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Season 3 | Episode 10

From Checkouts To Cows

We discuss how the health industry is expanding to better meet you where you’re at by taking a look at retail and rural health.

April 27, 2023 | 29 minutes


This week, we talk with Dr. David Carmouche from Walmart Health about the rapid growth of retail health as well as Beth O'Connor, host of The Rural Health Voice podcast, about the unique challenges rural Americans face getting care.

Speaker 1: I think what gives me hope is that there are new players who are trying to come to healthcare to solve problems in unique ways and learning from other ways that they've served customers

Speaker 2: Welcome back to Until it's Fixed, where we explore new ideas and work underway to make healthcare simpler and more effective for everyone. I'm your host, Callie Chamberlain.

Speaker 3: And I'm Dr. Kenny Pool.

Speaker 2: [00:00:30] Hi everyone. In last week's episode, we talked about how home and community-based care can meet people where they're at in their healthcare journey by literally bringing care to their front doorsteps. And in today's episode, we're continuing that conversation by taking a look at the rise of retail health.

Speaker 3: And as we talk about meeting people where they're at, we'll also talk about how it can be hard to do that when they live far away from a doctor's office or a hospital in a rural area. If you live in a rural area, some of your challenges caring for your [00:01:00] health are gonna be different. Compared to Cali who lives in New York City, you probably can't walk to a doctor's office or a urgent care center. In fact, you might be 50 miles away from the closest one.

Speaker 2: And I love that you defined for us what we're talking about when we talk about rural. So let's do the same thing for retail health, because it is considered to be one of the next big things in the healthcare industry. They're typically health clinics that are located in retail stores, supermarkets and pharmacies. So maybe you've been shopping and you've seen that there's [00:01:30] an area that you can go to receive some of these services. And the idea is that it's meeting you where you're at in a convenient location where it can be more of like a one-stop shop situation. And it's estimated that there're about 2000 of these retail health clinics across the United States. And during the last few years, retail health clinics have grown by over 20%.

Speaker 3: Yeah, I remember when I was a kid, you started seeing blood pressure machines near the pharmacy in the drug store. Then you started seeing pharmacies pop up in all your grocery stores and you started seeing them in some of the bigger [00:02:00] stores that were maybe like a step down from a department store. And you start seeing some of these services being able to even do urgent care for more basic ailments pop up in retail stores. Right. And so it's been an interesting evolution.

Speaker 2: So I have mostly been using retail health clinics for urgent care reasons. For example, I had a really bad ear infection and I called the nurse line and they were like, I don't [00:02:30] know that you should wait. So I went to an urgent care facility in a retail health setting. Mm-hmm. <affirmative>. But I also used retail health for basic stuff that I have to see a doctor for. And the reason for that is I moved about a year ago and my primary care provider is in Minnesota, where I used to live. However, I then find myself in situations like with an ear infection and I just didn't have somebody lined up. Mm-hmm. <affirmative>. And in those instances, it's been really helpful for me to just know that I can walk into a retail clinic [00:03:00] and be seen the same day.

Speaker 3: What's interesting is that you're saying this is somebody who lives in New York City and what you're speaking to is the challenge with access to basic primary care and then also urgent care or basic foundational care that exists in our healthcare system. And that lack of access is starting to parallel urban communities and cities, suburbs, even [00:03:30] with what rural communities have been dealing with for a long time. Right, totally. And all we're seeing with retail clinics is somebody raising their hand and saying, you know what? I got all of you guys. Right? I got something for all because these big box stores and franchisees, drugstore franchises, they're everywhere. Right. So we can take care of you whether you're in New York City or we can take care of you whether you're in rural America.

Speaker 2: Exactly. So let's start by talking to someone who knows a lot about retail health. I [00:04:00] had the chance to talk to Dr. David Carmo, who is the senior vice president of Omnichannel care offerings at Walmart, and he had some really interesting insights to add to this conversation. Let's listen in. Thank you so much Dr. David Carmouche for being with us today. To start off, can you tell us a little bit about your role at Walmart and how you got into retail health?

Speaker 1: Sure. Kelly, thanks for having me. At Walmart, I get the chance to lead what we call healthcare delivery, which [00:04:30] is centered around primary care and urgent care, behavioral health, dental care, and then telemedicine or the virtual extensions of that. The first 15 years of my career, I practiced internal medicine, uh, front lines of care and was convinced to leave that great situation to go to Blue Cross of Louisiana and did that for several years and then had a, just a tremendous seven and a half years at och Auctioner Health, the largest kind of integrated delivery health system in the Gulf South. [00:05:00] So through that work came into contact with Walmart and they were looking for a senior executive to help lead their expansion into retail care.

Speaker 2: That's amazing. And before we go any further, can you tell us a little bit more about what retail health really is?

Speaker 1: I think probably most people who experience retail health in America across a variety of different settings probably have seen it mostly as urgent care or convenient care. You know, sore throat, flu. Mm-hmm. <affirmative>, something like that. At Walmart, we've tried [00:05:30] to do something a little differently, although we see urgent care needs like covid or sprained ankle or rashes, et cetera. We actually want to do real primary care, taking care of chronic diseases, working with patients for prevention and wellness purposes, vaccinations, lifestyle, and then also managing their chronic diseases. We've also seen a need to combine dental services into that environment. And so we're one of the kind of unique places where you can have preventive dental care, but also restorative care, [00:06:00] crowns, root canals, et cetera. So full service, dental, full service, primary care, we insert behavioral health because of the significant need in America there as well. And then we have lab services, we can do x-rays and labs. So it's really holistic primary care.

Speaker 2: Yeah. And the idea behind that, I'm assuming, is that people are shopping so it's just easy to pop in, is that right?

Speaker 1: It is. You know, if you think about it, there are, I don't know, just around 5,000 Walmart supercenters across America. [00:06:30] Mm-hmm. <affirmative>, I think we say 90% of Americans live within 10 miles of a Walmart. The reality of it is 4,000 or so of those stores sit in what the federal government would designate as healthcare deserts or Oh, interesting. Places where there is not great access to medical care. And so Walmart sits kind of at the intersection of where healthcare starts to break down. It also happens to exist for us, at least in populations that really need better access to healthcare access. [00:07:00] Meaning where we've located the clinic, but also access in terms of hours. We've tried to make our clinics open, you know, for a broader set of hours than maybe traditional healthcare. So seven 30 in the morning to seven 30 at night during the, the week, and then weekend hours like nine to five.

Speaker 1: The thing we hear over and over again is they love the convenience. They love the fact that we've brought healthcare into their environment where they're conducting their normal day-to-day life. You know, they don't have to drive across town, maneuver a parking lot and go up an elevator to an office [00:07:30] building that they would never go to. In many cases they're in Walmart weekly in some cases. Yeah. So the ability to have healthcare where they live their life and be able to access it when they want it very conveniently as they do other things that are important in their world, we think is something that people love. The second thing is that people really like our pricing transparency. So many folks who come in pay cash, you know, many are insured Yeah. But have a high deductibles or are functionally paying cash. We are very transparent with our pricing. [00:08:00] It's on our website. It's posted very clearly in our clinic, so people know exactly what to expect. They're not gonna be hidden costs. It's right up front. We've tried to be super responsible with our pricing to make sure that we're affordable for most people, but I just think this notion of people not really know what they're paying for and what the ultimate bill's gonna be is such a big problem in healthcare. We've tried to solve that and I think people really appreciate that.

Speaker 2: Yeah, that makes sense. And that brings up the question of who retail health is designed for. So tell me about who you see coming through your doors.

Speaker 1: [00:08:30] It's really interesting. You know, I think, you know, one of the core customers is kind of the very busy mom with kids. And so if you think about having to knock out a school physical, pick up a medication at the pharmacy, run by the grocery store, and being able to do that with one trip, one stop. Hmm. I think that has resonated with the kind of the core Walmart customer. You know, we want to serve everybody though. And I think we also specifically wanna serve folks who are say 65 and older. Yeah. And they've also started to accept the fact [00:09:00] that, you know, I already use the pharmacy at Walmart. Yeah. I already do shopping at Walmart. I could have my medical care there too. That just makes my life easier.

Speaker 2: That completely makes sense. And the physicians that are inside the centers, if I come visit, am I gonna see the same physician the next time I come back?

Speaker 1: Well, that's our goal. Okay. I think it's really important for many folks to have that kind of relationship. They don't really wanna bounce in and see someone different every time. I will say, if it's something like a cold or a rash Yeah. Or something that seems [00:09:30] mild, I think convenience wins. And of course, you know, they'll see whoever. And so we do have that model, right. If someone has a care need like that, we'll get 'em the best appointment for them. And it may be a different provider, but for diabetes or hypertension or

Speaker 2: Right.

Speaker 1: If you're working with a clinician for lifestyle change, we really want that to be the same clinician over time. And we work hard to make that happen.

Speaker 2: That's great. And so tell me about when someone would consider visiting a retail health clinic over a more traditional hospital clinic, emergency room, urgent [00:10:00] care.

Speaker 1: So first of all, what we would like to believe is that the quality of the care that we're gonna deliver is the same or better, right? Mm-hmm. <affirmative>. So meaning we're hiring board-certified clinicians from actual care delivery. I think we aim to be, you know, as good as anybody. I think where patients will come to really, like Walmart is on the experience side of care. So imagine if you have diabetes and you see a high quality clinician that you trust and you build a relationship [00:10:30] with that clinician. And we are able to have a community health worker walk you after your appointment into the grocery store and show you some healthy food choices for your diabetes. And then you could stop at the pharmacy and pick up your two medications that were prescribed on the way out. And all that happens in one trip.

Speaker 1: That is very unique. And I think that's what patients are gonna really like. I think they usually have to come and experience us first because they don't know Walmart is in healthcare necessarily. They're first struck by how nice our facilities [00:11:00] are. They're second struck usually by the people and how we've trained them to be very customer focused. And so once they get in and see that, and then experience and start to put together all the convenience of all the things that we can organize for them, more times than not, we're able to keep 'em as patients.

Speaker 2: Yeah. And I really like the way you frame meeting people where they're at. I think that's a really important way to think about the retail healthcare space. Where do you see this industry moving in the future?

Speaker 1: [00:11:30] Well, the key is, can retailers be successful long-term in healthcare delivery? You know, most of the retailers are for-profit organizations. Yeah. So they, they don't do healthcare to say, drive more people into a Walmart. We're doing healthcare because we feel like it's a pain point for our customers and it's not being solved. And we want to contribute to that solution. But to do it at scale, to do it across the country with not, you know, 80 clinics like we'll have at the end of next year, but with hundreds [00:12:00] or maybe thousands of clinics, we have to have a model that works economically that's sustainable. Mm-hmm. <affirmative>. So I think the pivot you'll see in retailers is this pivot to what we call value-based care. Where we take responsibility for the full healthcare costs of patients who want to seek care from us. And therefore, the way we work economically is that we keep people healthy. If they don't need expensive healthcare services, then we can support our growth. So it forces retailers to be [00:12:30] really good at not just convenience, but actually being really good at helping people live healthier lives. Mm-hmm. <affirmative>, I think that's gonna be the big pivot. And so that's what we're really excited about and we're trying to do that from the beginning so that that is not something we wait to

Speaker 2: Learn. Amazing. Tell us a little bit more about the Walmart and United Health Group partnership.

Speaker 1: So this is just so exciting to me personally. I believe that unlocking value in healthcare for a customer is not gonna be done easily [00:13:00] by any one sector of healthcare. It's gonna be when different parties come together and combine their strengths to kind of do special things. And so I think this is one of those for United Health Group and Walmart to embark on a 10-year relationship. First of all, it's really interesting. Yeah. I don't think either company has done something that long at that scale. And so the agreement allows us to plug in to Optum's data and analytics and tools and best practices to help accelerate our performance. [00:13:30] And so, uh, feel really good about our opportunities to work together. Yeah. To do big things for American healthcare.

Speaker 2: Amazing. Thank you so much. Well, let's move into the lightning round. The first question is, what gives you hope?

Speaker 1: Well, I think what gives me hope is that there are new players who are trying to come to healthcare to solve problems in unique ways, and learning from other ways that they've served customers. And bring not only that capability and knowledge to healthcare, but also bring dollars and investment to healthcare to unlock [00:14:00] access and to reach down into communities and focus maybe a little bit more, not just on care, but also the other things that drive your health and wellbeing. Like your social situation, your ability to access healthy foods. Yeah. The safety of your neighborhood, your ability to get employment, solving many of those other factors that can help people help live healthier lives. So all of that together gives me great hope.

Speaker 2: And who has someone who's inspired you or had a really big impact on who you are today?

Speaker 1: Wow. There are lots, but I, you know, you can't not give this one to your [00:14:30] dad, right? Mm-hmm. <affirmative>. So my father at age 42, made a very courageous decision to totally pivot his career. And he's 82 now, and thankfully in good health and still runs, uh, his business. You know, when I was faced with this decision of staying in practice for 30 years or pivoting after 15 into healthcare management, I got some inspiration from him and his experience and courageous he was to do that and how it paid off for him. And I, I think, um, that gave me a little bit of the confidence to make that shift. And you and I wouldn't be sitting here talking [00:15:00] to each other. So I'm very, very thankful for both his experience as a son, but also the example that he gave me professionally.

Speaker 2: Amazing. Thank you so much for joining us today.

Speaker 1: Thank you for having me. I appreciate you coming.

Speaker 2: What I really appreciate about retail health is a transparency in pricing, which I think is a really exciting opportunity for the entire medical industry. To move toward a little bit more,

Speaker 3: What I'd appreciate about retail health is that they're taking [00:15:30] a big swing at an area that is an identified gap, and that's access to care. Mm-hmm. <affirmative>, our next guest is Beth O'Connor, who is last year's president of the National Rural Health Association, and the current executive director of the Virginia Rural Health Association. She has a true passion for this work, and in fact has a podcast that focuses on rural health called The Rural Health Voice. And I have to say that we always love when we talk to fellow podcasters, [00:16:00] so it's really good to hear what she had to say around rural health. Check out the interview with Beth.

Speaker 2: Thank you so much for being here. Beth, to start us off, can you share with us a little bit about what inspired you to get into this line of work and what your role is?

Speaker 4: So, I grew up in rural America, and so, you know, anything with rural connections was a natural fit. I went into health education. I had worked [00:16:30] in, uh, tobacco control program in Arizona, helping people quit smoking. And as part of that process, I learned that it makes sense to talk to elected officials about how the decisions they make affect what we're doing. And so I found out about the world of advocacy and discovered that they will actually pay you to talk to elected officials about the decisions that they make. And so that's how I wound up the executive director of the Virginia Rural Health Association. I'm in the immediate past president of the [00:17:00] National Rural Health Association. It's very meaningful to talk about, you know, what is it that you're really seeing in your local community, and how can we use that information to push forward change at the national level, if you're interested in rural health advocacy, the National Health Association of Events are amazing resources and opportunities to meet other people who are really working hard to make a difference, both in their local communities and on the broader level.

Speaker 2: That's amazing. Beth, you have a really interesting [00:17:30] background. Can you tell us a little bit more about the podcast?

Speaker 4: The Virginia Rural Health Association launched our own podcast in 2018. This was an idea that one of my board members had that I was less than excited about. At the time, I didn't know a whole lot of pod podcasting, and so I, I was very tentative about getting into, but she convinced me and I tried it, and it's been very exciting. And so, twice a month we release a new episode on the Rural Health Voice, where we talk to somebody from [00:18:00] some sort of aspect of rural health, looking at what happens when policy changes at the state or national level play out in our local communities. One of the things that we do a lot is try to make sure our elected officials understand how the decisions they make impact health and healthcare in rural America. And so the podcast is talking to individuals about what do you see going on on the ground?

Speaker 2: That's great. As Dr. [00:18:30] Pool said earlier, we love learning about other podcasts. So we're so happy to have you here and to hear more about your work. And at the start of the episode, Dr. Pool and I talked about what we understood rural healthcare to mean, but I'd love to hear your definition and how you define that term.

Speaker 4: You know, it's a complicated question. It depends on how you define rural. Every federal department has their own definition. Hmm. So do you use the CDC definition? Do you use the Federal Office of Rural Health policy [00:19:00] definition? It really just depends. Maybe that's someplace with more cows than people <laugh>.

Speaker 2: I love it. That's the official definition. That's great. So can you tell us a little bit about what some of those challenges are as it relates to healthcare in those spaces?

Speaker 4: Some of that's related to infrastructure. We saw 147 rural hospitals close since 2010. There's maybe another 600 at risk nationwide of closing. Do you have transit? Do you have grocery stores? [00:19:30] Some of that is the economic drivers that exist in rural communities. In rural areas. Usually the local economics are based on what can be extracted out of that community. Coal, timber, agriculture, those jobs are more likely to be dangerous jobs. So your accident rates are higher. We look at access; we have 25% of the population, but only 10% of the doctors. Oh, wow. So whether [00:20:00] that's physicians, whether that's dentists, whether that's mental health providers. There are a number of rural communities that are classified as health professional shortage areas, which means there's just not enough services out there.

Speaker 2: Hmm. That's really interesting because it feels counterintuitive that there's such a large population and such few providers available. What would be some of the reasons why that gap continues to exist?

Speaker 4: There's a number of things. One, [00:20:30] if you graduate from medical school, dental school, and you have student loan debt, living in an urban area may make more sense just because your salary's going to be larger. Some of it is you might be willing to live in a rural area, but you have a spouse that the type of career they have, they can't find a job in that rural area. Some of it's strictly what makes sense for my family. Some of those gaps are due to, is there the population [00:21:00] base in that county, in that region to support an endocrinologist, a cardiologist.

Speaker 2: Hmm. So what are some of the solutions that you're seeing?

Speaker 4: You know, there's <laugh>, we can talk about this all day there. There's as many different variety solutions as there are problems. Hmm. One potential solution is to have programs which encourage middle and high school students to consider healthcare careers and then support them in their educational [00:21:30] journey. Hmm. You know, can we make sure they know about the variety of healthcare careers that are out there? You know, if you ask a fifth grader, Hey, do you wanna go into healthcare? And they, when you grow up, they think of that as doctor, nurse. They don't know about the full spectrum of healthcare careers that are out there. So educational camps, working with providers, things like that can help them understand what all they can go into. Mm-hmm. I love that. For infrastructure. Looking at broadband access, [00:22:00] transportation access grocery stores to address food insecurity. This might be a local or state or national initiative to help make investments in rural communities and make sure profits derive from those rural communities are reinvested there for the lack of healthcare providers.

Speaker 4: Mm-hmm. <affirmative>, making sure that people understand the valuable options for a living in rural communities. If you're really excited about hiking or kayaking [00:22:30] Yeah. Or mountain climbing, there's some awesome options in rural communities for you, if that's something you want to do. People look at rural communities and the salaries they can receive in rural communities and look at that as limitation, because generally they're going to make less money. But when you compare that to the housing cost, Hmm. Your dollars for housing are going to go much further. Yeah. In a small town than they would someplace like Philadelphia or Houston. Of course. [00:23:00] So it depends on how you look at it. And something that I think rural communities need to do a better job of is selling their local community, making sure potential healthcare providers know what options are available.

Speaker 2: Yeah. I mean, outdoors and low housing costs. That's a pretty compelling argument, I would say. Can you talk a little bit about telehealth? I know that that's been very popular. Again, I'm interested in how that might intersect with the rural community.

Speaker 4: Sure. And you know, telehealth is [00:23:30] kind of waived as a magic wand for a lot of people as a way to solve the access issues in rural communities. And on several levels that does make sense. But people need to think of it as one tool and the box, not the entire toolkit. It's got some very serious limitations, especially for people who don't have high-speed internet.

Speaker 2: Yeah.

Speaker 4: I just got internet in February. Mm-hmm. I live in, by [00:24:00] definition, from pretty much any aspect. A small town, if not a fairly decent sized town. Yeah. I'm in Blacksburg, Virginia. My house is eight miles from Virginia Tech, a major research ‌university. Wow. Yeah. At one point, Blacksburg was designated the most wired small town in America. Huh. But while my address is Blacksburg, I don't live in town limits. I live eight miles out [00:24:30] on a windy, twisty road that goes through the national forest. I did not have any options until a few months ago. Wow. If you don't have broadband, obviously you don't have telehealth. Telehealth still can't replace a primary care provider, and it can't provide services and rural access when there are shortages everywhere.

Speaker 2: Wow. That's so interesting. So talk to me about why improving rural healthcare matters or [00:25:00] should matter to people who might not be affected.

Speaker 4: Oh yeah. And I have been asked this question. I have been asked, why should I care? Mm. And it absolutely matters. Your food comes from rural America, your water comes from rural America, your timber, all these sorts of things. Things that happen in rural communities, sooner or later there will be a price in suburbia.

Speaker 2: Yeah. Wow. Thank you so much for joining us. We're gonna move into the lightning round. First [00:25:30] question, what gives you hope?

Speaker 4: I think more people are understanding the investments into healthcare. Make a difference. You know, and not just for the that individual, but for the community and for the nation. Hmm.

Speaker 2: What's something new that you've learned recently?

Speaker 4: There are many places where they don't have labor and delivery services. They don't have prenatal care. So we've been looking at a number of options, a number of grants where we could implement programs to address this [00:26:00] barrier. And as part of that, this is something I knew was a problem, but I didn't know how bad it was, is the disparity for the African-American population and maternal health outcomes. We have to do something to address the disparities for African-American women.

Speaker 2: I completely agree. That's extremely important and something we've talked about on the podcast as well. Thank you so much, Beth, for being here. We really appreciate your time.

Speaker 4: Absolutely. Thank you.

Speaker 3: [00:26:30] So I really liked her interview number one, because her passion for the work, right? Yeah. And then in addition to that, she had a true understanding of the nuanced challenges of rural health communities. And not just from a stereotypical lens, which she called out. Right. I think the other thing to note that didn't get lost on me is that she reflects [00:27:00] that community. And that interview was another one of these examples that show that when providers, the healthcare workforce, sometimes even executive leaders within a healthcare space, when they come from and reflect the communities that they serve, that's why those outcomes are better. You know? Because you're not gonna find anybody that's gonna advocate for that community better. They may do it close to as good, but not better than she does. Right. [00:27:30] And so, to me, that's a model, and that's consistent with what we see across the board as it relates to providers from specific communities and them having good outcomes and good patient experience numbers when taking care of their communities.

Speaker 2: Mm. I love that. And that's what I was thinking about too, is like the people who are inside these communities have the solutions. Mm-hmm. <affirmative>. And it was so incredible to listen to her talk about, to your point, the nuances that you can really only understand by being a part of the community that you're trying to serve. And so [00:28:00] I also really appreciated her perspectives, and I think that theme is a theme that's really important, especially in my work thinking about philanthropy and communities and how we can actually serve in a meaningful way. So I love that you called that out. So thank you so much for listening. We hope you'll join us next week for our bonus episode. Imagine you're sick and it's a weekend and you have a regular doctor, and their office is, you know, most certainly closed. So what do you do? Who do you call? Where do you go? We'll get [00:28:30] into that a little bit more and break down the options that you might have related to telehealth visiting a retail health clinic like we talked about today, or getting seen in an urgent care center or emergency room. So that's it for today. Thank you for listening. Thank you for joining. Make sure to follow and subscribe wherever you listen so that you can get notified when a new podcast episode is live, and we'll catch you next time.