The health care company One Medical, under government scrutiny for allegedly using vaccine distribution to increase its bottom line, is facing a new challenge from within: employees who accuse the company of placing profits over patients.
Dozens of One Medical employees are trying to unionize as a response to what they say has been mismanagement of the organization's COVID-19 response, poor working conditions for staff and, they allege, a declining focus on patients.
One Medical officials strongly deny that the company's primary focus is anything other than patient care. "Delivering quality care to our patients is our number one priority," the company said in a statement. "Our success is measured not in membership numbers, but instead in the satisfaction and well-being of our patients."
Still, employees point to several changes in company policies that, they say, place profits over patients, including requirements for shorter doctor visits, less time to respond to patient concerns at the company call center and rushed schedules for laboratory employees.
One Medical has a reputation for being a high-end health care provider, and it typically charges its relatively affluent clientele a $199 annual fee — before members use insurance or pay out of pocket. The company promises a tech-driven scheduling and telemedicine experience along with a more personal relationship with medical providers. The company has a market capitalization of more than $3.9 billion and more than 500,000 members across the United States.
NPR spoke to 10 current and three former One Medical employees who described their work experiences. Almost all requested anonymity due to fears about their job or legal repercussions as a result of speaking out. Some but not all of those interviewed were part of the union-organizing effort.
The employees describe a company that they say fundamentally changed its focus after its initial public stock offering in January 2020, with increasing revenue and reducing costs taking center stage.
"The minute we went IPO, we pivoted away from patient care to membership volume," said one administrative staffer at One Medical. "It's about membership numbers and showing the investors our membership numbers have gone up." Added another employee, "Ever since we went public as a company, profit matters over employees and patients."
Richard Minter, a union organizer for Workers United who's in contact with employees at One Medical, said those changes are behind the unionization effort.
"[Company leadership] did things that helped foster a sentiment within the workforce that One Medical had forgotten about its staff — and that One Medical had, as a for-profit institution, turned their back on what was most important," he said.
A One Medical spokesperson called the assertion "entirely false and baseless ... our patients' health and well-being has always been, and will always be, our highest priority."
One example of what some employees believe illustrates a focus on costs rather than patient care is that One Medical patient physicals and preventive care appointments were cut from 40 minutes per appointment to 30 minutes after the IPO.
Providers and staff were given talking points in case patients questioned why they were limited to 30 minutes, and workers were encouraged to tell patients that the shorter visits were part of a "redesigned Physical," according to a copy of the talking points reviewed by NPR. Medical providers were advised in this document that they should use two minutes to "connect and ask the patient what they want to achieve today," 10 minutes to take the patient's history, six minutes to take vital signs and other measurements and then six additional minutes to finish the visit. Five minutes were allocated for walking the patient out and cleaning the room.
One Medical asserted that there had been no decline in patient standards, that the company did not change the total number of patients seen each day and that average visit duration remained the same. The Medical Group Management Association, a trade organization for doctor practices, told NPR that the average time for preventive care visits nationally was 30 minutes in 2019, the most recent year for which figures are available.
Work practices have also changed for One Medical administrative staff tasked with answering phone calls from patients, employees said. These calls involve things like setting up appointments or dealing with patient questions.
Company leadership began demanding that the staff meet strict targets on the number of calls taken per day, as opposed to the prior approach in which employees determined how long calls should be, employees told NPR.
Three individuals who have done this work described six-hour shifts in which employees were given a lunch break and an additional 10-minute break and were expected to take phone calls at all other times, with management watching to ensure they met strict metrics.
Employees at a One Medical call center in Phoenix said they were constantly monitored on the number of calls taken each day, the percentage of time they were on the phone and the number of tasks completed each day. The company expects staff to be on the phone for 65% of each shift, the staff said.
"You're just sitting there, looking at a metric, trying to meet a percentage. It's super anxiety inducing," said one of these workers. "The idea used to be that if you had a phone call from a patient, you'd have ... time to figure out how to help them."
Employees said many tasks that involve helping patients didn't count as time on the phone: messaging patients online, seeking medication authorization or following up with health insurance billing, for example.
"One Medical prides itself on being patient centered. ... We don't have time to message patients back. We don't have time to follow up. ... It's become an impossible job," said an employee whose job it is to answer patient phone calls.
One Medical disputed this characterization, saying in a statement that all contact centers have metrics that they measure. The company also said that the 65% figure was "not a requirement," but instead an average, and that the company "purposefully set[s] goals that provide a generous amount of time" for completing tasks that don't involve being on the phone.
"While we have always had performance expectations for virtual work, we have recently focused on providing additional clarity and transparency into those expectations to support our employees in their efforts to deliver the best possible customer care for our patients," One Medical said.
Those engaged in medical roles were also put under pressure. This year, One Medical phlebotomists, who specialize in drawing blood, had their morning preparatory period withdrawn, leaving little time to get equipment ready in the morning as patients waited, phlebotomists told NPR.
In response, One Medical said that there is no evidence patient care was adversely affected by the change and that the change was necessary to "make lab hours consistent across clinics in each market."
Approximately 30 employees are on an organizing committee to seek union representation and are being represented by Workers United. In late June, they announced their intent to request that One Medical voluntarily recognize the union. Failing that, these employees plan to seek the approval of the majority of administrative staff and phlebotomists to unionize — approximately 530 staff members, by their count. Doctors and nurses are not part of this organizing effort.
One Medical said that it would not voluntarily recognize the union without a vote. "We have no indication that a majority of these employees wish to unionize or agree with the reported assertions," a company spokesperson said. "If the affected employees vote to unionize through the government-run, secret-ballot election, we will recognize the union and work with it for everyone's benefit."
In a companywide meeting on July 23, One Medical CEO Amir Dan Rubin told employees to consider what he viewed as a downside of unionization.
"We think the best way to effect positive change is to work together directly, rather than through the filter of a union, which is unlikely to share our vision and brings a number of their own priorities to any situation. That said, we respect the official process and right to choose or oppose unionization," he said. "Before any of you involved in this make such a decision, make sure you fully understand what it means from a cost perspective. I'm sure you're all familiar that there are union dues."
One Medical faces these internal matters even as it confronts other external challenges: This year, numerous county and state departments of health halted cooperation with One Medical over allegations that the company provided COVID-19 vaccines to then-ineligible patients.
Further reporting yielded allegations that the company helped those with connections to company leadership skip the COVID-19 vaccination line and that the company may have sought a commercial benefit by collecting data from nonmembers it was vaccinating. Following this, the House Select Subcommittee on the Coronavirus Crisis started its own probe into the San Francisco-based company.
NPR was also made aware of a second probe initiated by the California Department of Consumer Affairs after the agency reached out to NPR in March and late July as part of its investigation on behalf of the Medical Board of California (the board would not confirm or deny whether its investigation was ongoing).
In a May filing with the Securities and Exchange Commission, One Medical acknowledged that it was also the subject of inquiries from the California attorney general, the Alameda County District Attorney's Office and the Federal Trade Commission.
One Medical's stock is trading at around $28 a share, down from its high of nearly $60 in February, before the various investigations began.
MARY LOUISE KELLY, HOST:
Dozens of employees at the concierge medical company One Medical are trying to unionize. They are citing mismanagement. Earlier this year, NPR reported on allegations that One Medical had provided then-ineligible patients with the COVID vaccine. The reporting sparked a congressional investigation into whether the company sought to profit from COVID vaccine shots. Now many One Medical staff members say working conditions are poor, and they say the high-end boutique medical company is putting profits over patients. Tim Mak of NPR's investigations team is with us. Hey, Tim.
TIM MAK, BYLINE: Hey there.
KELLY: Give me a little backdrop here. What is One Medical? What exactly do they do?
MAK: Sure. They're a nationwide medical provider. They're based in San Francisco. And they're valued in the billions of dollars. They typically charge a $199 fee each year for access to a tech-driven, high-end patient experience. So this past spring, we did an investigation into these allegations that the company had not properly screened COVID vaccine eligibility, leading numerous public health departments to halt vaccine distribution to the company. Not only did this lead to a congressional investigation, but the company also acknowledged that outside of the congressional probe, it had received inquiries from the California attorney general and the Federal Trade Commission. We kept digging and found a lot of employee concerns.
KELLY: Like what? What are they saying?
MAK: So One Medical went public in January of 2020. And we spoke to 10 current and three former employees for this investigation. A common theme we heard was that the company shifted its focus after its IPO, placing the bottom line before the patient experience. And employees have said they feel it's affected patient care. One example they use is that preventative care appointments were shortened from 40 minutes to 30 minutes and framed as a so-called redesigned physical. Staff were also complaining about working long hours while supervisors are monitoring every minute of their work, saying that they felt that their call metrics, that - these are folks who are working on the One Medical call center - that call metrics were the priority, rather than actually dealing with patient needs. Here's how one former staffer described her experience.
UNIDENTIFIED PERSON: There was a week at the beginning of May, maybe mid-May or something. I got off the phone with a patient. And, like, the call was fine. They didn't yell. But I just, like, sobbed because I was so overwhelmed with everything. So it was just, like, soul-sucking.
MAK: One Medical responded by telling NPR that delivering quality care to their patients is their, quote, "No. 1 priority" and that the IPO has not had an effect on their standards.
KELLY: OK, so the latest twist is employees want to unionize. What exactly are they demanding?
MAK: So a company-wide survey shows a lot of dissatisfaction. Some 50% of staff was looking for new work. Dozens of administrative staff and phlebotomists have asked for the voluntary recognition of a union. But the company's leadership has said no to this. So at some point, staff will be holding a vote to see if a majority of them want a union. In a recent meeting of One Medical staff, recorded by an employee, CEO Amir Dan Rubin argued against unionization.
(SOUNDBITE OF ARCHIVED RECORDING)
AMIR DAN RUBIN: We think the best way to affect positive change is to work together directly rather than through the filter of a union, which is unlikely to share our vision. And I'm sure you all are familiar that there are union dues, how it can radically restructure work relationships and impact our culture.
KELLY: Fascinating. One of many voices there from reporting by our own Tim Mak. Tim, thank you for that.
MAK: Thanks a lot. Transcript provided by NPR, Copyright NPR.