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Waiting for healthcare's Amazon

Many startups and companies from other industries have physicians, hospitals, insurers and medtech manufacturers in their sights, betting that they can offer better services at cheaper prices for dissatisfied consumers.

"These new entrants are nibbling at the edges of the traditional healthcare ecosystem, setting the stage for a New Health Economy," wrote PricewaterHouse partner and health industries leader Kelly Barnes in a new study, asking "Who will be the industry's Amazon.com?"

Probably not Amazon, nor any single of the dozens of digital health startups trying to tackle everything from health risk assessments to cost-estimating to glucose monitoring, nor any single company, although to some, Wal-Mart seems to have quite a bit of potential.

Either way, if Wal-Mart becomes a place for low-cost MRIs or if established players evolve and roll with the flow, consumers are "ready to move" and "willing to abandon traditional care venues for more affordable and convenient alternatives," Barnes wrote.

A recent PwC survey found that nearly half of Americans are interested in paying for and receiving services outside of traditional venues for minor problems, such as using at-home kits for strep throat or online consultations for skin rash evaluations.

Many consumers also interested in getting more complex services at home, online or in retail setting if it's more affordable and convenient.

Of the 1,000 adults PwC surveyed, more than a third said they're open to digital, home-based electrocardiograms, pacemaker/defibrillator monitoring, urinalysis, and chemotherapy treatment, along with online physician consultations. About a quarter of those surveyed would also be open to receiving dialysis or MRIs in a retail clinic.

If even a fraction of consumers end up using at-home, online and retail options for those tests and treatments, traditional medical practices and health systems could lose billions of dollars in revenue, unless they start providing those services in the setting consumers want.

"While the survey results signal a threat for today's healthcare companies, they also highlight an opportunity to reduce costs," Barnes wrote. "A hospital with a value-based care contract could find it cost-effective to send patients to local retail clinic partners rather than surgeons to have post-operative stitches removed."

Indeed, some health systems have already started acquiring or opening retail and urgent care clinics, as have some insurers, notably Humana, which owns the Concentra network.

In greater Philadelphia, for instance, Temple University Health System operates four "ReadyCare" retail clinics, Einstein Health has two walk-in clinics, including one in a Shop Rite grocery store, and Abington Health is in the midst of opening two urgent care centers, while the Rothman Institute, the region's largest orthopedic group, has several urgent care centers in the works after the first, in Marlton, New Jersey, opened last year.

When PwC asked 1,000 Americans "Are you open to trying new, non-traditional ways of seeking medical attention or treatment?" 64 percent said "Yes, if the price is right" and 18 percent said "Yes, regardless of price." Only 17 percent said "No, regardless of price."

Despite the regulatory barriers, many startups and established non-healthcare companies alike are trying to give American healthcare a run for some of its $2.8 trillion by tackling that issue of price.

New entrants, from a variety of industries, "regard their global reach, customer insights, commitment to transparency and trusted brands as critical assets to capture and dominate the fragmented health sector," Barnes wrote.

Twenty-six of 2013's Fortune 50 companies were new entrants in healthcare, PwC found, including seven retailers, eight technology and telecommunications companies and even two automakers looking for ways to add chronic disease care services to their products.

In 2012 AT&T opened its mHealth platform to developers to tap into the mobile application boom, Samsung's new smartphone comes with a built in heart rate monitor, Apple is expected to unveil a mobile health product soon, Time Warner Cable is experimenting with the Cleveland Clinic in offering telehealth video consults, and Google recently launched company called Calico, offering few details other than a focus on aging and its related diseases.

Walgreens, 37 on the Fortune list, has been targeting consumer health for some time, for instance offering some $400 million worth of immunizations annually, a four percent share of a $10 billion market.

Then there's one of Amazon's biggest competitors, Wal-Mart, which may turn out to be one of the biggest competitors for healthcare providers, or also one of their most promising partners partners.

After its $4-generic drug program debuted in 2006, Wal-Mart started looking for more health business. Walk-in clinics affiliated with regional hospitals can now be found in many Walmart stores, from Maine to California. Last year Kaiser Permanente opened micro-clinics in two Walmart stores that offer teleconferencing to KP nurses and physicians, available both to shoppers and store employees.

The question lingering is how far Wal-Mart will or can go into primary care.

Pretty far, argues Lisa Bielamowicz, MD, the Advisory Board Company's chief medical officer.

"A third of your patients shop at Wal-Mart every week," and "it could become your most formidable competitor," Bielamowicz said in a recent presentation for hospital leaders.

"What if Wal-Mart expands enough in primary care that it disrupts local, established patient-physician relationships and referral chains, combines clinical, pharmacy and consumer data to create comprehensive patient profiles and then uses that to create a membership model that can drive patient decisions, and then on top of everything, they're able to launch or partner with a nationwide affordable health plan and require aggressive price concessions to participate in their networks?" Bielamowicz asked.

Wal-Mart may or may not go all or part of that route, but if health organizations don't start offering their customers -- patients, members and employers -- tangible value, "somebody else will," Bielamowicz said.

Many are lining up to try, either one their own, like the newly-public company Castlight Health, or as part of established players, like the digital health startup Audax, created by a Brown dropout, that was recently acquired by UnitedHealth Group.

Either way, within a decade, "traditional healthcare business will look and feel like other consumer-oriented, technology-enabled industries," PwC's Barnes wrote. "Soon, it will have its own Amazon.com-style, iconic, new economy brands."