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 Welcome to this Weekend in Health IT News, where we look at as many stories as we can in 20 minutes or less that will impact health. It. It's Tuesday Newsday, and here's what we have on tap. Walmart First Healthcare Services, Supercenter opens up, uh, we get a first glimpse at that. Uh, best Buy is now.

Touting themselves as a healthcare company. We'll take a look at that. Sam's Club Humana team up to, uh, mitigate high cost of out-of-pocket healthcare costs. Um, Amazon care was announced. You know, it's, uh, it's, it's, it's amazing. I took one week off. I come back and, uh, every major retailer seems to have made an announcement since the last time I was on, I was doing the show.

So I am really looking forward to this show. We are gonna talk about the future of healthcare, or at least the healthcare that is being revealed to us at this point in the game. My name is Bill Russell. We're covering healthcare, CIO, and creator of this week in Health. It is set of podcasts and videos dedicated to developing the next generation of health IT leaders.

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Going back to my old days of programming. It was kind of fun. Uh, all right, let's get to the news. Two minutes in. Uh, why is Amazon doing what they're doing? Let's, um, let's start with that. Now I'll get into what they're actually doing. So here's, here's what's driving, uh, employers at this point. And, uh, gosh, you know, I'm gonna give some attribution to some of these stories.

So a, I'll have these stories. We have Forbes, uh, Bruce JSON wrote this story, uh, about Walmart's first Healthcare services Supercenter. Uh, first clip in glimpses into the new Walmart health format. Uh, talk business.net. Kim Souza Healthcare may eventually become bigger business for Best Buy than selling electronics Forbes.

Uh, Andrea Chang, uh, Sam's Club Humana team up to mitigate high out-of-pocket healthcare costs page. Uh, Meyer Fierce Healthcare. Best Buy, Amazon, Walmart, leading retailers race into home-based care. Home healthcare news, uh, this is from, uh, yeah, home Healthcare News, Bailey Bryant. And, uh, there's a column on, uh, am, uh, in the LA Times.

Amazon Care may be to healthcare what? Amazon Prime is the shopping. , uh, will Amazon Carey Teladoc Health and give it a massive boot or give it a massive boost? That's, uh, Motley Fool and Nicholas Rose Rosalio, uh, is Amazon Care, the beginning of a, uh, uh, strangler. Fig for healthcare, stat News, Vic Panda, and why Amazon Care may be the new model for corporate healthcare computer world.

Lucas, uh, Marion, M-E-A-R-I-A-N. Those last two articles I'm gonna hit on, uh, pretty significantly. They were really well written articles, but what I've done is I've just sort of bunched it all together rather than going through individual articles. And, uh, so I wanted to give attribution at the beginning.

Let me give you a little bit of what's going on. So why is Amazon doing what they're doing fundamentally? Uh, and this is again, excerpt from, uh, one of the articles fundamentally, and this is the Computer World article, which is really well written. Fundamentally, corporations are entering the healthcare services market to deal with the rising cost of care related to employee healthcare insurance.

The pace of wages, 26% and inflation 20% according to the Kaiser Family Foundation. Uh, Haven Healthcare is also looking for new ways to use data and technology to make the overall healthcare system better. Our people want transparency, knowledge, and control when it comes to managing their healthcare.

Jamie Diamond, the CEO for JP Morgan Chase, set in a statement at the time of Haven's launch. Uh, the three, uh, the three of our companies have extraordinary . Resources and our goal is to create solutions that benefit the US employees, their families, and potentially all Americans. Now the important thing is every time Amazon, like twinges a little bit, we go nuts in healthcare.

But I think this is a big one. I think this is a big, uh, announcement, but it's important to note that this isn't new. So, a decade ago, Intel opened onsite primary care clinics for employees in Oregon, New Mexico, uh, Arizona. And began offering optional annual health checks that would re, uh, reduce premiums for employees.

The chip chipmaker then used its purchasing power to create . The healthcare marketplace collaborative to push healthcare providers and insurers to lower their cost of care. Intel also worked with Seattle-based, uh, Virginia Mason Medical Center to develop best practices for creating standardized care of diabetes, high blood pressure, uncomplicated back pain, breast nodules, uh, migraine headaches, and problems with shoulders, knees, and hips, otherwise known as reducing clinical variation.

Healthcare was the only area of our business where we did not control quality of costs. Pat McDonald and Intel Fabrication Plant Manager said in a white paper and costs were out of control. When we manage equipment suppliers, we measure safety, quality and cost. We were doing, uh, we weren't doing that with our healthcare suppliers.

Uh, also of no ge, Boeing, JetBlue Airways, Lowe's, McKesson, Walmart are also using their combined purchasing power to offer bundled care for employees through industry consortiums of third parties. Around the same time, Amazon and its partners were strategizing on Haven Healthcare. Apple launched AC Wellness for its employees at Cupertino, California headquarters.

Offering a primary care clinic in a concierge like healthcare experience at home. So you see, I mean, we're gonna talk about Amazon, we're gonna talk about some of the things they're doing, but this is happening across the board. Employers are looking for a way to reduce the cost, not only for themselves, but for their employees, and the ones that are effective will have a, an advantage in the marketplace.

So there's a lot of reasons why they're doing this. So let's talk about what Amazon actually did. So according to its website, Amazon Care, which is the brand, Amazon Care, is what they rolled out, provides a mobile application that allows employees to access virtual and in-person healthcare services. Now you might say, ah, what's the big deal?

Well, the big deal is it's being offered. By Amazon. It's not being offered by Providence in the state of Washington, for example, or a University of Washington health system. It's being, it's being offered by Amazon in partnership with Oasis Medical, a nearby private practice that provides in-Home care for any of the companies, 60,000 Seattle based employees.

So it's important to note that they're doing this just in. The state of Washington, actually, it was some, something goofy, like zip codes that start with nine two, and I think it's the whole state of Washington, essentially. Um, and it's covering 60,000 employees. And this is a, a larger pilot, but it's a pilot.

Nonetheless, Amazon Care also provides applications for a video visit with a doctor. Nurse practitioner or registered nurse for advice, answers, diagnosis, treatment, or referrals, as well as uh, care chat, a text chat app that connects employees to a clinician for health advice and answers. Amazon's mobile care allows employees to have a nurse visit them at home to collect lab samples, performed some testing such as strep throat, administer common vaccines, or performed physical examinations.

And courier care allows meds to be delivered to their homes. All right, so this sounds like something I want, I want for my family. I want that initial visit. I want it, uh, same day. A televisit. I want access, I wanna be able to chat with my physicians. I mean, they're essentially doing what Amazon does. They design around the consumer and they design around what is the consumer asking for.

I thought it was interesting, uh, and I pulled this out of the LA Times 'cause they were talking to a spokesman for . Uh, Amazon Health or Amazon in general, I guess. And they asked, uh, you know, how Amazon care plays into Haven's plans, and the spokesman also declined to go there, but he did acknowledge that Haven is very much aware of this and is completely supportive of it.

One of the mistakes you might make is to think, oh, this is Haven's first major initiative, which is a mistake that I made when I first read that. I thought, oh, Haven's finally doing what they're doing. Um, this is actually another area that that they're doing. So you have Amazon doing this over here and they have Haven going on over here and they have PillPack going on over here, and they have, uh, we're seeing Alexa.

Uh, we're, uh, the Echo, I keep calling it Alexa. We're seeing the Echo show up all over, uh, in, uh, rooms and those kind of things. They're doing a lot of different things. And they're just innovating in all these different areas, and we will see where it sort of comes out. Amazon spokesman declined to comment on how PillPack might play into Amazon's broader healthcare initiatives.

Uh, I'm not, I, I would think there's someone over all of Amazon, uh, Amazon's healthcare initiatives, but for the most part it feels like they have a, they have an entrepreneurial culture. They have these groups that are doing a lot of really cool things and eventually it'll come together into a broader, uh, overall offering.

I think I. We will, I, we will have to dig into that. We'll see, uh, see if we can talk to some of the representatives at the health conference, which is coming up in a couple of weeks. Alright, let's, let's jump to Walmart. As, as if that wasn't enough that Amazon announced their Amazon care, which is a huge deal.

Uh, Walmart not to be outdone, Walmart is opening its first 10,000 foot square, square foot, uh, Walmart Health Center that features an array of primary medical services, dental care, and behavioral health services as part of a new model expected to eventually . Be replicated in other markets. Uh, the first such Walmart Health Brand Center opened Friday in Dallas, Georgia, uh, Dallas, Georgia.

The retailer says that the care clinics remain in an important part of their healthcare offerings, but are more limited in service. Okay, so the care clinics are the little . Uh, cutouts in the Walmart stores. These are 10,000 square foot health centers that are at the similar locations to where Walmart is today.

The larger Walmart health Center puts, uh, key health services under one roof, uh, a first for the world's largest retailer when it comes to offering primary care. Dental optometry. You get the picture, another Walmart health center like this one in Dallas, Georgia. It is Dallas, Georgia. Interesting. It's planned for Calhoun, Georgia early next year.

Uh, Walmart isn't saying yet whether the national rollout is possible for this model, but Slosky, who is the, uh, spokesperson, I skip that. Sorry. Uh, said the new centers are a serious strategy, not a dabble, and I believe that's the case. The reason I believe that's the case is because they, uh, are now trying to defend a little bit, somewhat defend their turf from, uh, CVS Aetna.

And, um, uh, the Walgreens, um, uh, boots Alliance, uh, program. But not to be, not, not that that wasn't enough. Sam's Club is teaming up with Humana. Sam's Club, if you, if you don't know, is a part of Walmart. Sam's Club is teaming up with Humana and Telehealth startup 98.6. To pilot a program aimed at helping its members mitigate some of out-of-pocket healthcare costs.

A program called Care Accelerator is not meant to replace health insurance. Plan, but to make it easier for those with high deductibles and others with high upfront costs, uh, for, uh, for care. To get care across, uh, basic services and prescriptions. Lori Flee, senior Vice President of Sam's Health Club and Wellness wrote in a blog post.

Sam's Club members that opt into the program will be able to purchase services bundles ranging from 50 to $240 per year. That include a range of services at the lowest price point. Individual members can get certain generic drugs for free. At Sam's Club, pharmacies pay a dollar for telehealth primary care visits at 98.6 and save on eye exams and glasses and dental care.

Humana will manage the provider network that will include in-Care Accelerator. Um, according to the blog posts at the $240 price point, up to six people can partake in the savings on generic drugs. Up to six people. This is like a, like a, um, cell phone plan, uh, telehealth visits, eyecare and dental care, along with free preventative screenings, discounts up to 30% on alternative medicines such as as chiropractic care or massages, and 10% off of hearing age purchased at Sam's Club.

Members who enroll in the $50 bundle will have access to five free generics. And those in the 200, uh, and 40 range will have access to 20 free generics, uh, fleas Road. In addition, Sam's Club will pilot the program in Michigan, Pennsylvania, North Carolina, with the goal of expanding it to members across the country.

So. Why is, why is Walmart doing this? Well, uh, they've identified a customer need, and quite frankly, there's gold and then there hills, it's healthcare, it's trillions of dollars. Uh, and they are in the process of, uh, putting themselves between the, uh, the consumer and healthcare. Insurance providers, you name it, they're now being one of the disin intermediators, as is Amazon, as is CVS as is.

And it is a, uh, foolish place to be when you get disintermediated from your clients, as we know from other industries. But this one is the most fascinating one to me because it, it's, it's borderline brilliant. When you see a company make this kind of shift, so Best Buy. Most recently, best Buy officials announced Wednesday that the electronics company is looking towards in-Home Senior Care as a large source of future growth.

Of its market cap buying three healthcare services. Surprisingly, for a company historically known for growing without acquisitions. According to the report, in our view, best Buy is assembling what could prove to be a formidable ecosystem focused on senior health. Which it can use, uh, where it can use its nationwide footprint to scale over time.

Morgan Stanley analyst wrote in a report, looking ahead, we believe that Best buys deeper push into health monitoring related efforts to reduce medical expenses for insurers and right to share in cost savings represents a significant revenue and profit opportunity in the long term. Why is Best Buy doing this, quite frankly to, uh, avoid

The potential for, uh, becoming irrelevant in the retail space as, uh, Walmart, uh, not Walmart. Well, Walmart does take some of the electronic sales, uh, but as, uh, Amazon and others take, uh, electronic sales from them, I. Although they've partnered with Amazon as well, and I think it's brilliant. I think it's brilliant.

When you, you look at the assets that you have, you determine, you have scale, you have, uh, uh, expertise. You have this, uh, geek squad. You can go into the homes. You've already built out the model four going into people's homes. You've, uh, gone through all the challenges and it is a huge amount of challenges to send a service organization into the home, and they've gone through it.

Um, and so they're looking for growth. It's a very well run company and, uh, they're gonna leverage their assets to grow. Uh, but let's not forget the others that are out there. So, um, CVS Health, Walgreens Boots Alliance, we've talked about those two. Uh, they are, they are on a roll. This, this year, CVS has said its new Health hub concept store will reach, uh, four US metropolitan areas and 50 locations by the end of this year as part of a major expansion.

So this is, you know, uh, actually another quote I wanna read here. So, the retailers see 10,000 baby boomers aging into Medicare coverage each day and are also looking to fill emptying space in their brick and mortar stores. In the face of changing consumer shopping habits driven by online retailer, Amazon, which is also exploring new ways to get into healthcare business, but has yet to offer face-to-face personalized healthcare services for, uh, customers.

For customers, yes. For employees. No, they are now doing that. So what's the implications? Um, great, great summary. Uh, I'm gonna give you some of my, uh, take on it, but Vic Panda wrote, uh, this great thing, I think they pulled it from his blog, but it's in stat News. And it's titled is Amazon Care, the Beginning of the Strangler Fig for Healthcare.

Uh, if you wanna see a play, play, and this is all quoted from him, if you wanna see a playbook for what's next, take a look at the strangler Fig. The plant grows by wrapping itself around the tree. Growing down the branches or up its roots, it can eventually encase the tree, leaving it to die. With the strangler fig remaining in place.

Giant companies like banks and insurance firms use this strategy to get off legacy information technology systems they depend on, but which are holding them back from the digital world. Most are trying to follow this strategy popularized by, and he talks about how it does it and it's actually, it's a really good strategy.

If you haven't looked into it, I'll look into it. It's, uh, Martin Fowler, um, . Anyway, you can look into it if Amazon replaces the existing healthcare system bit by bit, and employee employees of self-insured companies. . Migrate to this new digital health system. Do we all get to go along is the question, why can't the current health system that most of us non-Amazon employees depend on do the same thing Amazon is attempting to do?

That's a great question, and I believe it's possible to do, the existing healthcare system doesn't have to be replaced by something growing around it on the outside. The technology exists for it to go digital, yes. But will the culture allow it to go digital and will the regulatory environment . Allow it to go digital.

These, the existing healthcare system is stalled by questions about how do we pay physicians who provide virtual care outside of their practices, and how do we pay hospitals for that care? How do we ensure that the care meets proper standards at if it is happening someplace else? If a US physician can perform surgery to on a patient in France, can physicians in India who make a lot less than US physicians perform procedures on American patients?

We already see this dynamic in medical tourism championed by. Uh, people who are championing this, US doctors want to be paid for telehealth the same way they're paid for in-person care. And they don't want to care. They, they don't want the care shifted to low cost centers like factory or software workers have experienced.

Doctors want to be paid the same as they are now and live where their patients live. Um. They don't want a care to be. They don't want care to be offshore to surgeons in Bulgaria, India and the Philippines. So far, payers, providers, and Medicare aren't getting very far with telehealth. Each can veto a move it doesn't like by someone else, like legacy IT systems.

At big companies, everything is siloed. It doesn't work together well. It just keeps stumbling along. Uh, but because Amazon self-fund, its employees health insurance. It's like its own country. The company can just, just on this one aspect of care clinics for routine care. But if Amazon and Apple or Google decides to build a more comprehensive telehealth platform for self-insured companies, what if those companies seed from the existing healthcare system after they've replicated enough of the old system to migrate away from it?

Can they do that? And the answer is they can do it. It does . Strangle the existing system. If you start peeling and it's a 2% business, we know it's a 2%. Well, some health systems are larger than that in terms of their profit margin, but it generally runs. If you go to the JP Morgan conference, two to 4% business, if you start taking away any of that revenue that leads to that profit, you're going to turn these health systems upside down.

And the question becomes how long can they operate in a negative, uh, before they, they have, you know, challenges. So, um,

the landscape is changing. It's changing pretty dramatically. So what I like to end these, I, I like to end each story with a, so what I'm gonna end the whole episode with a, so what, you know, what can health systems do? Um, and I think the first thing is really obvious, but very difficult to do. And that is put the consumer at the center.

The first thing I would say is look at your budget. Um, you know, when I look at the budgets of most health systems, it, it, it is, especially on the technology side, which is the budget I'm primarily looking at, um, you know, and you look at it, you say, where's the spending going towards, it goes to maintaining the status quo, optimizing the status quo, or extending the status quo.

It, it's, um, you know, this really isn't gonna cut it, you know, we've gotta put the patients at the consider, uh, at the, at the center. Um, and I'm just gonna share stories from my past 30 days as a healthcare consumer. So let's consider the patient's expectations. One of the expectations is when I call a call center, I want to get an answer, not get transferred three times and have the call dropped.

Okay? That was the conversation I had with my wife. And, uh, second thing I want to know that, um. I, I wanna know what it's going to cost to have my 87 year old father-in-Law see a specialist calculated, not by some weird formula, but what is my out-of-pocket cost gonna be to care for my 87 year old, uh, Father-in-Law?

And the answer to that is no one knows. And that's, that's really an unacceptable. I would like an invoice that doesn't take three college degrees and two Masters and a former healthcare CIO to figure out after two phone calls. It seems pretty, uh, pretty straightforward. Um, if you're gonna, I just wanna say, if you're gonna go through the trouble of rebranding your health system, could you please pay as much attention to the branded experience across the departments and facilities?

You know, we see the same sign in front of the building and we assume that the two entities will talk to each other from a technology standpoint, and their phone systems don't and their technology doesn't. And it's frustrating 'cause we assume if the sign in the front . that you've spent a lot of time to make sure that we know that that building is the same organization as that building, then they should, they should function that way.

It shouldn't feel like four different experiences. It should feel like one orchestrated experience from building to building department to department, um. , you know, and, and that's, you know, the next one. Any chance we can make it, at least feel like the department I just walked into has some connection to the department I just left.

And, uh, a couple other things, but that's a rant. Um. You know, here's my 2 cents on this. If you're not designing for the consumer at this point, the customer experience, it's like standing still in the middle of a shooting range or a, a golf driving range. It's like go out and stand there and let people start hitting golf balls and expect not to get hit.

You're gonna get hit, you're gonna get knocked down, and you're gonna get knocked out. Um, you have to start designing around the cus customer experience, period. It's, it's, it's becoming a consumer business and the people who are really good at it are getting into it, uh, leverage. Um. You know, the Best Buy experience sort of inspires me.

Consider the assets you already have and how they can be leveraged. Uh, you know, it's, it's amazing. They, they looked at, um, their retail footprint, their, um, geek Squad staff and their expertise in technology, and they said we should get into healthcare. Not many people would've made that connection. But when you talk about, uh, people aging in place and the growth of, uh, people wanting to convalesce at home, it makes perfect sense for them to head in that direction and to continue to sell electronics, to continue to install electronics, internet of things, connect them up and uh, and those kind of things.

They're not gonna be a healthcare provider per se, but they're right at the center of where healthcare is going. Um, you know, you just have to appreciate that. Consider what we have. I mean, healthcare providers that have doctors, nurses, practitioners, contracts, uh, uh, with payers and, and others. Reputation, real estate, brand, geographic footprint, certifications, um, uh, investment portfolios, access to bonds, operating income at least today.

And, uh, and scale. I mean, so healthcare systems have a lot of assets that they could leverage. They just have to make that leap. And, and a lot of it's cultural, make that cultural leap to say, we're gonna be in a little different business. Our business is gonna look different tomorrow. It's gonna look different a year from now.

It's gonna look different five years from now, and it's gonna look very different 10 years from now. Um, I remember when I came into healthcare, I, one of the things that frustrated me is we would say healthcare is gonna change. And people would say, well, how quickly is it gonna change? And I thought, well,

It'll change in five years. And here we're seven years later and we're still talking about healthcare, going to the cloud where every other industry, every other industry has gone to the cloud five, seven years ago. And we're still talking about its merits and its, you know, the cloud gives you agility, period.

Now there are mistakes to be made in the cloud and you have to consider multi-cloud environments and you have to consider vendor lock-in and, and cloud lock-in and those kind of things. But at the end of the day. We should have been at the cloud. We should have been to the cloud eight years ago. We should be designing architecture that is agile eight years ago.

Um, and the other thing I would say on this is it's very easy to look at this and copy. And I wouldn't do that. I'd build something new. Go where healthcare is going to go, not where it's, where it's at. Alright, so if I can get into this agility thing just a, a little deeper, um, one of the things I wanna say is

Don't install another system that isn't built on modern, secure, and scalable architecture. Just don't do it. And I, I don't really care what it does or how well it does it at this point. Bad architecture is like quick drive cement to a health system's organizational agility. You, you know it. The, the problem is we've, we've done it for so many years that we've, we've, we've taken this quick dry cement and we put in a database and quick dry cement, and then we put in a, uh, another system and then we, we got a pack system over here, and then we got a different thing over here and they're all like quick dry cement.

And when you go to move, uh, it, that's the point at which we recognize that we, we've made some mistakes and we can't move. Um. , you know, and, and it's, it really comes around. It really comes to bear. Now. It comes to bear Now when the organization is gonna start sitting back, seeing these moves that are happening.

And they're gonna say, okay, IT department, we need you to do this with the data, and we need you to do this with IoT, and we need you to be able to set up these kinds of, uh, systems in people's homes and collect this kind of information and route it over to here and bring this. And now all of a sudden, the systems that we've poured in with quick dry cement, they don't move.

Or when we pick 'em up, we start moving and it's very cumbersome and slow. And I, I, I. I understand we can't undo all that overnight and it's legacy systems and we will, um, you know, you take three, five years, but you have a plan to get rid of those. But I would just say don't install another one. Don't keep making the same mistake.

'cause everyone you install, you're gonna have to take three to five years to, you know, wrap around it and make everything work. You know, that's probably enough for this week. Um, there's a ton of opportunity out there, uh, but also a lot of potholes and, uh, we've gotta avoid the potholes. Should be, it should be, you know, actually should be a fun

time seeing what happens in healthcare from a patient's perspective. I'm really excited, even from a healthcare provider perspective, I'm really excited because we now have, we are now starting to see . Uh, off on a distance what healthcare is, is going to look like and what players are trying to establish their, their footing in certain areas.

And we can start to respond to it. And we can start to say, Hey, you know what? I think we can do that better. And I think there's a better way to do that. And because of our position and because of our assets, we can do this. I hope we don't try to just keep throwing regulatory burdens and, uh, lobbying to hold on to

A, uh, dying business, but we allow this thing to, um, to, uh, change as every business does, uh, change over time and, uh, become better for everybody involved. Uh, better access, lower cost, higher quality, uh, should be fun. Call me if you want some help every Friday. Check out our interviews with Industry in Influencers and, uh, please keep your comments coming out.

Love your comments. Bill it this week in health it.com. Good, bad or indifferent, it really all helps. This show is a production of this week in Health. It. For more great content, you check out our website at, uh, this week, health.com, uh, YouTube channel also this week, health.com. Hit the menu under. Uh . Um, channels and you can hit, uh, YouTube and please check out the new, uh, new design.

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