Step 1 of 4 · 2007–19 · Membership primary care and employer health services

Redesigning administrative work made room for a better visit

Tom Lee had worked across several clinical settings before starting One Medical. His explanation of the original design centers on administrative work: rebuilding that work could give clinicians more time with patients despite largely fixed reimbursement. The company developed its own technology, used salaried providers and combined office care with remote access. In his 2012 Rock Health interview, Lee described designing the physical service and software together. OM4 OM1

Patients bought easier access to an ongoing care relationship. The software mattered because the company also controlled the staff and practice using it; scheduling and follow-up could be designed around the same service promise. By September 2019, One Medical reported about 397,000 members. Members used a care service whose offices, staff and software had been designed together. OM2

Rivals A conventional primary care practice supplied continuity; urgent care supplied convenient episodic access. One Medical combined continuity with more flexible access in its own practice network.

Founder Domain ExpertiseTech-Enabled Services

Step 2 of 4 · 2013–20 · Membership primary care and employer health services

Employer benefits brought groups of patients into the same service

By September 2019, One Medical had approximately 6,000 enterprise clients. Employers covered employee memberships and usually kept their existing insurance arrangements for billed visits. The company later extended virtual-only access to workers outside its office markets, giving a multi-location employer a way to offer some service nationally. OM2 OM3

The employer route reduced the need to persuade every patient to buy an individual membership before trying the practice. For the buyer, the offer could improve the experience of a benefit it was already funding. Physical offices still mattered where employees wanted examinations and procedures, so distribution had to fit local care capacity. The filing’s concentration disclosure also makes the tradeoff concrete: Google represented 10% of revenue in 2018 and the first nine months of 2019. Large accounts supplied reach and negotiating exposure together. OM2

Rivals Employers could retain ordinary insurance and provider directories, buy telehealth, or use other workplace clinics. One Medical offered a branded primary care relationship with offices and remote support.

Step 3 of 4 · 2017–20 · Membership primary care and employer health services

Hospital partnerships helped expansion and created a dependency

Health network partners supplied commercial and clinical arrangements covering 86% of One Medical’s members in September 2019. The filings describe coordinated specialist access, fixed payments in some arrangements, and access to health network payer contracts. Bob Herman’s contemporaneous Axios analysis emphasized the other side of the bargain: hospitals gained a route to commercially insured patients who might need further care. OM2 OM7

This explains why local health systems could support a new primary care network. One Medical brought patients and employer relationships; the partner brought specialist capacity and an established place in the local payment system. Expansion could build on those assets, but the partners retained bargaining power. Kevin O’Leary’s May 2020 earnings commentary noted discussion of hospitals restructuring payments during the pandemic. The hospital agreements supported expansion and exposed the company to changes in partner payments. OM3 OM8

Rivals Building all specialist capacity internally would require a different business. Partnering provided access, while leaving terms and parts of the care journey outside One Medical’s control.

Step 4 of 4 · 2021–23 · Membership primary care and employer health services

Iora changed the revenue mix before Amazon bought the business

One Medical completed its Iora acquisition in September 2021, adding Medicare patients under a risk-based care model. At the end of 2022 it reported 796,000 Consumer and Enterprise members and 40,000 At-Risk members, $1.046 billion in revenue, and a $397.8 million net loss. Consolidated revenue now combined membership fees and care-delivery payments with the much larger per-patient payments of the Medicare risk business. OM9 OM10

Amazon completed the acquisition on February 22, 2023. Its later filing reports approximately $3.5 billion in cash consideration net of acquired cash; the earlier $3.9 billion announcement included One Medical’s net debt. The purchase brought Amazon offices, clinicians and employer relationships as well as technology. The acquisition transferred a large operating practice network that was still reporting losses. The care delivery and insurance-risk work continued to require people, capacity and funding. OM5 OM6 OM10

Rivals Iora’s risk-bearing Medicare care has different economics from a membership service for commercially insured workers. Compare each population and reimbursement model separately.