From PillPack to digital health, how General Medicine's founders are building a healthcare storefront

Three former Amazon employees launched a new online healthcare marketplace earlier this year aiming to make healthcare a better experience for patients. The vision, executives said, was to make healthcare as easy as shopping online.

General Medicine, started by the founding team that built PillPack and Amazon Pharmacy, connects consumers to providers to either address specific medical needs or to chat about the symptoms they're having. Consumers can use General Medicine for a wide variety of medical issues, and the platform provides both insurance and cash pricing. There’s no subscription or access fee. 

General Medicine executives refer to it as a "one-stop-shop" for telemedicine, prescriptions, imaging, labs and specialists. PillPack co-founders TJ Parker and Elliot Cohen teamed up with Ashwin Muralidharan, who most recently served as technical advisor and chief of staff to Amazon's top health executive Neil Lindsay, to launch General Medicine.

The startup uses its own medical group plus a network of specialists, providers in the community and local ambulatory clinics and labs to provide care and help consumers navigate to the rest of the healthcare system.

From the beginning, General Medicine's founders wanted the platform to offer a full menu of services, from a dermatology visit to a cardiology consult, as opposed to the first wave of direct-to-consumer digital health companies that went narrow and focused on a single specialty or service, according to Parker.

"I think the bet that we made early on was that it was important to have breadth of selection and it was important to be able to take anyone's insurance. You can come to us, we can both take your insurance for our medical group or show you pricing for a third-party medical group and be available nationwide," Parker told Fierce Healthcare. "It's a very similar strategy to PillPack."

In May, the startup picked up $32 million in venture capital funding led by Matrix, BoxGroup, the Founder Collective, VXI Capital and JSL Ventures.

The startup's focus on depth and breadth appears to be a winning strategy, executives said. Since rolling out broadly in May, General Medicine has delivered care across more than 35 specialties and fulfilled over 800 different types of healthcare visits spanning routine, chronic and specialty care, according to the company.

"Compared to most digital health companies, we intentionally launched with a very broad selection, so you can come to us for literally anything, and we're seeing that behavior," said Parker, also a general partner at VC firm Matrix. "There's not a handful of things that customers are coming to us for at this point. It runs the gamut. It could be something as simple as they need a refill for a prescription that they have, and it's been very difficult to get that from the primary care provider, all the way through that they've had this complex issue that they've been unable to diagnose for a very long time, and we can help them wrestle through a much more complex issue."

General Medicine also is quickly expanding its reach across the U.S.—the company claims it has served consumers in 82% of U.S. counties. Parker declined to disclose how many consumers have used General Medicine to date.

The company also asserts its platform is making care more accessible as patients face high healthcare costs and long wait times for doctor appointments. More than 1 in 3 insured American adults say they've skipped or postponed necessary medical care or medications in the past 12 months because of cost, one survey found. Average wait times for new patient appointments can reach 31 days in many major cities, according to a recent AMN Healthcare survey.

Another survey found 26% of patients wait more than two months for care, and nearly half of those give up seeking an appointment and do not receive care, including for critical needs.

General Medicine says 81% of its customers used its platform to tackle previously delayed care, and 20% said it was care they’d put off for six months or more.

Nearly half of users booked visits in multiple categories. General Medicine sees the company as a hub for healthcare access, with customers completing referred appointments with more than 100 different provider groups and health systems.

Parker, a second-generation pharmacist, co-founded e-commerce pharmacy PillPack along with Cohen, which Amazon bought in 2018 in a $750 million deal. Parker and Cohen helped build Amazon Pharmacy, which was born out of the PillPack acquisition, as well as Amazon Clinic.

For the past seven years, Amazon has been working to disrupt healthcare, bringing its focus on being "customer-obsessed" to an industry not known for having a good customer experience.

Parker says there were lessons from his work at PillPack and Amazon about making healthcare more convenient, accessible and a more enjoyable experience.

"I think if you jump all the way back to when we first built PillPack, our intention there was to make it as convenient as possible for people and to remove the friction. I think a lot of people have tried to 'solve' adherence, and, in many ways, we were attempting to do the same thing, but very much by making it easier for customers. General Medicine has a very similar philosophy, which is, if it can make this convenient and easy, it will help people get care that they need," Parker said.

General Medicine started from the full spectrum of care and built the technology to make it accessible, executives said.

The company is building a distributed health system, Cohen said in an interview in May. For consumers with more complex healthcare needs, General Medicine can connect them to a network of specialists or even in-person care with providers in the community. The company also taps medical specialists for e-consults to connect patients to specialty care faster and extend the reach of its medical team.

The company’s network includes physicians across all major fields, including cardiology, endocrinology, oncology, neurology and women’s health.

“The U.S. already has world-class medicine,” Muralidharan said. “We’re just making it easier for people to reach it.”

Aaron Leong, M.D., an endocrinologist at Massachusetts General Hospital, works with General Medicine for specialty e-consults and believes the service helps close significant gaps in care. Often, patients have to take time off work and drive several hours to see him in person for a medical visit. Through General Medicine, Leong says he can extend his reach to more patients.

Telehealth state licensing requirements can limit Leong to only provide care to patients in Massachusetts. With specialty e-consults, General Medicine can tap into specialists' expertise across the country.

"Overall, we are delivering higher-level care because instead of waiting up to six months to then travel two hours to see an endocrinologist for what could be either a simple question, or it could be actually something quite urgent, you're actually able to initiate the workup or initiate treatment while waiting for the in-person appointment that may be scheduled six months out," Leong said in an interview.

General Medicine's model also enables better communication between the internal medical group and specialists, he noted.

"Generally speaking, as an endocrinologist, the communication with the internist or the primary care doctor isn't as well established. I don't really get that communication back with the primary care doctor. I write my impression in my note, and that's pretty much it. This is actually quite a bit of a burden for the patient because of the lack of communication between the primary care team and a subspecialist, and relying on the patient to be able to navigate that can sometimes result in either misinformation or fragmented care," Leong said.

Parker sees distinct differences between what General Medicine is building and Amazon Health, which has the online pharmacy business, One Medical concierge primary care and Amazon One Medical pay-per-visit telehealth services (formerly Amazon Clinic).

"I think the main difference is that we think consumers really do want to navigate this as a broad-based store, and be able to understand all their options, and be able to do things in a transactional way. Some of the components may be similar. I think it's a slightly different vision of where we hope to take this product and service," he noted.

Artificial intelligence plays a critical role in General Medicine’s ability to offer price transparency and a better customer experience.

Behind the scenes at General Medicine, the company analyzes the customer’s insurance information, including their 80-100 page coverage of benefits, Parker explained to lawmakers during a congressional hearing in September about the benefits of AI in healthcare.

"We use large language models to turn these PDFs into structured data, then combine that with open pricing files and other sources to give customers a clear, upfront price for any service, including procedures, labs, imaging, referrals and pharmacy at any location. This is the first time comprehensive pricing has been available in U.S. healthcare," Parker told lawmakers.

General Medicine also uses AI to develop actionable, proactive care plans to go beyond just the isolated medical need that brought customers to the appointment. "We take all data that we have about customers, so their historical medical record, the transcriptions from the actual visit, and then using AI and LLMs to to turn that into actionable next steps for the customer. We're looking at your full medical record and being able to provide recommendations for other things you could be doing for your health," Parker said.

These care plans can address all the patient's conditions and any overdue preventive care. With patient permission, General Medicine uses AI to pull together their medical history, labs and prescriptions, then flag what’s missing, such as a colonoscopy, a cholesterol check or a follow-up lab for blood sugar, Parker told lawmakers.

The company plans to build out consumer-facing AI tools to enable patients to interact with their medical records, self-navigate their own care and be better prepared for appointments, he told Fierce Healthcare.

There has been a push for the past decade to make healthcare more "consumer-centric" with limited results as healthcare pricing remains opaque and there is still significant friction in accessing healthcare.

Through PillPack, then Amazon and now General Medicine, Parker, Cohen and Muralidharan have been trying to "reorient the system around the end customers," Parker noted.

"I do think AI is a big unlock for consumers to be able to navigate healthcare better. I think historically, it's very hard to know what you need and so the only real solution was to to interact directly with a GP or the physician to figure that out. I think consumers can now get much farther down the path on their own, and then work with a doctor to both validate what they've discovered, and then be able to make that actionable," he said. "Consumer behavior has obviously gotten so accustomed to these types of experiences everywhere else, that while it may have taken an extra decade or more to start to see that come to fruition in healthcare, it's certainly happening, and I think we'll continue to accelerate."

While tools like AI chatbots can provide consumers with insights and recommendations about health issues, the next step is to make those recommendations actionable right away, Parker noted.

"That is the magic of what we're trying to try to build at General Medicine, which is combining these consumer-facing tools with the selection and the product catalog that we've built at General Medicine," he said.