Amazon now owns clinic serving Dartmouth College employees

Physician Joel Lazar, left, speaks with a patient who did not want to be identified in one of the exam rooms at Dartmouth Health Connect in Hanover, N.H., on April 9, 2012. At right is health coach Tyler Hanna, also part of the patient's appointment. Since May 2023, the practice is operated by a company owned by Amazon and employs just one full-time provider, a physician assistant. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com.

Physician Joel Lazar, left, speaks with a patient who did not want to be identified in one of the exam rooms at Dartmouth Health Connect in Hanover, N.H., on April 9, 2012. At right is health coach Tyler Hanna, also part of the patient's appointment. Since May 2023, the practice is operated by a company owned by Amazon and employs just one full-time provider, a physician assistant. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News file photograph — Jennifer Hauck

By NORA DOYLE-BURR

Valley News Staff Writer

Published: 09-27-2023 6:16 PM

HANOVER — A primary care practice that serves hundreds of Dartmouth College employees and their families is now operated by a company owned by Amazon.

Dartmouth announced the change earlier this year in a message to employees that outlined the practice’s evolution. It first launched as Dartmouth Health Connect in 2012 in partnership with Iora Health, a private Boston-based company. Iora sold to San Francisco-based One Medical in 2021, and earlier this year, One Medical was sold to Amazon.

“Although ownership of the practice has changed, they remain committed to providing the excellent health care and personalized patient experience that has been our goal from the beginning,” Provost David Kotz and then-Executive Vice President Rick Mills wrote in a May 24 message to employees.

The practice, located on Allen Street in what was formerly Omer & Bob’s in downtown Hanover, launched initially as a partnership between the college, Dartmouth Health and Iora. It began seeing patients just a couple years following the enactment of the Affordable Care Act and aimed to be innovative by reorienting primary care toward keeping patients healthy and reducing costs, in part by decreasing the use of emergency rooms.

“We can talk all we want about improving health care in the country, but if we can’t successfully deliver health care to our employees who live in the Upper Valley, then we’re not going to be successful,” Justin Anderson, a Dartmouth College spokesman, said in a Valley News story in 2011 about the launch of the clinic, which took place during the tenure of Dartmouth President Jim Yong Kim.

The clinic employed a team approach, including two physicians, a nurse, a practice coordinator and health coaches, responsible for staying in touch with patients and helping monitor things such as medications.

The clinic also used an atypical payment model whereby the college paid the clinic a fixed price per patient, reducing the burden of billing insurance companies and also skirting co-pays for patients. Iora had previously established similar clinics in Seattle for Boeing employees and in Atlantic City, N.J., for casino workers.

Early reports indicated that the Hanover clinic’s patients were better able to manage chronic conditions such as high blood pressure and diabetes, according to a 2013 Valley News story. Patient satisfaction as measured on surveys was 9 out of 10, according to the 2013 story.

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Gwen Dionne, a 59-year-old semi-retired Dartmouth dining services worker who lives in Canaan, said the office’s location and the lack of a co-pay were big draws for her when she originally signed up for Dartmouth Health Connect.

“I loved it,” she said in an interview last week. “It was right next to work practically. The only thing I didn’t like is if I was sick, I had to go all the way to Hanover.”

In addition to the convenience and the lack of expense, Dionne also liked having a health coach.

“I could email concerns or whatever,” she said.

But a decade after it began, there are signs that the program may no longer be meeting everyone’s needs. The practice, now known as One Medical at Dartmouth, currently employs just one full-time provider, physician assistant Erin Storm, for about 1,300 patients. In addition to college employees, dependents and retirees, the Hanover clinic also cares for King Arthur Baking Co. employees. It is not accepting new patients while it is recruiting for two more providers. Dr. Anne Johnson and Dr. Joel Lazar left the practice in May around the same time patients were told about the sale.

In addition to Storm, the practice’s current patients are invited to turn to a “robust Virtual Medical Team who can treat many of the most common acute care needs patients have,” according to the email from Kotz and Mills.

That service is available 24/7 but is not intended to treat complex or chronic conditions.

A web page updating patients on the practice emphasizes that the acquisition of One Medical by Amazon in February does not give Amazon access to patients’ data.

With the acquisition, “nothing changes for One Medical members as they can continue to access and count on One Medical for the high-quality care and high-level of service they receive,” Clinton McGue, a One Medical spokesman, said in a Monday email.

One Medical, which has more than 8,500 employer clients throughout the country, offers primary care services including preventive health, chronic care management, mental health and sexual health.

The goal is to “keep patients on track with health goals and confidently navigate their health journey,” McGue wrote.

“With the support of Amazon, we look forward to continuing to increase access to care and improve health outcomes.”

Asked whether the model is working for Dartmouth, Jana Barnello, a Dartmouth spokeswoman, said the college continues to measure the success of the practice through utilization, net promoter scores and feedback from employees.

“We are looking forward to One Medical hiring two additional providers to offer greater access for our population in this challenging national health care environment,” Barnello wrote in an email.

The challenges the clinic currently faces are part of a broader set of challenges facing primary care across the country, said Elliott Fisher, a professor of medicine and health policy at The Dartmouth Institute.

Fisher said patients are generally getting sicker, with chronic diseases such as diabetes and substance-use disorders on the rise. Primary care providers are compensated at lower rates than specialists, fewer providers are going into the field, patient visits are brief and there’s often more paperwork to do at home at the end of the day, which can result in burnout.

It’s a “vicious cycle,” Fisher said.

Given what Fisher described as a “crisis” in primary care, there is now an opportunity to innovate and expand on models such as Dartmouth Health Connect. While there’s “good reason to be nervous” about what Fisher described as “the corporatization of American medicine,” he said those corporations with a hand in the insurance industry have a “pretty powerful incentive to keep people healthy.”

Fisher couldn’t speak to the specifics of One Medical’s approach, but he said “the model is the right model for rethinking primary care.”

Chris Peck, president of SEIU Local 560, which represents Dartmouth employees, is a patient of the practice. He said he’s been happy with the care he’s received there.

“I can’t say enough good things about the staff that work there,” he said.

But the recent changes include having to call an 800 number, which reaches someone far away, rather than calling the local clinic directly.

“A lot of people are uncomfortable talking to somebody in Texas about specifics about their health,” he said.

Peck, like Dionne, also likes the convenience of having the clinic in Hanover. He has gone there to have blood drawn and for flu shots, he said. He also said the clinic was “handy for little emergencies” such as having a deer tick removed. Now, he said, same-day appointments are no longer available. If he were to need to have a tick removed, he would go to the emergency room.

For her part, Dionne said she still feels connected to the clinic even though the two doctors have left, but she wasn’t “100% sold yet” on staying. There is some incentive for her to stick with the clinic, however — she said, it’s “hard to find a new doctor.”

Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.