the most profitable patients).
That's separate from what we're talking about here.
If you're talking about EMTALA, it has nothing to do with Medicare. What law do you think prohibits people from charging subscription fees? Because AFAIK every state in the union has concierge medicine.
> If you're talking about EMTALA, it has nothing to do with Medicare.
Literally the first paragraph of the Wikipedia page about EMTALA:
> It requires hospital emergency departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay.
Amazon pharmacy is probably one of the best interactions I’ve had with Amazon and pharmacies in general. We moved everything we could to it. The support has been great. Get things quickly all the information is right up front.
Agree. I also use PillPack for my recurring meds, also an Amazon company. The standard for medical company interactions is a very low bar, but both companies kill it every time.
I have a migraine medicine (Qulipta) and have gone through half a dozen pharmacies in the last two years. The fact that I have both insurance and a manufacturers coupon seems to screw them all up, and several just stopped doing migraine meds. I am not functional without this medicine. I would literally qualify as disabled since I have migraines so often. Even two days of not having the med throws me off for a full week.
Without insurance or the coupon it's $1600/month. With insurance it's $650/month. With the coupon and insurance it's $0/month.
Amazon is the only pharmacy that didn't mess up the insurance. They also autoship on time every month. I'm not even joking when I say that I actually cried over how difficult it was with other pharmacies.
> one of the best interactions I’ve had with Amazon and pharmacies in general
Clearly they were spending too much money on it. The idea is for there to be no interaction other than a payment/delivery cycle. If there are plural positive interactions the overall system was poor (needed multiple interactions) and staffing too expensive ("best" rather than mediocre).
Guys, I'm starting to think there's no amount of capital that can bring the necessary efficiency/low prices to the American healthcare system while also maintaining a profit motive.
No amount of capital can cut through the corruption and regulatory morass that has been built up over decades between the biopharma and government revolving door. That needs to get cleaned up before anyone has any chance of solving this.
I am sure there is room to improve things on the corporate side but I also feel that we need major structural changes on the government side. Both parties receive significant funding from insurance companies and both parties are so pro-corporate that it’s hard to find any viable candidates who will oppose expansion of bureaucracy as long as doing so ensures more profits. The real problems are systemic.
Top five pharma companies had earnings of $82B in 2022. I'm sure some of that is bolstered by vaccine sales but the problem lies in uncapped prices and uncapped greed.
And who owns the most shares of these Companies? Organizations like BlackRock and Vanguard.
>And who owns the most shares of these Companies? Organizations like BlackRock and Vanguard.
Those are just the fronts for the people who actually own the companies. Blaming them makes as much sense as blaming the local bank for wealth inequality because they hold all the money.
Hopefully, this is a precursor to them getting out of this space entirely. My fear is that they'll use their economic power to dominate this space and make it impossible for me to avoid using them in one way or another.
I don't object to people who are OK with Amazon having a hand in their health care being able to do so. I just don't want them to have anything to do with my life in general, and especially not when it comes to really sensitive things like that.
I worry that I may not end up having a choice. Or, worse, that I won't be able to tell if they're involved at all.
Others should have the ability to involve Amazon if they want, and equally I should have the ability to exclude Amazon.
A struggle I have seen play out numerous times, and at one point my own company fell victim to it, is that there are these obvious operational inefficiences in healthcare that every tech entrpenuer thinks they can hop onto as an easy oppourtunity. Then they run face first into the wall of a highly regulated industry in which, in most states, corporate power over care is severely restricted. Secondly, the last 5% matters just as much as the first 95%. You have to get to 100% because you are dealing with real people not "transactions".
It took us 10 years to really get the hang of how to create positive operational change in big healthcare systems and it's very nuanced and slow. In a nutshell it's a lot of carrot and stick or maybe a lot of micro-carrot and micro-stick.
Amazon tried the brute force approach with Haven and it failed spectacularly. The pharmacy and one-medical plays were a dip your toes in the water approach but from what I have seen they are replaying most of the same mistakes.
I created ClearHealth which was the first and possibly only fully federal certified open source EMR. We started with EMR but very quickly became a healthcare operations management company that managed some very large multi-state acute and ambulatory care groups.
Don’t use OneMedical anymore but surprised people think Amazon is making it worse. The writing was on the wall well before the acquisition that you fill an office with a ratio of something like 1 doctor to 10 PA. Most visits can be covered by a PA.
For those looking for chronic care and a stable doctor, I highly recommend going the route of a direct care physician. As a family of two adults and one child we pay something like $180 a month to go see a doctor anytime with no copay or visit costs. For better or worse I see this as a better outcome in the US. Pay for a DPC doctor and then a high deductible plan for emergency.
People are saying One Medical isn't great but it's by far the best experience I've had with health care. Good comms, easy to get visits, walk-ins for bloodwork etc etc. It's just super convenient. I'm in NYC and maybe it's different elsewhere but it's totally worth the subscription for me.
58 comments
[ 2.0 ms ] story [ 128 ms ] threadCompetitor services costing muliples of what OneMedical does keeps me in place for now; that, and getting an appointment and the experience of that appointment at a "normal" doctor's office is still the same as it's always been: scheduling is a massive PITA, and you're lucky if they aren't running at least 30 minutes behind by lunchtime.
The Amazon acquisition seemed like the best outcome we could hope for. Experience says it's unrealistic for OneMedical to remain independent forever, and Amazon has much better customer service than almost any other big company with a broad customer base. Insofar as the OneMedical experience was stellar mostly because it was being subsidized with ~$1B in VC/PE money (which is plausible to me), belt tightening was inevitable.
Longtime One Medical customer here, it feels the same good experience to me.
I'm at an age where if I'm going to the doctor, I want a doctor. That's harder to come by.
That's not a real option unfortunately.
"CLAIM YOUR EXCLUSIVE OFFER * Join for $99/mo (normally $149) * Ends Friday"
Sales tactics like this are literally the last thing I want from my doctor.
It is pricy, but being able to text someone at anytime and all of my basics are covered is nice. There isn't anything they can try to upsell me on since it's all included.
I got the same type of appointment for something around $20 directly from Cigna. And that's with a high deductible account.
I doubt they're better. The Amazon of Healthcare doesn't seem like the best place for high quality doctors. but then it should be cheaper than your regular premiums and stuff.
I really don't know what they're offering.
Cigna (and any insurer) is always going to charge you way more for services that they don't provide themselves, because their direct incentive is to encourage (or force) you to use the services that they provide directly instead of using independent in-network providers. Their profit margins are way higher on those (compared to in-network providers), and furthermore they have way more control to use those as a mechanism to gatekeep further specialized care. You can sort of think of it like a loss leader, but in reverse: providing those services "at-cost"[0] allows the insurer to save way more by using that virtual visit to deny you a referral to a specialist, or denying you a particular procedure, based on some clinical guideline that the insurer has decreed, when an in-network independent provider would have come to a different judgement.
Remember that, for in-network coverage, the amount that you have to pay is a somewhat arbitrary number that is entirely decided by your insurer, and has very little (if anything) to do with how much the providers on the other end are actually making. Cigna makes you pay more for independent providers because it benefits them to charge you more for those.
I'm using Cigna here because you mentioned Cigna, but to be honest, all the insurers operate like this.
[0] "cost" is a fuzzy term here; I'm being figurative
Scheduled a quick appt for the same day, they checked up and did the first aid stuff on the knee, and then redirected me to a radiology clinic a few blocks away for an x-ray. I just checked the billing portal, and the visit to OneMedical ended up costing me $8, while the x-ray at a radiology clinic afterwards cost me $5.
So yeah, that’s just anecdotal, but your cost of $400+ for a short online appt just doesn’t feel right. Not doubting you, but I doubt that this is a typical experience.
In many (most?) states, they are actually legally required to offer services to you without a subscription, but you won't be able to use the app. In other words, you have to call them like a normal doctor's office and book an appointment, and when you do, they will have to provide you the same medical care and services that they would for any other patient.
This is not specific to One Medical; it's due to laws that prohibit additional fees for medical services. In a similar vein: in many states you can use the Costco pharmacy even without a Costco membership, although you can't buy anything else while you're there.
That said, you're not really missing out. One Medical's entire shtick is that they have a slick UX and "appointments start on time" (in theory). In practice, their medical care is... let's say variable, at best. You're paying for a slick UI and convenience slapped on top of a care delivery system that's no better than what you might get elsewhere.
For emergency services from hospitals that provide emergency services, that's true. But for virtually anything else I don't think it is.
You're thinking of a separate law, which requires emergency rooms to provide emergency medical services to all patients if they accept Medicare or are attached to a hospital which accepts Medicare. (This is one of the reasons that there's been a proliferation of standalone for-profit emergency rooms in the last several years - it's a way to bypass this requirement and serve only the most profitable patients).
That's separate from what we're talking about here.
Thanks for this connection. :)
Literally the first paragraph of the Wikipedia page about EMTALA:
> It requires hospital emergency departments that accept payments from Medicare to provide an appropriate medical screening examination (MSE) to anyone seeking treatment for a medical condition, regardless of citizenship, legal status, or ability to pay.
I appreciate the incompetence by which they are doing it as it they encourages the good people to leave.
https://www.businessinsider.com/amazon-products-services-fai...
https://observer.com/2022/10/amazon-cancel-pandemic-products...
Without insurance or the coupon it's $1600/month. With insurance it's $650/month. With the coupon and insurance it's $0/month.
Amazon is the only pharmacy that didn't mess up the insurance. They also autoship on time every month. I'm not even joking when I say that I actually cried over how difficult it was with other pharmacies.
Clearly they were spending too much money on it. The idea is for there to be no interaction other than a payment/delivery cycle. If there are plural positive interactions the overall system was poor (needed multiple interactions) and staffing too expensive ("best" rather than mediocre).
https://www.modernhealthcare.com/assets/png/CH107294927.PNG
And who owns the most shares of these Companies? Organizations like BlackRock and Vanguard.
Those are just the fronts for the people who actually own the companies. Blaming them makes as much sense as blaming the local bank for wealth inequality because they hold all the money.
https://news.ycombinator.com/item?id=39280477
I don't object to people who are OK with Amazon having a hand in their health care being able to do so. I just don't want them to have anything to do with my life in general, and especially not when it comes to really sensitive things like that.
I worry that I may not end up having a choice. Or, worse, that I won't be able to tell if they're involved at all.
Others should have the ability to involve Amazon if they want, and equally I should have the ability to exclude Amazon.
It took us 10 years to really get the hang of how to create positive operational change in big healthcare systems and it's very nuanced and slow. In a nutshell it's a lot of carrot and stick or maybe a lot of micro-carrot and micro-stick.
Amazon tried the brute force approach with Haven and it failed spectacularly. The pharmacy and one-medical plays were a dip your toes in the water approach but from what I have seen they are replaying most of the same mistakes.
For those looking for chronic care and a stable doctor, I highly recommend going the route of a direct care physician. As a family of two adults and one child we pay something like $180 a month to go see a doctor anytime with no copay or visit costs. For better or worse I see this as a better outcome in the US. Pay for a DPC doctor and then a high deductible plan for emergency.