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Episode 213
July 16, 2021

Walmart Health and the Consumerization Healthcare

Marcus Osborne, Vice President of Walmart Health joins the show to talk about consumerization healthcare, omnichannel experiences in healthcare, and what Walmart is doing to make healthcare more accessible and affordable for all.

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this episode sponsored by

The “84-Point Check”, but Make it Human

  • With almost a million and a half associates in the United States and 150 million customers in stores and online, it's safe to say they’re one of the largest retailers in the world. But what are they doing in health? A lot, it seems.
  • Walmart has been in the healthcare world since the 70s; they realize that they have a significant role to play. With 90% of Americans living within 15 miles of a Walmart, they’re aiming to address the care needs of people and help get access to basic healthcare in an affordable way.
  • “How do you engage customers in healthcare? … By building robust omnichannel experiences that aren't about one channel but are about how all these various channels can come together to create something far more robust.” -Marcus
  • With omnichannel systems coming online in healthcare it’s providing more opportunities for personal monitoring systems, taking a proactive approach to healthcare. 
  • You take your car to the shop and get an 84 point check on maintenance; why not an 84 point check on humans? “I'm not looking for one size fits all. I'm looking for a solution that is one size fits one.” -Marcus.  This approach brings a personalized experience for every person, creating a revolution of diagnostics. 
  • Not only is healthcare being affordable broken, but also the speed of care. Patients have to go through multiple doctors, specialists, and tests to get the answers they need weeks later, while also not knowing how much it will cost them in the end. This revolution of diagnostics will ultimately result in a more efficient healthcare system that most Americans can afford. 
  • COVID helped accelerate healthcare as we know it today, showing us that speed of care can happen. If it can happen in an omnichannel or a parking lot, then it can happen in the office as well. 
  • “We as consumers deserve to be treated better than the system has treated us, and we deserve to have more access. We deserve to have things be more convenient and we deserve to be treated better and have things be simpler.” -Marcus
  • Walmart Health is on the road to greater access for all Americans. One of the ways they're doing that is by looking at the communities with greater demand, a net health need. This method is what has driven them to open in cities in Georgia, Illinois, and more.
  • A consumer and a patient are one in the same. Consumers want high quality, for things to be affordable, convenient, simple, and they want a choice. Patients want all the same things. 

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Brian: [00:01:52] Hello and welcome to Future Commerce, the podcast about next generation commerce. I'm Brian.

Phillip: [00:01:58] I'm Phillip. And today we have a very special guest, Vice President of Walmart Health. Mr. Marcus Osborne is joining us on the show. And welcome to the show, Marcus.

Marcus: [00:02:07] Thanks for having me.

Phillip: [00:02:10] I don't have the numbers right in front of me. Walmart. Hey, everybody knows Walmart, right? One of the largest retailers in the world, largest employer doing amazing things and transformative things in retail. What are you doing in Health?

Marcus: [00:02:23] Well, yeah, and maybe I'll give you some of the facts and figures. I think it's worthwhile.

Phillip: [00:02:28] Yeah. I think it is.

Marcus: [00:02:28] I mean, you mentioned that we're blessed to have, depending, call it one hundred and forty, hundred and fifty million customers in the US who still come into our stores and then, you know and many more who are engaging with us digitally and some both. We do have almost a million and half associates in the US. And so I think you ask the question, what are we doing in Health? It's on one hand, it's a business that we've been in for a while. We've been in the pharmacy business since the late 70s, and we've had vision centers since the early 80s. And you think about selling direct to consumer healthcare  solutions, OTC items, vitamins and supplements. And, you know, it's an enormous business for us. But I would say we can only step back from this question about Walmart in Health. You know, we would say we've always been in it. I think it's recognizing that we have a bigger role to play. And particularly when you think about we're the largest food retailer in the US. We sell more bikes than anybody in the US. So when we think about our impact on the health of Americans, we have a very significant role. But specifically what I'm focused on with the Walmart Health business is to say, how can we also do more in terms of addressing the care needs of people? And what we know is for a number of reasons, that Americans are struggling to get access to basic care, to get access to the basic services they need. And a lot of that's driven by a lack of affordability. The cost is too expensive. The lack of accessibility and convenience, the complexity of the system. And so what really Walmart Health is about is us saying how can we also do more to address the care delivery needs and the healthcare  services needs of our customers. And so Walmart Health, the venture and the business itself actually represents a number of things. But one of the first parts of it is us opening these new centers that bring together a full array of services, primary care and lab and imaging and mental health services and physical therapy and dental and vision and hearing services and other services. But bring them together all into one setting, make them really easy to access, make it affordable. So we take insurance, but if you don't have insurance, we deliver things on a cash basis at very low prices so that everybody can afford it. And so that's really what we're about more broadly is how can we, using the platform that we have, help our customers and help actually all Americans get access to the care they need? And that's really what Walmart Health is about.

Phillip: [00:05:27] I mean, something to the tune of 90 percent of Americans live within 15 miles of a Walmart.

Marcus: [00:05:33] Yup.

Phillip: [00:05:33] So, I mean, if anyone's position to bring more equitable access to healthcare , it's you guys.

Brian: [00:05:38] I'm so excited by this whole concept, just even personally. I find this to be just utterly compelling. I have four kids as many of our listeners know, and oftentimes... They're all boys. And it's often that I'm like, I wish there was more that I could do at Walmart Health, because I feel like there is an opportunity here that you've correctly identified to bring healthcare  in an affordable way to Americans. How much of your customer base benefits from Walmart Health right now?

Marcus: [00:06:18] As we think about the services we deliver, we operate thousands of super centers today in the US. And I think in total, if you include our Walmart stores and our Neighborhood Markets and our Sam's Club, that's over 5000 locations in the US. The Walmart Health infrastructure, we just launched those first sites less than two years ago. And so we have gotten big in places like Georgia. Florida is the next big market for us. We're in other states like Illinois and Arkansas and a smaller presence with some just primary care presence in Texas. So we've got a ways to go before we kind of reach the scale of Walmart across the US. But, you know, what we're trying to build is something that enables us, a platform and a capability, that enables us to help people get care in the communities where they are. So we're nowhere near that kind of Walmart US scale in terms of its reach that you kind of mentioned earlier, just in a few markets and still need... But I think what we're trying to build is a platform that enables us to get there. And I should note it's not even so much about these physical centers. We recently just completed a transaction, an acquisition of a company called MeMD, which is a group who is providing telehealth services primarily kind of to employers and to the employees of these enterprises. And this is a group who is doing primary care and behavioral health and other kind of health services virtually. And for us, that's the idea of bringing that platform as part of the overall Walmart Health omnichannel offering is really compelling because, again, it's about 1) enabling us to reach more people and do it faster, but 2) enabling us even in those communities where we have physical sites of care to reach people the way they want to be reached and not dictate to them how they get care, but say, "We want to give you options and you choose the best path for you." And so I think what we're in, is in a growth and scale mode. So it's certainly an exciting time for us.

Phillip: [00:08:34] You and I spoke on a panel that was addressing the benefits or maybe the hidden downsides of the consumerization of healthcare . We spoke together at HIMSS earlier this year. I thought you had a really balanced approach on sort of this idea of what consumerization of healthcare  even means. Telehealth certainly is something that comes up a lot when you talk about like the digitization of the relationship between the care provider and patient. Does this acquisition sort of rece nter what the Walmart health relationship is like with the patient? Or does this, like, fit more squarely into how you'd envisioned it all along?

Marcus: [00:09:22] No, no, I think it envisions how we sort of thought about it all along. And you use the kind of word "consumerization" in healthcare  and has talked a lot about in healthcare . And I'll honestly tell you, in some ways, I find that kind of term funny. And the reason why I find it funny is by implication, what that implies and when people talk about that, what it implies that by its very nature, the healthcare  sector, healthcare  industry isn't a consumer business, and what I like to say is healthcare  and healthcare  delivery in the US is as much a consumer business as a retail is a consumer business. No one talks about the consumerization of retail because that's almost kind of an absurd thing. Well, at the end of the day, healthcare  is about an individual or a family getting the care they need so they can have more control over their health and live healthier lives. And so for us, that's really the [00:10:36] ambition. It's not so much about driving consumerization in healthcare . It's about saying that healthcare  is and always has been about the consumer. We've just done a really bad job as a sector, in industry in the United States, of understanding that. And our challenge then is how do you actually bring forward solutions that fundamentally represent that reality, that the consumer is in the center of the sector? They have always been the center of this industry. [00:11:03] That it's our job as providers, as health insurer payers, as the product guys, Pharma and device manufacturers, to serve the consumer. And so to your specific question about MeMD, we also view the world, and I would say this is very much influenced by the work that we have going on the retail side, we view the world through the lens that all things are omnichannel. And what what I mean by that term omnichannel... People often confuse it with multichannel. Multichannel means do you have multiple channels of access? So in healthcare  it means do you have physical sites and centers? Do use telehealth? Do you use digital health? Meaning AI driven solutions. Do you have care in the home solutions? Omnichannel is actually about creating experiences and where you have all those channels, but the channels start to integrate and work together in a way that allows consumers to create wholly new experiences that no one channel by itself could deliver. And I think for us that's always been the vision. I would say that in many ways, personally, I'm surprised that the healthcare  sector hasn't, that groups who deliver care, haven't kind of moved faster into addressing and delivering omnichannel solutions. But I think for us, what the MeMD acquisition was about was just the representation of what we've always believed is that the very best solutions, if you want to engage consumers, if you want to, particularly in healthcare , if you want to have them feel like they have control of their health, be more engaged in their health and produce better outcomes, the way you're going to do that is by building robust omnichannel experiences that aren't about one channel, but are about how all these various channels can come together to create something far more robust.

Brian: [00:12:53] I think, to that end. So, I mean, you mentioned telehealth as a way to sort of add to that omnichannel experience. Right? So now we can connect digitally over health and the way that we can engage in care can be done in multiple different ways. I also think about innovation in sort of monitoring. And it's something that we've talked about a lot on this show is sort of body data that we can gather now. And it's getting better and better all the time. And I think about all the different bands that are out there and the different watches and the different systems. You've just acquired into telehealth. As we think about retail and how consumers and brands interact with each other, sort of as a relationship, there's a lot of, you know, what I would consider sort of push activity and there's a lot of pull activity as well. But in healthcare , it almost always feels like the patient is coming to the provider and saying, "I have something that feels wrong," or whatever. There's a lot less of a proactive behavior of the provider reaching out to the patient saying, "Oh, we recognize something is happening." Or "There's this next step in your preventative care," or whatever it is. And so with new systems coming online and the ability to do telehealth, do you see opportunities with personal monitoring systems for a more sort of a proactive approach to healthcare ? Or am I jumping too far ahead right now?

Marcus: [00:14:51] No, I see enormous opportunities. In fact, I sort of talk about that I think one of the... As you think about the value chain and how people are engaging in care, that one of the failure points in my mind is that we've told people that the only way you can kind of assess your health is by going to these places that also have the people who treat you. So in other words, and a lot of times people are like "I don't understand why you're talking about." Well think about that. Think about how you care for your car today, your automobile. That would be like saying for you to understand the overall kind of performance and health of your vehicle that the only way you can do that is by taking it to a mechanic. And I think we all sort of know 1) mechanics are expensive, 2) They're generally in short supply. And so they're supply constrained, and there's other sort of challenges there. So instead, what we've actually built in the United States beyond there being much more robust monitoring and intelligence built into your vehicle, that's assessing real time the health of your vehicle, we also have these beautiful things like Jiffy Lube and Valvoline centers and Walmart auto care centers and others that you come in and you get your oil change and your tires rotated. But they also do not do, and I was sort of laughing the other day... I went into a center and they did an eighty four point check. So that's eighty four points of testing, assessment, and diagnostics that they did. And I kind of laughed. The reason I laughed is I sure like that as a human right?

Brian: [00:16:31] Mmm.

Phillip: [00:16:31] Mmm.

Marcus: [00:16:31] And so the good news is I think we're already moving there and you sort of started to go there. You think about I mean, kudos to Apple. You look at how much the transformation is occurring on that watch and its capability in terms of monitoring. It's no longer just pulse, but EKG and you're looking at so I imagine the next over the next three to five years, there's a wildly innovative roadmap there, not just with them, but other groups of these sort of devices that touch or that are near your phone and other things that are going to enable you to kind of better monitor. I look at things like all the kind of connected home devices, the next generations of Nests. Nest Thermostats aren't just going to be about managing temperature in a home, but they're going to be able to monitor movement in the home. So if you want to know whether your mom got up and got out of bed, your eighty two year old mom got out of bed this morning, you'll know. If you want to know what potentially the temperature of people in the home is and whether there's changes in temperature, you'll know. So a lot of the connected devices are increasingly kind of adding features that are health related. We're actually seeing, and a lot of people aren't talking about it as much as they should, not just innovation, but a real revolution in lab and diagnostic solutions that are going to make the kind of more traditional lab testing much easier to access, much more ubiquitous, much lower cost, even the obvious things. Like look at how many people have done genetic testing over the last three or four years simply because of the rise of groups like 23 and Me and

Phillip: [00:18:23] Yeah.

Marcus: [00:18:23] The funnel effect is there are cars being built where you have your hand on the steering wheel and the car is monitoring your health, not just its health, so that is becoming more and more pervasive. And when you think about that, what that's really going to do is exactly what you describe. It's going to create a much more intelligent, aware front end. So we're going to be able to identify individuals who have issues or risks sooner and then that connects to the system and says, I'm going to help guide you to given what I've identified that risk, I'm going to help guide you to where what's the best path to get the care you need to address the risk to kind of put down that risk so that you can you can stay healthier, longer. So put differently, I think we may not see it, but we're kind of coming to our own human equivalent of the eighty four point check that we've been doing for our cars for years.

Brian: [00:19:20] Except for it's real time. And it's from home.

Marcus: [00:19:24] Except for it's real time. Yup. Exactly. But I'd actually argue, you look at what Tesla has done. I mean, they're monitoring the health of your vehicle in real time and making adjustments real time. I mean, you don't even know it.

Brian: [00:19:34] Yes.

Marcus: [00:19:34] I mean, so I think even what we've seen in the automobile and the transformation there is certainly going to be occurring for us as humans, which is exciting.

Brian: [00:19:43] And I'm thinking even beyond just like direct response to issues, but also like becoming healthier.

Marcus: [00:19:50] Yes.

Brian: [00:19:50] So you think about all of the opportunities that Walmart has with really healthy food and health goals. And I think about the way that, you know, Phillip and I have both gone through health transformations in the past three years, and having an opportunity, you mentioned Apple, and we're both using Garmins. And the opportunity to help insert smart, really data driven insights into when to consume food, when to consume hydration... What's the healthiest thing at that moment based on your personal body? I think there's just a ton of opportunity there to sort of dynamically be able to address things in the moment. And we talk about real time ordering and omnichannel. I mean, understanding inventory that people have at home is going to take part in this as well. So understanding what prescriptions they have, what hydration tools they have, the things that they could run out of at specific times, depending on when they need to consume them, and being able to remind. Like there's just so many opportunities here that I see, especially for Walmart. This is huge. This seems as we were talking just a minute ago, I'm like practically like losing my mind over this because...

Phillip: [00:21:21] Yeah. He's jumping out of his skin.

Brian: [00:21:22] I am.

Phillip: [00:21:22] You'd have to have sat through two hundred and forty episodes of the podcast to know how excited he is.

Marcus: [00:21:27] Let me give you two examples, because I think you're spot on. And I mean, I can give you a million. I mean, we could do a literally twenty four hour podcast on all the examples. But there's sort of two, like I think about somebody like a Whoop, who you think about how you're encouraging fitness, but the insights are come to is it's not just about, you know, we want to encourage people to be active, but we also need to encourage how do we represent recovery? And that each human, each of us individually are different. And so so that these days where it's interesting, like what if you had a device who doesn't just tell you you need to go out and do your 10000 steps every day and let's track them and it's like automaton. What if instead they say, "Hey, your body is just not in that space. It needs to recover. So maybe this is a day you sit in the couch and take a nap for 30 minutes." Right. Or, you know, if you're going to go out and do anything like make it, a don't even do a brisk walk. Just do a walk or sit outside for a few minutes. But like, well that's a different kind of... That's much more personalized or I think about Viome, who's created testing tied to your human biome and your gut health. And they're assessing the type of foods that align with your internal gut your biome and those that sort of are not aligned with it. And now that lends itself to creating supplements and vitamins and supplements are designed uniquely for you based on their understanding of your biome. And so it's no longer like you should just go buy a multivitamin or you should go buy vitamin C. It's we want to actually create a tailored solution that's designed for the way your system operates. And I think that's where we're going. And that stuff, I think is so exciting. And quite frankly, as consumers, as a consumer, that's actually what I'm looking for.  [00:23:21]I'm not looking for the one size fits all. I'm looking for the solution that is one size fits one. And so I think increasingly a lot of these digital solutions in these more advanced diagnostics and more advanced biometric and monitoring solutions are enabling us to go down that much more personalized path. [00:23:44]

Brian: [00:23:44] And the speed of care, because that's another thing that's broken with our system right now.

Marcus: [00:23:47] Yes.

Brian: [00:23:48]  [00:23:47]It takes so long to go get your diagnostics. You go to the doctor because you feel like you might have a problem. And then the doctor says, "Well, I recommend you go to the specialist," and then the specialist says, "Well, I recommend you get these tests." And when you get the tests two weeks later, then they've got to go back and get analyzed. And by the time they get analyzed and you get a call, then you've got to go back into the doctor to talk about your results. And all of these points along this whole chain actually cost money. And it's not transparent how much they're going to cost as you go along the chain. And so the opportunity, and I love where you're headed with revolution in diagnostics, because I think that's also going to be part of this speed to care that's also going to make things less costly for consumers and ultimately result in a more efficient healthcare  system that more Americans can afford. [00:24:46] And so I'm so hyped right now.

Marcus: [00:24:48] So let me give you an example. I mean, I think you hit the nail on the head, and I'll give you a data point. I mean, we talk a lot and I think about from our own associates, and we see this in the data coming from them. We think about how much unnecessary inappropriate care is occurring. And an example, one of those areas is in the musculoskeletal space. How many of our associates are saying, "Well, I've got really significant knee pain or hip pain," and let's stick with the knee pain example. So then they sort of get steered in the normal path. "OK, I'm going to send you this orthopedist," and guess what, based on that assessment is a high probability you're going to go in and they're going to say, "Well, you need surgery," right? "You need to get a scope," or maybe "You even need to get your knee replaced." What we now know from our own assessment is, at a minimum, 30, and it appears to be closer to 50 percent of the knee replacements that were being done on our associates in a given year were inappropriate or unnecessary, meaning there was a better path to care, physical therapy, or something else that would have generated a better benefit for you, would have addressed your knee pain and enabled you to be much more functional than surgery did. And so you think about that dynamic now on the back end there, like I think about a company like Spiral Health who's got a kind of more advanced, muscular skeletal assessment. One of the things that they're finding is not only are there better ways to care for it, what we're finding is we're often misdiagnosing. You're coming in with knee pain. But the problem is that your knee. The problem is it's not your right knee, it's your left hip that's out of alignment. And so they come back and say, "Well, actually, the best course of treatment is not surgery. It's to go in and see a chiropractor or an acupuncture specialist or to do yoga." And now you think about that change and you think about the broadening of we as consumers know there's a broad array of solutions that we can avail ourselves of to address our health, but what we're trying to find the best one for us given our need, and that often the system is particularly bad at directing us down the best path for us. And so I think you're exactly right. That's what we're going to see. I think with all that's occurring, it's going to change where and how and what's the type of care we get and how is it delivered to us. And I see that in almost every area of healthcare .

Phillip: [00:31:14] This is like such a breath of fresh air. First of all, thank you for sort of like just falling into the rhythm of how we operate the show, because I think we like to dream big of what the world could be like. And I think a lot of that always gets tethered down by, you know, what actually is and where are the challenges right now. And, you know, one of those is we just came through a public health crisis and we could talk about how, you know, how it's exposed all of these inefficiencies in healthcare . For me, I had a very different experience. I actually experienced for the first time ever going to a CVS or a Walgreens and having my very first, like digital native healthcare  experiences where I had genuinely, really great scheduling experiences and really great messaging about my visit and testing was actually pretty fast and I got my results over text message and I have to have this, you know, again, putting the retail hat on, I think about consumer expectations. And I have to wonder how much that has a parallel in patient care is are their patient now expectations post COVID, where we've had greater access to better experiences that make us rethink the way that the world could work? And now we take those expectations into the rest of our management of care. And we think, why can't everything act like that? Why can't everything be like that experience? Because that actually was a great experience end to end. I didn't have to have seven different portals, and I didn't have to have, you know, three different relationships and lost an online log in to something. When I left my appointment, I didn't have to then take a list of 20 items to go get at a different place. Like these are all solutions that are being solved in retail today. How does that... Are their patient expectations, Marcus, that we are now having to compete with? And how is that going to upset the way that traditional care providers have to digitize their business or modernize?

Marcus: [00:33:36] Yeah, so I think two things. One is I almost congratulate the three of us. We made it almost 30 minutes and didn't use the word COVID. So that was like...

Brian: [00:33:45] {laughter}

Phillip: [00:33:45] Oh, sorry. I broke it, and I tried not to do. {laughter}

Marcus: [00:33:49] The second thing I think, you know  [00:33:52]people like to ask this question, like, how much did this pandemic change healthcare ? I don't actually think it changed anything. What it did is it was a propellent to a set of changes that were already happening, but happening much slower than I think we as consumers would like. [00:34:10] And I think what you hit the nail on expectations around customer experience and customer service have changed. I'll give you a small one, and I've asked this, did you all have to get a COVID test at any point over the last year and a half?

Phillip: [00:34:31] Twenty two of them, yeah.

Marcus: [00:34:33] Ok, so what I will tell you is if you did that there was less... I believe this number is sort of roughly correct based on what I saw reported. Less than one in 20 of those tests came through what you would consider to be the traditional healthcare  system, meaning through your primary care physician's office or an urgent care center or in a hospital. They were being done in the parking lots of Walmart or Walgreens or CVS. They were being done in really kind of interesting places. They're being done and kind of interesting ways. Did you have to call into a doctor's office? And they told you, "Unfortunately, we don't have any appointments today, but I can get you in two days from now." You just you literally just drove up and got in line or you used the scheduling app, and they said, "You need to be at this spot at exactly 9:52." And if you were there at 9:52, you got out at 9:55. So what happened? Now you have consumers, including myself, who had that kind of experience, who said, "Hold on, if that worked for COVID, why can't I do that for flu or strep or any other infectious disease? Heck, why does it matter? Like why can't I do it for anything? Like all diagnostics, all labs. Like why can't I just go test anything I want to test, figure out what the result is and then act on it?" You start to ask questions exactly like, "If you can schedule an environment where there are hundreds or thousands of people coming in to get tested, and you can schedule me into an appointment and guarantee me that if I'm at this spot a certain time, you will take care of me within minutes, why am I still waiting for two hours in the lobby for a doctor's appointment," which actually happened to me here recently? Because, why do you not have technology and systems that enable you to kind of manage your flow better so that you get me in and out? So I think... And you have certainly seen that in telehealth, right? Where people are coming in and because they've got load balancing other things, they can say, "We're going to keep you in the waiting room for five minutes or seven minutes if you've just now come in. But if you schedule an appointment, will guarantee you that we'll see you within two minutes of the time of your appointment." OK, if they can do that, why can't we make the whole system work that way? And so I do think... I do think it certainly has changed or maybe not changed, but it has further accelerated this belief that we as consumers deserve to be treated better than the system has treated us, and we deserve to have more access. We deserve to have things be more convenient. We deserve to be sort of just treated better, have things be simpler. And so I do think it has really acted as an accelerant in a way that will probably take a couple of years until we fully understand how much it did accelerate our not just our thinking, but our demands and our desires from the system.

Brian: [00:37:40] I'm hoping it's sooner than that because I'm excited about Walmart Health rolling out on a broader basis. And so I'd love to hear more about how you're rolling out Walmart Health across your stores. Phillip mentioned the footprint that you have and there are so many things... I know I mentioned I've got four kids and they're pretty rough and tumble. And so I've definitely experienced a few broken bones from riding bikes and skateboards, all of the above. And the process of getting an X-ray all by itself is just, it's a kind of a nightmare. And I do remember, I think when Walmart...

Phillip: [00:38:24] Brian, just ask, "When are you coming to Seattle?"

Brian: [00:38:26] When are you coming to Seattle? Yeah, that's all I'm asking. Actually, no, but I would love to hear more about your roll out.

Marcus: [00:38:34] Yeah. You know what I can say is I think one of the big questions is, as you think about the markets that you go into first or how do you kind of prioritize? There are a number of things. But we're trying to use an approach that I think in many ways is interesting. We have built this approach and then a number of things happened. I know we talk about covid, but you also think about the George Floyd murder, and the dialog that has occurred since that and other related events, which were tragic. But that drove a conversation around the inequities that exist, driven by race and ethnicity and particularly those in health, the health inequities that exist systemically. And what was interesting is we kind of stepped back and looked at not just how we built Walmart Health and the journey we were on to make that model work, but also where we were going with it. We use this kind of concept. We created this concept of the net health need. And what that really tries to do is you look at the market and say, "Well, how many how many people are actually truly providing care?" And you don't just count the number of physicians or primary care doctors or dentists or whatever. You actually say, "Well, how many these doctors actually accept Medicaid?" Because if they don't accept Medicaid it's the same as not having access if you're on Medicaid. So we would look at how much care was being delivered in that community. And then we look at the underlying demand for care, like how much care was already being consumed by the people who live in that community, regardless of whether they were getting it from providers that were local or further away. And then we also started to look and say, "Well, but how much care do they really need?" Like, if you've got a diabetic and this person says, "I haven't gotten any care in the last year," that's probably not good. This is somebody who you would want to provide much more support for. And so we created this concept that was trying to look at what real demand should be for care based on the underlying health of the community and what is the real ability of that community from a provider perspective, the supply to address demand. And so we created this kind of net health need. Now that's really driving where we go, and as we look at markets, because we want to go where there's the greatest need. What's interesting and there's a strong business principle around that you should always go where the demand is greatest and where there's not oversupply. But what it also started to align with was this sort of as we started to have a conversation around inequities of health, not surprisingly, those communities of color are often the ones that have the highest net health need because they have been wildly underserved. So I think about when we made the decision to move into Illinois, move into the Chicago market, we didn't just move in Chicago. We went into two communities, Austin and Chatham, because they were the two communities that had the highest net health need. And maybe just to bring it to light, I mean, in Georgia, for example, the first market we went to is Dallas, Georgia. And Dallas is a wonderful community. But you look at the typical community in Georgia, and the ratio of people for every primary care physician might be one for every twelve hundred, maybe one for every fifteen hundred. In a really well served community it's one four eight hundred. I believe in Dallas at that time, it was one primary care physician for over eight thousand people. And so you started to see people... When you would look at it, a lot of people saying, "I'm not getting my care. I'm not getting care." You're like, OK, well, that's a community I want to go into. Because that's the one where we think we can have the greatest impact. So that's kind of a longer story. But that's really what's driving us, is to really look at those communities where there's the greatest need, because they represent both the moral component, which is let's help those who have the greatest need. There's also a strong business component, which is that there's demand there. So let's go where the demand is. And so that's really driving where we're going and how we think about rolling these solutions out.

Phillip: [00:43:03] Somebody will write us an email after this comes out and ask us why we didn't ask the following question. So Brian and I, I think, have already expressed how bullish I think that we are in having a company the size and scale and influence that a Walmart does to help solve this, because it's not been solved, and it's been a long time. So why does a company that has the kind of resources and the operational excellence like yours try to be part of the solution? So I would commend it. But the question has to be asked. Where is the threshold between the consumer and the patient? They are one in the same person, but in one side of the house, they're a consumer who is treated one way and on another side of the house they have to become a patient where new rules apply. How do those two modalities of that person play out? I'm sure there's a lot to unpack there, but how do those play out and how does your relationship on one side of of the threshold versus the other inform the other experience?

Marcus: [00:44:17] That's a really interesting question. I guess the way I would think about it is I actually don't think today there are those two modalities, I think the way I would answer it is that I don't think that there should be two modalities. I think it is one. When I think definition when somebody talks about, and I use the word healthcare  consumer a lot [00:44:43]... When I think about the word consumer, on one hand, people are like, "I don't like the word consumer because it's all about consumption," and like, OK, I get you. But when I think about the word consumer, what I actually think about is someone who is empowered and in control. [00:44:58] And if they don't get things the way they want them, you're going to know about it. And if you as a solutions provider to them, and this certainly is the case in retail, if you don't take care of me as the consumer, then I will take my business somewhere else and you won't exist. And we all know that the history of retail in the US is littered with not only names of great companies, but as littered with the names of a number of companies that were great once that are no longer in existence today. And I won't sort of discuss those tombstones. But when I think about the patient, I can tell you, I actually saw this a few years ago... It was one of the most interesting things. Somebody was describing this kind of consumer patient dynamic. And they showed this woman who had four boys and she was keeping them in line in the community, in her church and in the job that she had, she was bold and they showed her walk into the doctor's office. And this was a woman who was tough, bold, smart, sharp. And she rolled in to the check in desk. And the next thing you see, she became a very different woman. Her shoulders sloop, her head looked down. She was slight in voice. And, you know, my reaction to that is I hate that. Like we don't want none of us want to be a patient. We all want to embody us as the version of us as a consumer, the one who's in control, who's clear about what we're demanding and wanting and has clear expectations and is looking at the other side at the people who are providing care and saying, "You should be delivering to me the things I want in the way I want them at a standard in the ways that I need them." And so I think about that. What do consumers want? They want high quality. They want things affordable. They want things convenient. They want things simple. They want choice. They don't want to be forced. They like let me choose how I'm being served and how I choose to be served in this moment may be different than how I might want to be served later on this evening or tomorrow or in a week. And that's certainly the case in retail. I don't you know, honestly, I'll tell you, I don't know there's any different in healthcare . I think it's the same. I mean, obviously, these are different sectors, but I think at the core the same reality exists. And it's not just in retail. I think retail, financial services, healthcare , that the demands of what a consumer wants and how they want to be treated, what they expect, and how they want to be served, that kind of underlying standard is the same. And I don't know that there should be the kind of distinct modality between the consumer and the patient. I think there is a difference between the retail consumer and a healthcare  consumer. But I think then it's just based on the differences between those service lines. And recognizing that what quality means in healthcare  is maybe a little different than what quality means and in a retail setting. But in both instances, as a consumer, I want quality and I want it. And so I don't know that there is a difference.

Phillip: [00:48:49] I think that goes back to the prior question that I asked, which is, you know, having your proficiency as a consumer, as most people would probably rate their proficiency as a consumer as being quite high. I'm quite educated as a consumer because I shop all the time. I have lots of retail experience because I have to engage in commerce to live. It's when you find yourself as a patient, you're in undiscovered territory, something that's a different experience for you. And so I would agree with you. But we've now, you know, just to hearken back to that prior question, we've all had some sort of new experience as being consumer healthcare  or having an experience around COVID that I think has shown us that there's different levels of care in the world in different ways to experience healthcare . And maybe that better informs us all to have higher expectations going forward. Brian, you were going to jump in.

Brian: [00:50:01] Oh, yes. I was going to say I think we've seen this play out a little bit in the drug market to some degree where there's alternatives that pop up and there's competition that happens within the drug market. It does take a little bit longer maybe than in some sectors. But actually, one of the places where I feel like Walmart just sort of jumped in and sort of represents exactly what you just talked about is the release or the announcement of the release of the low cost insulin alternative. And I'd love to hear just a little bit about your thoughts, Marcus, on the impact this is going to have for patients and how this represents Walmart's strategy going forward with drugs. And I guess you've already kind of, I think you've kind of already outlined the strategy here.

Marcus: [00:50:55] Yeah, well what I'd say is in some ways it goes back and often I get accused, they say, "Hey, Walmart guy, you always love to talk about cost. That's all Walmart is, the Save Money Live Better guys." It's always about price and cost and lower cost and those kind of things. And what I'll tell you honestly. Yeah, it is. And particularly in healthcare . It is. You ask the question, number one healthcare  issues collectively are the number one point of stress, angst and concern among Americans. And you ask the question, "Well, what's the thing about the system that is causing you the greatest angst?" It's the cost. It's the perceived lack of affordability. And so one of the things we've seen, going back to more than a decade and a half ago and the launch of when Walmart launched the four dollar generic program, which was a program that said, "We're going to find the viable generic drugs that in every kind of major therapeutic class, so that everybody, regardless of the chronic illness or disease you have or if it's for women's health or men's health, we're going to find solutions for you that are just four dollars so that you can afford your meds." I think what we found is when doing that, it generated phenomenal results through the system. The phenomenal results where it wasn't just that it reduced drug spend overall, it actually drove medication adherence. People were able to stay on their drug regimens longer. You heard stories about people, you know, seniors who were pill splitting or "I would take my pill," if I'm a 75 year old male, "I take this pill today, and then I have my wife take it tomorrow." And you didn't have to do that anymore because you could both afford your meds. And so kind of fast forward, we've actually had kind of a private label rely on insulin for a number of years. What's exciting about this announcement is it is a more advanced and innovative product. It's sort of a fast release insulin. And so the idea of being, you know, you think about how many diabetics we have in the United States and how many of those are on insulin and how many of them are saying the cost of insulin is so significant that "I couldn't afford to stay on the regimen I have or to take insulin at all or take it as consistently as I should," which is then putting their life and at risk, health at risk. And so I think what this is just another example of, but a very exciting one is that it's showing that even going back to the four dollar generic program where that was about generics, this is about a kind of a more innovative product that we've got to find, and we can find ways, when you work together, when groups like Walmart and Novo Nordisk work together, you can find new ways to bring those innovative solutions that are being created that better address the underlying kind of health issues and health needs of consumers. We can bring them to market and make them more affordable because we can be smarter about how we manage supply chains. We can do things with greater efficiency and scale. And so, yeah. So I think it's exciting and  [00:54:27]it just further kind of represents, I think, the opportunity to say if you can make price matter, if you can make healthcare  more affordable, people will engage in their health. When they engage in their health, they'll have more control. If they have more control over their health, overall costs, their health will improve and overall spending will decline, which is a good thing. [00:54:47]

Phillip: [00:54:48] Oh, we're coming up on time. I'll take you up on the twenty four hour podcast, and I know Brian will as well.

Marcus: [00:54:58] {laughter}

Brian: [00:54:58] No doubt. {laughter}

Phillip: [00:54:58] It's been such a pleasure having you. If we could, if you had to look into the crystal ball, what do you think the next stop on, Brian, the multiverse... What do you think the evolution of Walmart Health is over the next five years?

Marcus: [00:55:17] You know, I think it's probably just two things and it's not very exciting or super sexy, but I think it's we have an opportunity. We've got a lot of work. We're doing a lot of work to improve the model. But being able 1) is scaling what we're already doing and being able to reach more customers. And I think probably, 2) is further development and engagement around the omnichannel model. Because I think the combination of scaling what we're already doing and what we have, plus building a more robust omnichannel experience around all of it with this belief that if we can improve that access, if we can again make it easy and simple and affordable, people will get the care they need. If they get the care they need, that's a good thing. It will ultimately be better for not just for them, their families, the communities they live in, but it will also be better for the system. And so I think it's for us to kind of continue the march to scale and the march to really try to enable that omnichannel experience.

Phillip: [00:56:30] Amazing. Marcus Osborne. Walmart, thank you so much.

Marcus: [00:56:35] Thank you.

Brian: [00:56:36] Thank you.

Phillip: [00:56:36] And thanks for listening, Future Commerce. You can tell us what you think the future of healthcare looks like and how retail experiences are forming your opinions about patient experiences. I want to hear from you. Drop us a line at and subscribe so you never miss an episode of Future Commerce. Thanks for listening, and we'll talk to you soon. How do I end this show? I forget. That's it. {laughter}

Brian: [00:57:05] {laughter}

Phillip: [00:57:05] All right. Bye bye.

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