Google’s secretive healthcare business wants to organize the world’s health information, but insiders describe how turf wars and trust issues are hamstringing the operation

  • It’s been nearly two years since Google revived its Google Health division.
  • The new Google Health has big ambitions to tackle some of healthcare’s stickiest problems. It won’t be easy.
  • It’s still battling fallout from public distrust stemming from a controversial data deal with the health system Ascension. It’s also lost out on some major deals as it tries to hammer out its road map, insiders told Business Insider.
  • It’s not yet clear internally how Google Health fits in with the other health businesses within Alphabet, including the organization’s Google Cloud and Verily operations.
  • For more stories like this, sign up here for Business Insider’s daily healthcare newsletter.

Health was always on Larry Page’s mind.

The Google cofounder often spoke about his dream that Google’s ability to organize the world’s information might one day save lives.

“Imagine you had the ability to search people’s medical records in the US, and any medical researcher could do this,” he told an audience at a KV CEO summit in 2014. “I imagine that would save 10,000 lives in the first year.”

But Page, who had been diagnosed with vocal-cord paralysis, also appeared frustrated at the regulations and privacy restrictions placed around health information.

Just two years before, in 2012, Google had shuttered its first serious healthcare effort, Google Health, a service that let users store and manage their medical records online. Despite Page’s vision for a vast health repository that might one day help doctors crack the toughest medical problems, few users showed any interest in the service.

“Google came in to health trying to solve what it perceives to be consumer problems, and it failed,” Jeff Becker, a senior healthcare analyst at Forrester, said. “And it was a pretty public failure.”

Larry Page
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Reuters

But Page and fellow Google founder Sergey Brin couldn’t shake the fascination. After Health closed its doors, Page launched a new company focused on combating aging, named Calico. Later, in 2015, when Google blew up its corporate structure and formed Alphabet, its life-sciences division was spun out into its own company and renamed Verily.

Like Alphabet’s other “moonshot” companies, Calico and Verily were given the resources and freedom to solve big ideas without the pressures to deliver revenue. But the new structure left Google’s own health projects scattered across the company with no home.

Then, in 2018, Google started to reorganize many of its balkanized health efforts under one roof and brought in David Feinberg from the health system Geisinger Health to head up the new collective. Once again, it called the effort Google Health.

Read more: POWER PLAYERS: The 18 leaders at Google Health shaping the tech giant’s secretive healthcare business

Since then, the Google Health team has taken on an altruistic tone while it helps doctors more easily search medical records and uses artificial intelligence to detect diabetic eye disease.

The mission is to make Google, a company that makes the majority of its revenue from advertising, a resource for people with questions about their health, and a partner for clinicians solving healthcare’s stickiest problems.

There are a lot of reasons Google would want to pursue healthcare, but if you step away from that sort of altruistic worldview, there’s simply lots of money spent on healthcare services globally.

There’s money to be made in healthcare. Tech giants like Alphabet, Amazon, and Microsoft have been pushing deeper into the $3.6 trillion US healthcare industry.

All are vying to sign big deals as healthcare companies move to the cloud, and they’re using add-ons, like chat bots, to get ahead. For Google, it’s meant pitching its Google Health unit as a resource in major cloud deals, two employees familiar with the group’s partnership strategy told Business Insider.

“There are a lot of reasons Google would want to pursue healthcare, but if you step away from that sort of altruistic worldview, there’s simply lots of money spent on healthcare services globally,” Becker said.

Read more: 11 tech chiefs, analysts, and bankers in healthcare reveal how Amazon, Microsoft, and Google have used the coronavirus to make new inroads in the $3.6 trillion industry

But nearly two years since Google Health came together, it’s still unclear how the group fits into the company’s bigger vision for healthcare or how it’ll make money, Business Insider has learned through conversations with former and current Alphabet employees, a review of internal documents, and conversations with healthcare-industry experts.

Google Health’s work with search and clinical tools is promising, but it’s early and the group leans heavily on other parts of Google for partnerships. Much of the past 20 months has been spent ironing out its goals and how it fits in with other health-focused parts of the business, such as Google Cloud and Verily.

While Google Health has struck up deals to work with large health systems such as Ascension and Stanford Medicine over the past two years, talks with some other major players including CVS Health and The Gates Foundation have fallen apart along the way, Business Insider has learned. Experts within the healthcare industry are still confused over what Google Health actually does.

“I’ve had good experiences working with them, but I’ve found that over the years their strategy has shifted in ways that we haven’t always been able to keep track of,” Bill Evans, the CEO of Rock Health, a digital health fund and advisory firm, said.

Internal pressure is mounting on Google Health to finally get something tangible off the ground that does drive revenue, a person familiar with the matter said.

A Google Health representative confirmed that the goal was to build Google Health into a business, but did not say whether it had targets to meet, such as Google Cloud’s reported 2023 target to pass Amazon or Microsoft in the cloud market.

“We formed Google Health because we believe our technology can empower people with the information they need to stay healthy and the potential to help caregivers take better care of their patients,” a representative for the product area said.

“Healthcare is complex and health is multifaceted; we’re proud of the early progress we’ve made across a number of areas, including our most recent work partnering with public health during this pandemic,” he added.

Google CEO Sundar Pichai speaks during the Google I/O 2016 developers conference in Mountain View, California
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REUTERS/Stephen Lam

Google Health pulled together employees from across Google

Over several months in 2018, during a process codenamed “Tuscany,” engineering teams focused on healthcare across Google consolidated into the new Google Health supergroup. That included employees from the artificial-intelligence research teams Google Brain and DeepMind, as well as healthcare-focused workers from Nest, the connected-home company Google bought in 2014.

“It was this process where Google said, ‘Children, come together, figure out your business strategy between all of your healthcare teams and make it cohesive,'” said one person who was involved in the reorganization.

Google Health set up in Palo Alto, California, up the road from Google’s Mountain View headquarters, in what used to be Nest’s offices. During the transition and consolidation, some employees’ projects were canceled and others merged in the reshuffling.

For now, Google Health has four areas of focus: consumer tools, which includes work on search and maps to surface authoritative information; clinician tools that Google is trying to use to spark partnerships with doctors and clinicians; imaging and diagnostics; and a research group led by Google Brain cofounder Greg Corrado.

Many of the experts on the team want to see machine learning democratize healthcare access by making routine procedures faster. For example, the group is studying how AI could be used to predict how long patients would need to stay in the hospital and how it could predict acute kidney injuries. Ultimately, the Forrester analyst Becker said, the goal would be to monetize these AI models.

google health power players 4x3
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Google; Geisinger Health; Samantha Lee/Business Insider

But as Google got its health teams organized, there was a big question mark over how Verily would sit in the new world order. When Verily was spun out into Alphabet, in 2015, Google saw it as a vehicle for commercializing projects built by Google’s health teams, three Alphabet employees said. “As time went on Google realized they could just do that themselves,” one of them said.

Read more: As Verily looks to IPO, CEO Andrew Conrad says an inter-Alphabet ‘sibling rivalry’ with Google’s own health team is hurting both companies

To date, the only major example of this partnership was a technology to screen for diabetic eye disease, which the two launched in India last year. The goal of the algorithm was to speed up eye exams for millions of people at risk of preventable blindness.

Healthcare is big and broken.

Referred to as automated retinal disease assessment, or ARDA, the underlying computer-based model was the result of years of research led by Lily Peng, a physician-scientist and product manager at Google Health.

Verily ultimately built the ARDA screening tool to be distributed in India last year, but current and former employees said Verily employees working on commercializing ARDA moved into Google Health, where all technical work on the project now takes place.

Verily has been courting outside investors for years, and CEO Andy Conrad is pushing to take the unit public, as Business Insider reported.

The ambitions of the two health units have created tension between Google Health and Verily. In April, after Verily had launched its response to the COVID-19 pandemic, Conrad emailed his employees saying he wanted to end the “sibling rivalry” with Google Health.

“Healthcare is big and broken, and neither Google nor Verily will win if we are divided,” Conrad said in the memo. “I am committed to making this work better. I don’t want to go back to a world of foolish sibling rivalries.”

Some big deals have fizzled out while Google Health tried to pin down its strategy

As Google Health has tried to get a jump start on early milestone deals, it’s lost out on key partnerships with organizations such as CVS Health and the Gates Foundation as it hashed out its internal road map.

Google Health and Cloud teams entered discussions with CVS over a partnership last year, a project named “Rigel.” The proposal was to build what one employee described as a “digital front door” for CVS, which would let customers more easily book appointments and order prescription refills through Google Search, according to Google Health and CVS sources familiar with those discussions as well as internal documents viewed by Business Insider.

CVS executives flew out to meet senior members of the Google Health and Cloud group about the deal in August 2019, but discussions eventually fizzled out, two people familiar with the matter said. “There was no vision or product road map,” one person who was involved in the discussions said. “It was a bit of a mess.”

One person at CVS with knowledge of the talks said there were financial concerns from CVS’s side. Google did not comment on the deal when asked.

“We’ve had exploratory conversations with Google Health, much like we do with many other companies in the health space,” a CVS representative said.

David Feinberg leads Google's health vertical
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Google Health

Last year, the Google Health team laid out a plan to team up with the Gates Foundation, according to internal documents seen by Business Insider. It was to provide Google resources and employees to help the foundation’s work in underserved markets, but those discussions drew to an early close.

Google declined to comment on its talks with the Gates Foundation, and the foundation did not respond to a request for comment.

Teams at large tech companies will often meet with investors to share what they’re interested in. In turn, venture funds can invest in startups that later attract interest from the bigger companies for partnerships or acquisitions.

In a meeting with Google’s business-development unit more than a year ago, members of Feinberg’s team told a healthcare investor that internal priorities were still muddled.

“We pulled back because they sort of said very openly ‘We don’t yet have the model for what we’re going to do internally,'” the investor, who wished to go unnamed because of business relationships with Google, said.

There’s not been a change, to this person’s knowledge, since then. “My impression is that there isn’t sufficient clarity on their side,” the investor said.

Google Health had no comment about the meeting.

Last fall Google Health went public with its ambitions, weeks before being rocked by a privacy scandal

Google revealed very few specifics about its plans for healthcare until October 2019, when Feinberg, the former Geisinger chief, laid out a vision to organize the world’s health information, making it broadly accessible and useful.

Read more: One of Google’s top doctors explains how its coronavirus response is feeding into its long-term plans to reinvent how people get health information

About that time, Google made two additional hires. Karen DeSalvo, a former healthcare advisor to President Barack Obama, came on board in October 2019 to lead a clinical team of doctors who works across project areas.

Her appointment coincided with the hiring of Robert Califf, a previous advisor for Verily and the former head of the US Food and Drug Administration, as a full-time strategist in 2019.

Then came the news in November that Google had teamed up with Ascension, a massive health system headquartered in St. Louis that tapped Google to migrate its health records to the cloud.

Reporting on the partnership in The Wall Street Journal unleashed a national uproar over privacy and people’s health information. Their arrangement prevents Google from using Ascension’s data to feed its search business, but the backlash made a mark on Google Health’s best-known project to date: coming up with a tool Ascension’s doctors could use to more easily search health records.

The controversy failed to abate the skepticism toward a tech giant whose primary source of revenue is advertising.

“They got taken over the rails,” a healthcare investor, who asked not to be named, said. “I don’t think anyone expected that level of backlash. It really made them rethink how they should be presented in the healthcare world.”

Nearly 2 years in, Google Health is still facing an identity crisis

As of April, Google Health had nearly 600 full-time employees, according to an internal email seen by Business Insider. The leadership team includes Google and healthcare-industry veterans.

For all its big hires, employee data at Google Health shows that employees are concerned about inefficiencies within the young product group, though they support the broader mission to make people healthier.

On April 14, Feinberg sent around the Google Health team’s responses to the “Googlegeist,” an annual company-wide survey that asks employees to rate their opinions on Google as a whole as well as their specific product group and leaders.

  • Of the 510 people within Google Health who took the survey, 89% rated “Google’s mission” as “favorable,” a score that matched the average across the company.
  • But some categories showed a much bigger deviation from the wider company. On “execution,” Google Health achieved its poorest score of all the categories. 40% of employees gave it a “favorable” rating and 32% rated it “unfavorable.” That was 23 percentage points worse than the company’s average, the data showed.
  • “Retention and function” for the Google Health group also scored quite low, with just 51% of Health employees rating it favorably and 25% giving it an “unfavorable” rating.

“I see a lot of hard work ahead of us,” Feinberg wrote in an email sharing the results with his team. “But I also see opportunity.”

Some of this hard work will be figuring out how Google Health fits into the bigger picture of Alphabet’s health ambitions.

“There’s lots of different healthcare strategies at Google now, but they’re very fractured,” Forrester’s Becker said.

Verily CMO Jessica Mega
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Todd Williamson/Getty Images

Insiders said the fracturing has sometimes caused confusion when trying to spark up deals with partners, particularly when groups pitch to the same prospective client individually. Verily will boast about the power of Google Cloud and the Cloud team will try to tantalize clients with the prospect of working with the bright minds of Google Health.

A recent Cloud partnership with the US Department of Defense leaned on some AI models developed by Health to spot cancer, although the Google Health team likely won’t be involved in the project’s deployment going forward, one person familiar with the matter said.

But Google Health’s future working relationship with Verily is less clear, as employees inside the life-sciences company said Verily is intent on becoming more independent from the Google mothership. The separation between the two has already led to parallel projects across both Verily and Google that some employees have described as redundant or competitive.

They’re blazing the way in some of this stuff, but after the publication, then what happens?

There are also obvious opportunities to do more together, insiders said. In a paper published in JAMA Oncology in July, a team of researchers in Google Health said their AI outperformed general pathologists in grading prostate cancers, one of many examples of the work being done inside Google.

“Why isn’t Verily helping them commercialize that?” one former Verily employee said. “They’re blazing the way in some of this stuff, but after the publication, then what happens?”

Karen DeSalvo Google Health
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Google Health

Many Verily employees have moved into the new Google Health group since it launched, according to insiders and LinkedIn data viewed by Business Insider.

“There was some envy over the fact that if you worked at Google Health, you could work on some things you wanted to work on,” a former Verily employee said. “You weren’t working on a product; you were solving a big problem that you chose to work on,” they added. “At Verily you had to sell what you wanted to work on really hard.”

Read more: Google is releasing data on how people have been searching for COVID-19 symptoms, in the hope it’ll help researchers track the virus

A quarter of Google Health’s life has been spent during the coronavirus pandemic, and it’s helped focus its search ambitions, partnerships with health officials, and collaboration across the company, chief health officer Karen DeSalvo told Business Insider in August.

In light of unprecedented interest for online doctors’ visits, Google jump-started a program that shows which providers do telehealth in search results and in Maps. The Google Health team is also trying to help researchers by aggregating COVID-19 symptom search trends.

“If we’re going to really make a difference in the lives of people’s health, we have to do that by addressing not only tools and support for carers, but we have to do that as much as we can directly to consumers and other parts of the system,” DeSalvo said in August.

Are you a Google insider with more to share? Contact Hugh Langley using encrypted messaging app Signal (+1 628-228-1836) or email (hlangley@businessinsider.com). Contact Blake Dodge at Signal (+1 252-241-3117) or email (bdodge@businessinsider.com).

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