With many tech giants looking for openings to disrupt the healthcare industry, a recent survey of health professionals point to Amazon as the one tech player likely to have the biggest future impact on the healthcare sector. Yet it would foolish to discount the potential for Goggle becoming a disruptive force in healthcare in light of a series of recent high-profile investment, hiring and partnership initiatives.

Google’s parent Alphabet via its Verily Life Sciences unit has now invested $375 million in next-gen health insurer, Oscar Health (amounting to about a 10% interest) which will use the funding to jump into the Medicare Advantage market starting next year. Earlier investments included Clover Health, a healthcare technology company and Collective Health, an enterprise health insurance software and services company.

Given these moves, no one should be surprised to see Goggle make a play in the health insurance space and this was underscored when the company signaled its intention to hire a health plan executive. Importantly, the value potential for traditional health insurance companies is tied directly to care management, which, in turn, is largely dependent on data. And this is where access to Goggle Cloud storage and computing tools could become so indispensable.

Meantime, the latest well known healthcare executive hired by Alphabet’s is former Cleveland Clinic CEO Toby Cosgrove who was named executive adviser to the Google Cloud healthcare and life sciences team which, building on its data-processing expertise, is expected to develop products related to healthcare data and analytics as part of its push into the growing population health market.

Perhaps the quickest way for Google to have an immediate impact is by partnering with traditional healthcare players ranging from software vendors to health insurance companies where data management and analysis is so dependent on the cloud, Already, the National Institutes of Health is partnering on one of its biometric data initiatives with Google Cloud. Meantime, Verily is partnering with 3M to develop health population management solutions and is also working with Duke University and Stanford Medicine on a project to gather and analyze data from some 10,000 participants.

So whose ox is being gored under the Trump Administration’s blueprint to lower prescription drug prices? Well, if you guessed the powerful and politically well-connected multinational pharmaceutical companies — surprise — you’re wrong! A close look at the myriad policy proposals and actions announced by the White House and its Department of Health & Human Services (HHS) point to a focus mainly on drug prices but not drug manufacturers.

While the Administration is tweaking how Medicare reimburses hospitals and physicians for certain drugs and is seeking feedback on the idea of passing drug rebates directly to seniors, the bottom line is that the various proposals under consideration mostly takes aim at some of the key players in the $450 billion U.S. drug market: pharmacy benefit managers, health plans and providers but largely spares the drugmakers themselves from suffering any real pain.

In terms of industry feedback to the blueprint, two consistent themes emerge from comments by the top players in the drug market: everyone generally opposes government price-setting which is already prohibited by law and all agree that drug prices are the fault of someone else. Pharma’s leading trade group takes its aim against PBMs while the other key players— PBMs, hospitals and health insurers — charge that its drugmakers\themselves which are blame for today’s problems with drug pricing.

Already. Amazon has begun selling medical supplies and equipment in the U.S. and specific medical products globally, In January the internet giant announced it was joining with Berkshire Hathaway and JP Morgan to form an independent, non-profit health care company for their U.S. employees, and recently appointed Dr. Atul Gawande the venture’s CEO.

In its clearest signal yet of its intent to disrupt key components of the healthcare industry, Amazon has now agreed to acquire online pharmacy PillPack, confirming months of speculation that the customer-centric company would jump into the pharmacy sector. Privately held PillPack is still a relatively small player, with an estimated $100 million in annual revenue, Amazon — with $178 billion in sales last year, exceptional tech-nology, nationwide distribution capabilities and a history of disrupting oth-er industries — poses a formidable threat to the traditional pharmacy business where escalating drug prices and the need to reduce their costs to consumers has become a red hot policy and political issue. In addition, PillPack already has pharmacy licenses in all 50 states and relationships with most major drug-benefit managers such as Express Scripts Holding Co., eliminating Amazon’s need to build those ties from scratch.

Of course only time will tell whether Amazon has the right formula for what most ails the U.S. health care industry — unending cost spikes & eye-smacking inefficiency — but given its track record in disrupting other industries, I for one wouldn’t bet against the customer-centric colossus whose very name has become a verb: as in, to be “Amazoned” means to have your business crushed because the company got into your industry.

Look for these anticipated changes in the U.S. health insurance market to have some direct consequences for healthcare providers who will likely have to collect payment from a wider array of patients and potentially rack up even more bad debt in the year ahead. Ironically, animus over health insurance could well cause a backlash against Republicans inside Congress whose majority is on the line, particularly in the House of Representatives, in the U.S. midterm elections this November.

Coming like a shot out the the blue, the Centers for Medicare and Medicaid Centers may have opened up a real hornet’s nest in asking for public input on who should be allowed to perform testing in U.S. laboratories as defined by the Clinical Laboratory Improvement Amendments of 1988 (CLIA).

CLIA sets specific education and experience requirements for personnel allowed to perform moderate and high complexity testing. Unchanged with minor exceptions for more than 25 years, CLIA personnel requirements have been the subject of intense debate since they were finalized in 1992. Now with highly sophisticated molecular and genetic testing becoming more mainstream, the issue of who is allowed to perform such testing takes on even greater importance. That’s why its critically important that CMS receive feedback from as many knowledgeable industry personnel as possible.

To many lab professionals, CMS already went a step too far when it previously issued guidance decreeing that a bachelor’s degree in nursing is determined to be equivalent to a bachelor’s degree in biological science for purposes of the educational requirements for moderate and high complexity testing. Now the agency is seeking public comment on whether CLIA regulations should be modified (1) to expressly reflect that a nursing degree is equivalent to a biological science degree; or (2) to add nursing degrees as a separate qualifying degree to the current list of qualifying degrees.

The request for public comment (including evidence, research, and trends) appeared in the Federal Register last month with CMS seeking information in drafting proposals, in consultation with the Centers for Disease Control and Prevention (CDC), to update the existing CLIA regulations through future rule making. The agency is seeking input on the following specific CLIA areas:

1. Personnel and histocompatibility requirements;
2. Flexibility to impose alternative sanctions for labs issued a Certificate of Waiver (CoW) determined to have participated in proficiency testing (PT);
3. Appropriate sanctions in situations where it is determined that a lab has referred its PT samples to another lab and has reported the other lab’s result as their own;
4. Updating fees for determination of program compliance and additional fees for labs established under CLIA regulations;
5. Collecting other fees CMS is authorized to collect such as fees for revised certificates, post survey follow-up visits, complaint investigations, and activities related to imposition of sanctions; and
6. Other areas of CLIA which should be reviewed and potentially updated

Comments to are due by March 9 (refer to file code CMS-3326-NC) Electronic comments should be submitted to http://www.regulations.gov or send by regular mail to: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-3326-NC, P.O. Box 8016, Baltimore, MD 21244-8016.