When you think of the Big Tech giants moving into health care, you probably think of Amazon, Google, Apple, and IBM—companies that have made clear they want to dramatically change the way America provides health care.

Dec. 5 webinar: What 'Google Health' will look like in 5 years

But a sleeping tech giant may be waiting in the wings. After a few tentative, not-entirely-successful stabs at health care in past years, Microsoft is once again aiming to take on the industry, securing high-profile deals with the likes of Humana, Novartis, UCLA Health, and Providence St. Joseph.

But will Microsoft be successful in its new strategy? And, if so, what will it mean for health care? Let's dive into the company's four big health care bets to learn more.

1. Microsoft wants to dethrone Amazon as health care's cloud provider of choice

As health systems face a need for increased data capacity and enhanced cybersecurity, they're increasingly moving their data storage off their premises and into the cloud. Health care companies are projected to spend $11.4 billion on cloud computing in 2019—making it extremely lucrative market for Big Tech to enter.

Amazon has dominated the cloud market since it first began offering services in 2006, and its platform, AWS, still owns a 48% share of the $32.4 billion market worldwide. With a 15.5% share, Microsoft's Azure cloud comes in a distant second, but it's been gaining ground—with more than 60% growth from 2017 through 2018. While Amazon still offers the greatest depth of cloud products, Microsoft has been rushing to introduce similarly cutting-edge offerings, including machine learning, Internet of Things (IoT) features, and server-less computing to their arsenal.

And health care-specific services have been a major component of Microsoft's strategy. Through its new Microsoft Healthcare team, the company is following a "blueprint" aimed at securely bringing more health data to the cloud and creating services to process that information in new ways, according to Peter Lee, head of Microsoft Healthcare

This push has resulted in the release of new tools such as a Healthcare Bot, which aims to facilitate the creation and use of conversational health assistants powered by artificial intelligence (AI). The tool already counts Quest Diagnostics, Kaiser Permanente, Premera Blue Cross, Children's Healthcare of Atlanta, and others as users. Microsoft has also introduced an Azure application programming interface (API) which uses fast healthcare interoperability resource (FHIR) standards to allow the secure transfer of data—and enables all Azure users to harness protected health information (PHI) in new ways.  

Microsoft clearly hopes that these products will help it edge out AWS in gaining more cloud contracts. And it has reasons to be hopeful. Its longstanding collaboration with Epic—and the fact that Epic is relying on Azure for many of its AI offerings—gives Microsoft a solid leg up. Microsoft also benefits from existing relationships with many health systems that use its Windows operating system and its business tools such as Office 365. Microsoft has also been shifting its workforce to prioritize cloud sales, and it seems to be working: In July, CFO Amy Hood noted that "In FY 2019, [Microsoft] closed a record number of multi-million-dollar commercial cloud agreements with a material growth in the number of $10 million-plus Azure agreements."

In the health care industry, partners these major deals include providers such as Mount Sinai, Providence St. Joseph Health, City of Hope, Cincinnati Children's, and Promedica Innovations; industry players such as Stryker, Siemens Healthineers, Roche, and GE; and other major health care organizations such as Teladoc and Walgreens.

2. Microsoft wants to be seen as providers' partner—not a competitive threat

One notable aspect of Microsoft's strategy is the way it presents itself to potential partners. Consider its relationship with one of its newest and most high-profile provider partners:  Providence St. Joseph.

As announced this past July, Providence will work with Microsoft in a multi-year strategic alliance which will shift data and applications from the 51-hospital system to Azure cloud and provide Providence's 119,000 doctors access to Microsoft Office productivity software and collaboration tools. Microsoft also will work with Providence to turn an existing Seattle facility into a "hospital of the future"—retrofitting it with technology such as natural language processing (NLP) and machine learning tools.

But while other Big Tech companies are tiptoeing into the direct provision of health care (consider Apple's launch of its own employee health clinics, or Amazon's acquisition of PillPack), Microsoft is presenting itself as a friendlier, less competitive partner. As Providence CEO Rod Hochman said in announcing the deal, he chose Microsoft over Google, Apple, and Amazon because it's not "trying to do health care."

He added, "[Microsoft isn't] trying to be in the health-care business, but [is] trying to make it better."

Further, unlike other Big Tech companies, Microsoft has been willing to share the spotlight when products launch. For instance, Microsoft has partnered with UPMC on a number of projects, including creating three new "digital" hospitals—the first of which is expected to open in 2020. Through the partnership, Microsoft has been willing to give credit for joint projects in exchange for the opportunity to test and pilot the projects at the health system. "Microsoft has technology tools they're very anxious to deploy in health care, and to the extent that they can come to UPMC and UPMC can be what we call 'customer zero' for these products, they think it's a huge benefit to them," said Tal Heppenstall, president of UPMC Enterprises.

3. Microsoft wants to use AI to make health care better

If there's one area of health care where Microsoft's aspirations are higher, it's in the emerging field of AI.

For instance, the company recently announced a deal with UCLA Health, through which UCLA will rely on Azure not only to store its vast health data but also to help analyze it quickly. UCLA is hoping it can aggregate data from a variety of sources, analyze it to tailor care to the individual, and, eventually, harness it to prevent disease.

One of UCLA's first goals is to implement an algorithm that aims to predict when a hospitalized patient's condition is at risk of deteriorating. "The integration of information from structured data, like lab results and medication information, with unstructured data, like documentation, genomics and medical images, creates an incredibly powerful big-data learning platform for discovery," said Michael Pfeffer, CIO for UCLA Health Sciences.

Another use case for Microsoft's AI tools involves a recently announced five-year partnership with Novartis. One of the major projects is called Data42, which will mine two million patient years of clinical data from hundreds of studies completed over the past two decades to try to uncover new insights. Another project will use deep learning to advance the speed and precision with which the pharmaceutical company develops new medicines. Novartis is hoping that using Microsoft's AI can speed up the drug discovery process—which currently takes an average of 14 years and up to $2.5 billion—while differentiating the organization from its rivals.

Microsoft is also employing AI to meet provider's other challenges. For instance, the company is working with Nuance Communications, a software company, to revamp hospital exam rooms with AI and NLP. The partners aim to create a system that will listen in on patients' visits and automatically create a document in the EHR, which the doctor can later review and edit. Microsoft is also collaborating with SilverCloud to deliver evidence-based mental health treatment using AI, and investing in several clinical applications for AI, including Project Inner Eye, which can help oncologists tailor treatment, and Project Hanover, which aims to advance precision cancer therapy.

However, it's worth noting that none of these AI projects are that unique from what other Big Tech companies are trying. Amazon is also looking to improve the EHR through AI and NLP, and Google is similarly partnering with pharmaceutical companies to use AI for drug discovery and pursuing clinical AI applications. So although the potential for AI in health can feel boundless, it may quickly be becoming a red-ocean market.  

4. Microsoft wants to help health care professionals talk to each other—and their patients

Even as Microsoft invests in building faster and better AI algorithms, it's not losing sight of the human dimension of health care. In fact, one of its core ambitions is to help health care professionals talk to each other and their patients.

One of Microsoft's major offerings is its Teams platform, which offers secure messaging, a patient care coordination hub, an audio-visual conference and meeting platform, and a workflow streamlining tool. The tool is built to enable HIPAA compliance and can connect with the EHR to collate patient information.

According to Emma Williams, corporate VP of modern workplace verticals at Microsoft, "more than 500,000 organizations, including 91 of the Fortune 100 and many of the most innovative health care providers, are empowering their employees with Microsoft 365 and Teams." How many are actively using Teams is, however, unclear.

Still, Microsoft touts providers such as St. Luke's University Health Network for illustrating how health care organizations can use Teams. As envisioned by St. Luke's CIO Chad Brisendine, "Clinicians will carry a smartphone loaded with the mobile app to accelerate communication … quickly in a 'digital huddle,' [which] will expedite their decisions on treatment protocols, improving health outcomes for patients."

The result, according to Brisendine? "[C]linicians will spend less time navigating different systems and more time with their patients."

Microsoft's ambitions extend beyond the provider sphere. In October, it announced a partnership with Humana aimed at improving communication for 41,600 Humana employees and the company's beneficiaries. Humana employees can use the Teams platform, according to the press release, to "assist members, to centrally manage and securely share patient interaction history and files, and to communicate by chat and voice with care team members and health plan administrators to improve quality of care." Notably, the partnership also aims to develop on-demand and virtual medical services for beneficiaries, including on-demand telemedicine services and predictive member care powered by voice technology.

Can Microsoft succeed?

What's most striking in reviewing this list of Microsoft's high-profile health care deals is how many were announced this year or last. Clearly, Microsoft's strategic turn toward enterprise deals is paying off—even as it continues to present itself as a non-threatening partner to health care organizations.

But Microsoft will not have an easy road to success. Amazon and Google are making similar plays with cloud storage and industry partnerships, and these younger companies have a reputation for moving more quickly—and adapting more easily—than the more bureaucratic Microsoft. Plus, while Microsoft boasts a few leaders with health care expertise—such as Jim Weinstein, the former CEO of Dartmouth-Hitchcock Health System, and Joshua Mandel, who led many health efforts at Google—the company doesn't have as deep a bench of industry experts as Google, nor as much money to hire them as Amazon.

Still, with health care's AI market expected to grow to $6.6 billion by 2021, and plenty of growth potential in other areas of health technology, the pie may be large enough for all these Big Tech players to share.