This Week Health

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July 14, 2020: Big news today. We discuss CommonSpirit’s new partnership plus a major industry first, Walmart and Village MD have big plans to open almost 700 full service doctor's offices. We look at the Oliver Wyman paper on six future health system archetypes. And is digital health the leading future modality? Does that mean we all get our very own da Vinci in our homes? Tune in to find out as Bill breaks down each of the seven modalities, Urgent Care, Primary Care, Diagnostics and Pharmacy Specialty Care, Procedure and Surgeries, Acute Care, Post Acute Care and Navigation and Guidance.

Key Points:

  • CommonSpirit strikes partnership to offer direct-to-employer primary care [00:04:15
  • The most important aspect of your model should be technology agility [00:06:20
  • Why is Amazon feared in healthcare? [00:10:30
  • And why is Apple even in the conversation of healthcare? [00:10:35
  • Check out Bill’s List - the current rank order of how things get prioritized in healthcare. Do you agree with him? [00:13:55
  • Oliver Wyman’s paper about the six future health system archetypes [00:17:35
  • Is digital health the leading future modality? [00:23:45

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this Week in Health it. It's Tuesday Newsday where we look at the news which will impact health it today, Walmart, Walgreens, and Common Spirit make moves, and is it time for a digital only health system? My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

this episode and every episode since we started the C Ovid 19 series has been sponsored by Sirius Healthcare. Now that we are exiting the series, Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show's efforts during the crisis and beyond.

Don't forget, we've gone to three shows a week. Tuesday we cover the news Tuesday Newsday, which is today, and we have interviews with industry influencers on Wednesdays and Fridays. Sometimes you just have to stop and say thank you. And I want to thank everyone for your support of the show. We've eclipsed a hundred thousand podcast downloads through the first six months of this year, and that's an amazing accomplishment.

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So it's a subscription to help you to share the show with peers. See what happened during the Covid series was several CIOs said, look, I'm really busy. I, I, I really can't listen to all your podcasts. Can you just send me like something where I can skimm it, where I can just see what the high points are for each one?

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If you haven't signed up for three X Drex yet, you're missing out. Text Drex, DREX to 4 8 4 8 4 8, and receive three texts every week. With the stories that will help you to stay current. This is a, a service of Drexel Ford, a frequent. Contributor of the show, but not today. Today it's just me and we have a lot of stories to cover.

So actually I have about 14 stories here. I'm gonna get through five. I can almost tell you right now. I'm gonna get through five because it's, I, I'm gonna talk at fair length about some of these things. No telehealth stories today for the most part. But just a quick note, if you want the exceptions to continue in the funding to be made permanent, you're gonna wanna support chime advocacy with stories and data.

They have to make the case to Congress who is the only one that can fund these programs permanently. Uh, so if you are passionate about this and a lot of you are, reach out to Chime and to Mari and share the data and share the stories with them. I just wanted to make that clear. A lot of people are, you know, cheering and excited about the, uh, bipartisan

Things that are going on, there's still work to do to make that a reality. It's not just going to happen. It does require all of us to really, to step up and provide that team with the information. They're, they're in DC doing the things we want 'em to do for us. Uh, but they need information from you to make that a reality.

Alright, first story, common spirit. Strike's partnership to offer direct to employer primary care. This is Becker's story. Common Spirit announced June 24th that it is partnered with paladina Health to offer direct employer primary care and region served by Common Spirit through the partnership Chicago based Common Spirit, which.

Owns 137 hospitals, 21 states, you get the picture and Paladina WI will initially offer membership based primary care services through newly constructed clinics in Las Vegas, and then expand to other markets. Employers will pay a fee for each employee for primary care services. The employees can then access primary care without copays or out-of-pocket costs.

Uh, and it goes on, has a quote from Rich Roth who is, uh, vice President of Strategic Innovation for Common Spirit, who has yet to come on the show. And I'm trying to shame him into coming on the show 'cause I would love to have a, uh, conversation with Rich, who's a friend. I talked to him. Uh. Fair amount at, uh, conferences and whatnot.

He said, to keep our communities healthier, we need to increase access to care models focused on prevention and primary care access. Working in partnership with Paladina Health, common Spirit will support employers by developing direct to primary care options focused on access, affordability, health, and wellness.

As so what? This is a great move. I'm looking at business models that will scale into other markets. Uh, the barriers are coming down. New models are gonna allow for growth into new markets, and I'm looking for the health systems and companies that are being aggressive coming out of the covid, uh, crisis. I realize when I say coming out of the Covid crisis, what I mean is we're entering a new phase, uh, of, of Covid, and we're really coming out of this financial crisis that.

Is, uh, looming around healthcare and I, I'm, I'm looking for the organizations that are, are gonna fill the spaces that are left open by the less opportunistic health organizations. Chaos always provides opportunity for someone. It may as well be your health system, you know, from a health IT perspective.

What about this story? I, I'm gonna keep coming back to I, and I think it's gonna be a recurring theme over the next year, which is agility. Technology agility is the most important aspect of your model. The question becomes, can you go into a new market quickly, open up a new office, stand up new services, and actually we know you can.

I mean, we've just proven through C-O-V-I-D that you can and you can do it very quickly. What we need to do now as healthcare IT leaders is we need to make that a way of life. F right. We can't go back to, oh, that project's gonna take a year, three years, this kind of funding. We need to operate with that same agility we just did.

Uh, and that same focus we just did around a core set of projects that's gonna propel our health system forward and deliver better care in our communities. So that's the so what for that? We're gonna continue on this theme. This primary care thing is very interesting. So Walmart has been. Busy. So Walmart confirms a new avatar.

I'm not exactly sure what that's about, but it's also Walmart is also launching a health insurance agency. Uh, Walmart also diverged plans, divulged plans about healthcare super centers. Walmart also dove deeper into the pharmacy space with a, uh, partnership with APBM startup. So let me give you, uh, Walmart's been busy.

Right, so Walmart quietly launched a new health insurance business. The company called Walmart Insurance has filed with the Arkansas Secretary of State last month. Walmart is making it clear what an executive declared in the virtual conference that it is firmly in the healthcare business, not just retail healthcare.

Okay. They're firmly in the healthcare business, not just retail healthcare. And it looks like the new subsidiary will be focused on selling. Oh, so they're, they're talking about the new insurance product that's coming out. They're gonna be focused on Medicare Advantage plans. Uh, though the company was mom, when asked about additional details, the spokes woman's statement about the sale of insurance policies to our customers also leaves open the possibility of Walmart expanding its services beyond senior shoppers in the future.

Okay, so they're expanding into insurance. Second thing, separately, on Tuesday, Walmart announced that it struck a partnership with PBM Startup Capital rx, which provides health plans real-time information on prescription drug prices. Walmart has been a big player in pharmacy space for several years, and the company appears to be deepening that through this partnership everyday low price has been a guiding principle for Walmart.

We take pride in providing affordable prices to more than 160 million customers who shop Walmart each week. Walmart Health and Wellness, vice President Luke Klein, K-L-E-Y-N, said in a news release, working with Capital RX will allow us to do sa. The same for prescription drugs. And then finally, Walmart talks about their healthcare super centers.

Okay, so this isn't just the little clinic as you walk in the front door. This is, uh, much more extensive. We talked about this a little bit last year, but let me give you another, another glimpse into this. So the company says it's looking beyond traditional retail clinics as it seeks to create super centers with comprehensive healthcare services.

In the past few months, Walmart has been designing a different kind of Supercenter, one focused on healthcare. The company rolled out two Walmart Health clinics this month in Loganville, Georgia, in Springdale, Arkansas. and before you sort of look down your nose at that and say, oh, those are real rural places.

That's exactly how Walmart took over the world is they started rural and then they moved into the, into the center of the cities. So not to be taken lightly. These aren't your usual walk-in clinics that might serve as a quick place to get vaccinated or get a cold checked out. Rather, they're more like a one-stop shop for healthcare with primary care, urgent care diagnostics, x-rays, behavioral health and dental care.

Walmart's other big differentiator, differentiator. A primary care appointment costs just $40 and for children, $20. And then they, he goes, let's see, Walmart, president of Health and Wellness, Sean Slosky says, we didn't set out to disrupt healthcare. We set out to meet the needs of our customers at Walmart.

So what? . Walmart didn't set out to disrupt healthcare, but they are absolutely laying the groundwork for doing just that, uh, for health. It, what does this have to do? You know, how does Walmart do it? This is the question you have to ask yourself. How does Walmart do it? Why is Amazon feared in healthcare?

Why is Apple even in the conversation in healthcare? So in order to explain this, I'm gonna go to another story about Walmart. So Walmart had this massive intranet. And they talked about the, uh, the story I read was actually, it was a, uh, ad really for this Adobe marketplace, but for the most part it talked about how Walmart took these disparate intranets and turned 'em into a single intranet, right?

So today, one Walmart serves as a global community for over 2 million people. Whether at work or at home, any employee can access what they need to feel supported, informed, and armed to do their job effectively. And while having an intranet with a good reputation amongst his workforce. amongst the workforce is an important asset for any company.

It becomes a, it becomes vitals in, in times of crisis one, Walmart was built with the same regard for customer experience as any external property. Let me say that again. One, Walmart was built with the same regard for customer experience as any external property. For starters, it was personalized based on the nature of an employee's role.

Important for a company that, that employs everyone from store associates and data scientists to mechanics and marketers. Each of these people have a unique need when they log on, and the intranet has the ability to recognize that it can also shift the experience to, to fulfill a request that happens on the clock versus occurring at home.

You know? So what's the, what's the, so one around this, build your services with the consumer in mind. Build loyalty, build fans to do anything less is really wasting time. Eventually, people will have a choice and when they do have a choice, they're gonna choose the brand. They're gonna choose the service based on their own self-interest.

Right. And sometimes that's gonna be financially driven. I want the lowest cost. Sometimes it's gonna be convenience driven. I want somebody that's gonna be open on the hours where I need to be, you know, to have the service delivered. And sometimes it's gonna be based on quality, but always through the lens of what does it do for me, the consumer.

I. now. Now, you know these are really huge moves by Walmart, and that is really what we should expect in these times from well-funded customer-centric organizations. They're gonna take the opportunity to move aggressively into healthcare. And if you think I'm kidding, next story, Walgreens and Village MD to open up 500 to 700 full service doctors offices within the next five years in a major industry.

First. Business wire article, the expanded partnership will open five to 700 village medicals. Village Medical at Walgreens, physician led primary care clinics and more than 30 US markets. In the next five years with the intent to build hundreds more thereafter, the clinics will uniquely integrate the pharmacists as a critical member of the Village MD's multidisciplinary team to deliver the very best healthcare to patients, and will be staffed by more than 3,600 primary care providers who will be recruited by Village md.

What's the so what on this primary care is under assault. Okay. I mean, you see that these stories are just, it's under assault. Why is it under assault? It's a classic disintermediation strategy. Those who control this consumer and their behaviors actually control the spend. So they're trying to control the spend of healthcare.

This is why it's imperative that you are constantly upgrading your consumer experience. I was asked this week, and I'll throw this out as an aside. I was asked this week if I thought the consumer was a reason that a health system would select a specific technology, and I placed it at number seven on my list of reasons they would select a technology.

And, uh, I'm gonna throw out my list and I wanna see if you agree with me. Here's my rank order of how things get prioritized in healthcare, at least technology decisions, right? So the first is to a, avoid a public failure or revenue disruption. And there's plenty of these stories around anytime you see a health system on the front page of a newspaper with a public failure or revenue disruption, an EHR that went

You know, implementation that went bad a, a breach. So that's number priority. Number one, avoid public failure or revenue disruption. Number two, physicians are upset, right? Can't tell you the number of times I've heard, Hey, this physician set of physicians comm, this community of physicians is upset. We need to take care of that new functionality that drives material revenue, right?

If you can drive material revenue with the implementation of technology, that's gonna be prioritized. Not number one or two, number three, uh, number four, you know, the avoiding, avoiding pain is more of a driver than actually, you know, than, than actually getting more revenue. It's, it's kind of interesting.

Number four, I said, we can save money. , right? So if you have an ROI that's less than a year, that's gonna be something that gets prioritized. Uh, the next is nurses and other clinicians are upset different categories than physicians. Unfortunately, it's true if there's a group of physicians that are upset, they are more tied to the revenue stream.

So we take care of them. But not to be minimized. The nurses and the other clinicians are a group that you absolutely need to keep happy and therefore that gets prioritized. What's next? We can be more secure and reliable. That's right. Security is 1, 2, 3, 4, 5 is number six on the list. And number seven on the list.

I put patient experience. Okay, so that's my, that's my left list and that was off the cuff. I'm a little overworked right now, so I may be a little more cynical than usual. But I'm curious if you think the patient or consumer experience would rank above these six items. Okay, so the six items avoid public failure, physician groups that are upset, new functionality that drives material revenue, saving money for the health system nurses and a, a group of nurses or clinicians that are upset about something, we can be more secure, reliable.

Do you think the patient experience ranks above any of those and do you think there's others that might even rank above that when you're selecting technology? Let me know. Shoot me a note. Bill at this week, health . That was, that was a tangent. The So what if, just to focus the, so what is focus on your consumers or Walmart, Walgreens and CVS are gonna end up being your consumer.

They're gonna send patients to you and you're gonna pay them. Uh, as is gonna be the case with Walmart. They're gonna become a payer. So they're gonna have insurance and they're gonna start directing, uh, the care of their people, and they're gonna direct them to the lowest cost, highest quality. That's what Walmart's all about.

So you, you know, I still remember, I, I had a consulting, uh, organization that I was a vice president for. We had, we had about 2,800 engineers across the country. And our largest clients, our three largest clients, were essentially other consulting practices. Okay. So it, it's, it's, this is a, essentially what's gonna happen is they're gonna be delivering care in your, some of your largest clients.

Some of your, some of these health systems that are listening to this right now, your largest clients are gonna end up being, uh, those players. It's gonna be the, the, the Walmarts and, and others of the world. All right, here's a, uh, story. I think this is a probably one of the most fascinating pieces that I've read in a while.

Is it time for a digital only health system? This is actually an Oliver Wyman article just on their website, and this is a pretty long one, so I'll probably, I'll probably end with this one. I could go, I might go into another story, but we'll, we'll see where we're at when we get to the end. In 1989, a new type of bank called First Direct launched in the United Kingdom.

Okay, 1989, having no branches, tellers, or any customer facing physical presence. While automatic teller machines have been in wide use since the early eighties, it was once common to call the bank's call center for some everyday banking needs. The idea of never setting foot in a physical branch was revolutionary for most customers at the time.

Most banks used the TE Telebank to indicate a special way to interact with them outside the normal flow of physical interaction in the local branch. In fact, one of the first fully functional direct banks in the US was named Telebank. . Fast forward. Lemme get some water. Fast forward to 2020, and the line between conventional and direct banks has blurred and the term telebank has fallen out of use today.

A non-physical access mode, be it phone, mobile, web is the first choice for most consumers when it comes to their banking needs. We don't need telebank because that is now the default. Gonna take a drink, gimme a second.

So I've heard this story or a similar stories used over and over again, and I've heard it, I've heard, uh, clinicians and others sort of debunk this and say, healthcare is very different. It's a very physical activity. And while aspects of healthcare are very physical, it's interesting to see what happened over the last four months.

So two years ago, Oliver Wyman wrote a paper about the six Future health system archetypes. . Right. And the the six archetypes are scale and efficiency leader, and that is they create affordable, regional and national health solutions with an innovative operating model in corporate center. Okay, so that's some of the stuff we just talked about with Walmart.

That's what they're aiming to do. And, and Walgreens is also aiming to do that as are others. Experience and access leader, right? Offer personalized health experiences to meet a unique patient needs. And they gave, uh, because it's organized around the experience they gave the example of a Delta or Starbucks, it's a more personal experience, a specialized portfolio manager.

These are portfolio asset managers, uh, deploying the most appropriate type . To each market and as their, as their example organizations, they gave Unilever and Procter and Gamble. These are brands that you don't see on the, uh, marquee, but they're brands that, uh, control a lot of assets, move a lot of assets around, and deliver a lot of services.

The next is clinical leader, develop and monetize innovative treatment technologies and training. You know, we talked about this a bunch at, uh. At the JP Morgan conference that there's a bunch of, uh, especially academic medical centers really starting to position themselves in these, in these areas where if you want this kind of treatment, this kind of special genetic treatment and those kind of things, this is the place to go.

Just get on a plane and go there. That's where you want to go for that kind of treatment. And we're seeing, we're seeing that sort of take place. And they, the clinical leader, they gave two companies, Tesla and Apple as sort of their example. I'm sure I understand that one. Population health manager own and manage risk for a total cost of care.

And they, they gave GE and Siemens as an example. I'm not sure about that one either. And then non-hospital system, and this is the one we're talking about here, divested IP care to focus on ambulatory, digital and retail offerings. Right? And they talked about like Charles Schwab, it being this one, but the last concept, the non-hospital system was the one, it's safe to say

We considered at the time to be the least likely the bunch to come true. Yet, as industries around the world from renowned coffee chains to major airlines, layoff workers file for bankruptcy and essentially collapse under c Ovid nineteen's weight, we now realize that the non-hospital system model is perhaps the last one of these six standing.

Think about that. I mean, and, and we've seen it. Right. At least during the, the peak of covid, if you were, if you were designed more like a telebank type model, you had ways to continue to deliver on your business model, much like Amazon does, but Macy's does not. You get that picture. So the, so you know, why is that?

Why is the non-hospital system still standing? The first reason they give is the rapid acceleration of Covid 19 provided to virtual care adoption in recent months. In the period of three to four months, we've seen digital care adoption increase mirror a decade's worth of innovation, which is really true.

The second reason, and less visible than the above, but equally important is payers increased demand for full service integrated digital care solutions. Post Covid Ovid, 19 more payers are looking into the space to address an expected surge in demand for low cost health coverage options by employers tightening their belts.

Or new unemployed consumers. So far though, there is a dearth of comprehensive digital care solutions that payers can use to create a robust delivery network. And we talked about this a couple weeks ago, that what the payers are gonna do is they're gonna start creating digital only solutions. Digital only payer, uh uh, bundles.

That you're gonna be able to buy. But in order to do that, me as the consumer, as a, uh, small business owner, I'm gonna have to agree that, you know, the first visit is gonna be, the first visit is going to be a, uh, a telehealth visit and follow up visits. And certain they're, they're going to, they're going to dictate what kind of, what kind of modality I actually am able to use moving forward.

So that's the second reason, you know, so . They go on to talk about, and I, again, this is a great article if you get a chance to take a look at it. Uh, is Digital health the leading future modality? And then they go through, let's see, seven modalities, okay? Urgent care, primary care, diagnostics, and pharmacy, specialty care, procedure and surgeries, acute post-acute care, uh, navigation and guidance.

And they talk about each one in the context of telehealth. Give you an example. Urgent care. Uh, this is perhaps the best known use case for digital care today, popularized by innovations such as Amwell, Teladoc, and others. Urgent care includes the basic, often transactional care designed to solve low level acute need with traditional challenges of remote diagnostics falling away.

The new connected device is a digital modality for this use case is becoming more prevalent. We know that. Primary care In contrast to urgent care's transactional nature, primary care is about longitudinal provider, patient relationships, and holistic health management. There are critical elements that would remain, would likely retain their importance, particularly for a subset of older, sicker patient populations.

Still, as recent experience SH has shown the vast majority of visits can be performed digitally in various synchronous phone. . Video or asynchronous modes, even though these high need popul, even for these high need populations, right? Uh, they talk about diagnostics and pharmacy. While the use use case generates significant economic value for health systems today, there's a limited need for a digital oriented health system to own these assets.

Patients can be referred to and scheduled for local operators for imaging studies, specimen collection, and, and the like. Specialty care. Another modality. The office-based portion of non procedural surgical specialty care is another case where most services can be and often have been delivered digitally.

A direct physical examination is needed prior to a decision for a surgical procedure and therefore a small physical. Footprint will be needed. However, the pre-screening of patients for elected surgery, especially those cases such as back surgery where a substantial number of patients may not wish to have surgery can be done remotely.

So they even talk about that modality and its digital possibilities, procedures, and surgeries on the surface, this use case is the most challenging to deliver digitally. And I'm sure right now what you're thinking is, oh yeah, we're gonna put a da Vinci in the home and a physician. No, we're not gonna do that while the, while the care needs to be delivered physically, many services are technical, procedural in nature, and thus lend themselves well to subcontracting with local operators.

In the same vein as imaging studies, this includes services where the specialist presence is not required such as infusion or even those where the procedure is becoming a commodity. And given a satisfactory level of quality and safety, keep in mind they're talking about is it possible to have a digital only health system that outsources services?

Alright, so acute and post-acute care, despite the above, there will be times when acute care settings, whether emergent or post-surgical need will be required. Absolutely. However, as large multi-specialty physician groups, . Have been demonstrating for years, it is possible to nurture long-term patient relationships, including the occasional hospital stay without operating one.

Okay, and then go on to talk about where digital falls into that navigation and guidance. A health system, not spending mind, share, and capital in managing vast and depreciating fiscal access. . Assets can devote attention to building a sophisticated and consumer friendly care experience and actively support the patient along their care, their health journey.

Uh, so navigation and guidance clearly can be digital. In summary, a digital, he, a digital oriented health system, can meet the needs of its patients with limited to no owned fiscal assets. Can you imagine that a digital oriented health system can meet the needs of its patients with limited ? To no own physical assets.

When physical care is required, it can be sourced locally from operators. The key deciding factor whether to own any local talent in a market will be whether the system wants to be physically intense, episodes of care where specialists are forming strong patient relationships over a period of time with patients.

You know, I, if nothing else, this is really thought provoking. . And if I were the CEO of a health system, I would probably be asking these people to come in, uh, to speak with me. The so what And, uh, I'm gonna take this back to an existing health system today. The so what is that? Models for care are changing all around us, and we should be reexamining our models for care, not sprinting back to the models of care that we had in December of last year.

So what C-I-O-C-M-I-O and CMO should be in lockstep right now. Around telehealth, tele telemedicine and virtual care, collect the data, evaluate your system readiness, tear apart existing workflows, and put 'em back together with the new lens, with a new reality in mind. Telemedicine is here to stay. Yes.

The number of visits is, is going down right now, and so that's gonna give you the indication that it's not gonna, it's not gonna stick, but it is gonna stick and it's gonna go into a lot of different models. You know, it's the other thing to keep in mind that as these visits go down, that's an indication that we have not given this intelligent design.

We responded to a problem, but we haven't given it intelligent design. If you want to change a model, change the culture. You have to do more, uh, than just provide the technology and the funding. You have to do the work of changing behavior, and that requires a plan. Build the case, tell the stories, move towards the future of health.

Uh, this is a great read. I highly recommend it. Oliver Wyman website. You could also hit our website. We'll have a link to this story as well. Uh, great story, very thought provoking. If nothing else, have your, your team, your leadership team, read it and then discuss it. See if you agree. See if there's areas where you, your health system could potentially, uh, change or adapt and start to fill gaps before someone else steps in and starts to fill those gaps.

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