News Day – Walgreens, Cuban’s HLTH, CVS Misses an Opportunity


Bill Russell

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It’s Tuesday News Day and today we look at Walgreens, CVS, Amazon, Mergers, Trends and pay tribute to a great leader in Bernard Tyson…

Bill Russell: 00:08 welcome to this week in health it news where we look at as many stories as we can in 20 minutes or less. That’s going to impact health it. My name is bill Russell healthcare CIO coach and creator of this week in health IT. a set of podcasts and videos dedicated to developing the next generation of health leaders. Uh, before we get to the news, we want to talk a little bit about the passing of a great leader in our industry. Bernard Tyson, the Kaiser Permanente CEO. Uh, you know, I didn’t know Bernard, but I did get to interact with him in the past month at the health conference in, uh, in Vegas. Uh, I went to a press briefing where he was, uh, talking about the next steps in Kaiser’s, uh, program around homelessness and addressing homelessness in the area. Uh, you know, my tribute, uh, to Bernard Tyson is to talk about the work that he was so passionate about on that day.

Bill Russell: 01:02 And so I want to share a little bit of, uh, what he was talking about and a little bit of, of what they’ve been doing. Uh, earlier this year, Kaiser unveiled the first three, uh, in January, uh, of its project aimed at reducing homelessness and preventing displacement, two of which are being funded by the $200 million thriving communities fund. The system announced last may initiatives include investing 5.2 million in Oakland, California based not for profit community development organization for the purchase of a 41 unit apartment complex in East Oakland to be used for affordable housing. Tyson said the system also plans to permanently house more than 500 of the city’s homeless individuals age 50 and older who have one or more chronic health conditions and provide them with social services and supports. But the largest investment comes in the form of a a hundred million dollar fund Kaiser created with not for profit housing organization, enterprise community partners to preserve and expand affordable housing in communities within the eight States and district of Columbia where the system operates. Enterprise match. Kaiser’s $50 million commitment.

Bill Russell: 02:15 Bernard Tyson was impressive. Um, that day he fielded the questions behind the podium, uh, with grace. Uh, I even threw a technical question how to, um, which I like to do with CEOs from time to time and, uh, and I was impressed at his command of the concepts, uh, of the question I asked. Uh, but I think the most impressive thing was that, um, when the, when his, uh, his briefing was over, he came down off the podium and started talking to people in the audience based on the questions that they asked. And not only was he, was he talking to them about things, he was soliciting their input and asking them, you know, what they thought and, and how, um, how they might approach it. Um, you know, I only spent 30 minutes in the room, uh, with the man over his entire lifetime. But, uh, you know, I came away with one thought and that is, this guy is the real deal.

Bill Russell: 03:15 Um, he really wanted to end homelessness and he was very passionate about it. Uh, he will be missed and our thoughts and prayers go, uh, to his family. Uh, today we have a lot of stories to look at because I have been at conferences over the last couple of months. Uh, I’ve been at the health conference, the chime conference and the, uh, health 2.0 conference and a lot’s been going on Amazon plans, a new grocery store. I’ll talk about why that’s, uh, pertinent to health care, Cleveland clinic and American well, uh, on, um, uh, do a partnership around a high acuity care Walgreens. And KKR was just announced today and I’m going to touch on that a little bit. Uh, Mark Cuban on health, uh, at the health conference, uh, health court and uh, we’ll talk a little bit about that. I can’t believe we’re talking about the nine biggest trends for 2020 already, but there was a story in Forbes and a nine biggest trends for healthcare.

Bill Russell: 04:10 I’m a technology and I’m going to cover that very quickly. And a California regulators, uh, did not approve st Joseph health and Adventists come together. I’m only going to cover that in that it has a, uh, I think there’s a trend to keep an eye on. And then CVS and tele med. And I think we’re going to start with the CVS Telemed story, uh, in a minute. But they are, they’re doing telemedicine nationwide. Uh, we want to thank our founding channel sponsors who make this content possible. Health Lyrics and, VMware. If you want to be a part of our mission to develop health leaders, go to this week, for more information. And this episode is sponsored by health lyrics and health lyrics. Uh, you know, when I became a CIO, I was really overwhelmed at first and one of the things I did was hire a CIO coach to help me in the journey.

Bill Russell: 04:58 And a CIO coach is someone who has wisdom that can only be gained through years of experience. It was invaluable to my success in the role. And I now coach CIOs, uh, through health lyrics. If you want to learn more, visit so, and don’t forget over the next three weeks, I’m going to be dropping the 12 CIO episodes that I recorded at the chime conference. We take a look back. We asked each of the 12 CIOs the same eight questions, looking back on the year and looking forward on next year. So you’ll get to hear their priorities, what they tried to accomplish this year, maybe succeeded or didn’t, and what they’re looking to do next year. And uh, you know, I, I think it’s a must listen to anyone who’s in sales trying to sell into healthcare, um, you know, really needs to listen to these episodes. It is, uh, it is, you know, that good to get that perspective and to realize not every healthcare system is the same.

Bill Russell: 05:52 They’re a very different, all right, let’s talk CVS. I’m going to go through these stories rapidly. So CVS takes tele med nationwide with minute clinic visits, visits, uh, 24 hours a day, 365, 32 States, district of Columbia. Uh, the thing is called MinuteClinic video visits. They’re going to charge 59 bucks per visit and they’re going to handle a minor illness, injury and skin conditions. And they’ve had thousands of visits so far. I’m doing this on the fly, just so you know, I’m, I did not prepare like I usually do. So I’m reading the stories with ya. Um, so they’re going to be rolling this out and 1100 retail medical clinics, uh, as you know, in order to diversify they acquired Aetna, they’re also taking 1500 of their stores are creating health hubs. They’re taking 25%, cause we’ve talked about this before on the show, 25% of the space.

Bill Russell: 06:47 And they’re allocated, I guess they’re taking away the Fritos and the soda and they’re putting in a more health related services. So they’re, that’s an attempt to diversify as they begin to see slowing sales in the, um, in the retail retail space, especially the pharmacy space, uh, with generics and other things. So, um, here’s the, uh, here’s the, so what on this one, I, I think they’re missing an opportunity and that opportunity is, uh, Mark Cuban w, which is a story I’ll share here in a minute. In fact, I’ll, I’ll just go here and then I’ll come back. So Mark Cuban health court at the health conference in Vegas. And, uh, the reason I say health court cause it’s the talk that a lot of people were talking about. He did a couple of things. One is he took on the insurance industry and he took on the, uh, pharmaceutical industry, uh, head on and he dropped the F bomb about five times, which you don’t normally hear at a healthcare conference.

Bill Russell: 07:45 And, um, you know, regardless, he was on the stage with Andy Slavitt, uh, who is a former CMS administrator and helped the Obama administration through their, uh, website debacle he is a, technology genius, um, really understands how to make a technology sing and did that, uh, for that, uh, for that whole program. Uh, but he’s now running a thing called the United States, uh, United States of care, United States of care, I want to say healthcare, the United States of care. And, um, it is a fund that’s raising money to address the, uh, disparities, the disparities in, in the amount of care that people receive. Uh, the people who are disenfranchised, uh, Medicare recipients, people who fall through the cracks and those kinds of things. So he’s, he’s got a fund and they’re helping to raise investments. These guys went back and forth a little bit, but for the most part, I’m going to talk about what Cuban said.

Bill Russell: 08:43 And here, here’s two things. So, um, Cuban pointed to an example of a named drug in the market that another drug company purchased before ratcheting up the price by 2000%. He said that he began looking with a team of health experts into how much it actually costs to create the drug. They said the market is not huge, relatively speaking, but it is about $70 million market. But for that 70 million, the cost to buy those drugs wholesale for one year for the entire United States, the entire United States, $250,000. Cuban said. So I said, Cuban said, uh, well, why don’t we just go F’m up? Uh, he suggested acquiring a wholesale wholesale or manufacturer in a bid to disrupt the drug market where he’s going to, what he’s going to do is create a club, kind of like Costco, where you pay $100 to be a part of the club.

Bill Russell: 09:33 And we’ll go through the whole series of drugs where we’re doing and we’ll charge you $100, but we’ll do everything at cost plus 15%. Cuban also funded a study and, um, the study essentially said we got to get rid of the insurance companies. And, uh, he noted that most large companies around the U S are self insured. And that there is an opportunity here to cut off the middleman. And as you know, when you have these layers in any other industry with each layer, you get a markup. And that’s one of the things that’s, that’s happening in healthcare. Um, I appreciate Mark Cuban. I appreciate him, uh, attacking this. Uh, I agree with them. You know, for every dollar we save in healthcare, we’re spending three in pharmaceutical costs. The cost of drugs has to be, in fact, if you’re going to address the costs in healthcare, you gotta address a handful of things, but one of them is the, the, uh, drug costs.

Bill Russell: 10:33 Uh, the second is end of life care. You just have to address, uh, end of life care or, you know, it’s just, it’s not, not going to work. That’s not what he talked about. So I’m just gonna try to stick to the story here. Um, going back to the CVS thing, the thing I think CVS missed the, so with that, I think CVS missed is this opportunity for a, uh, a club kind of thing, like a Costco type model. And they have a real opportunity here. They have a suite of services that are desirable to the community. Uh, they, they could do a, a club that gives you access to drugs, access to drugs. It gives you a discount on drugs, gives you a discount on, on the whatever goods that are going to continue to sell in those stores. Uh, it gives you a discounted rates to the, um, to the, uh, a telemedicine platform and to visit for that matter.

Bill Russell: 11:28 Uh, you know, they essentially create the first health, well not the first, but they’ll create a healthcare club that is national in scope and offers telemedicine services and whatnot. I think the thing has a potential, uh, I think one of the challenges is they’re starting to think like health care and they need to break away from that and they need to stop thinking like healthcare and go back to their roots and think like retail. Um, I think that’s the thing I liked about them is they were sort of sort a hybrid but leans more towards really understanding the consumer and they need to go back there and uh, and stay there. Now getting back to Mark Cuban, I quite frankly, I, I love it. You know, go after the cost of drug prices, go after the multiple layers, a perfect opportunity for a, for a shark tank type a entrepreneur.

Bill Russell: 12:13 I look forward to hearing what he does next. Uh, let’s hit, I’m just going to go up on this. So California regulators, the regulators say no to Adventist health and Saint Joseph health merger. So I mean, nothing exciting here. I mean, you’re talking about small markets here, Adventist and Saint Joseph health system. What you are going to see is a whole bunch of really small markets in uh, the Northern California area. Uh, things like Napa, Sonoma, um, gosh, Mendocino, Humboldt or Lake Mendocino, sorry, uh, uh, anyway, you get the picture. I mean these are all the, the beautiful places that you want to visit and uh, tastes good wine. Uh, they’re not densely populated. Uh, these hospitals are not huge and, uh, they, they don’t really equate to a lot of money. Um, but I will say that they are a critical part of the care fabric within those communities.

Bill Russell: 13:10 Now, one of the things you’re seeing here is you’re seeing two things. One is you’re seeing Providence divest of, uh, underperforming assets in markets that they will not be able to be essential, essential, meaning a significant market share. Uh, you have Sutter in that market. You have Kaiser in that market. Uh, there was no way for them to really get essential. And so they’re jettisoning, um, uh, assets and you’re seeing that across the board. You’re seeing that with the Ascension and others as well. You, uh, market essentially reality’s going to be critical. They’ve deemed it to be critical and that’s what they’re pursuing, where they can have economies in a single market. So you’re seeing them try to do that. Uh, the department of justice is stepping in and the reason they’re stepping in quite frankly is because they believe that mergers and acquisitions have not led to better care and better, uh, uh, better quality of care and lower costs.

Bill Russell: 13:59 Uh, and they may be right. We, I’m not sure we have enough data to show that. Um, I hope that’s the reason they’re stepping in. Uh, the other reason for them to step in is to just, uh, you know, extract some sort of concessions out of, uh, these large health systems, which, uh, which they do from time to time. But again, I, I, they’re going to stand on the, on the, uh, platform for it is not, uh, providing I think health systems. The, so what on this is, I think health systems have to start to publish numbers on the benefit to the community when a merger and acquisition goes through. And if there is none, I think they just need to be transparent and say there is none and then figure out a way to, uh, to make it a benefit to that community. The other thing I really don’t understand is, you know, you have, you really do have, uh, economies of scale already at the Saint health system.

Bill Russell: 14:51 You’re talking, they’re a part of a $20 billion health system. It’s not like they need help with security or any of the it components. They have enough money for those things. So, um, so it’s just a matter of, you know, when you get these islands off on their own, it’s hard to support them at scale. And so anyway, um, just a trend to keep an eye on. Speaking of trends, nine biggest trends that are going to hit healthcare, I’m just going to rattle through them, give you my thoughts, AI and machine learning to of course AI, machine learning. It’s all we’re hearing about. Uh, here’s what I’ll add to it. A slow pace and clinical fast pace on an administration side. We’re already seeing it with the RPA and uh, we’re seeing a lot of RPA, a lot of conversations around it. A lot of systems are talking about doing it next year, a big year for RPA.

Bill Russell: 15:40 I would’ve put RPA in there. It’s a subset of our robotic process automation. It’s a subset of AI and machine learning. Um, but, uh, anyway, slow and clinical fast on administrative, uh, robotics, not a surprise, just a continuation of the DaVinci work and other things. A computer and machine vision. Uh, we are seeing this, you’re seeing, um, those algorithms be used in the clinical side and the imaging side. Uh, you’re also seeing it, uh, use to support and to elevate the RPA processes. Um, RPA processing. If you’re buying an RPA system that doesn’t, it doesn’t support a computer vision, uh, it’s going to be way too brittle. You’re going to want something that supports computer vision, uh, along with it. So keep that in mind. It’s a, uh, I think it’s a critical component of any AI platform. Wearable tech, Tim Cook’s betting the farm on it might not be the farm.

Bill Russell: 16:34 It’s Apple. They have a lot of money. Uh, but he’s saying that Apple will be a healthcare company. You’re seeing, uh, uh, Google just bought Fitbit. So yeah, wearable tech is going to be big and we’re seeing the, we’re seeing big players for an after it, uh, genomics. Yeah. I think genomics will be big in 2020, but at not big. Like all of a sudden it’s going to spike. It’s just going to continue. Uh, genomics and precision medicine is how I would say it. I think you’re going to see advances in precision medicine. The area and genomics, I think it’s the most interesting is generational genomics. I would like to see someone that gives me the ability to move my parents’ medical record, which is now, you know, we have a couple of decades of the EMR. I’d like to move my parents record my record and my kid’s record into the same, uh, system and start to look for patterns and similarities.

Bill Russell: 17:21 I think there’s a lot of opportunity and let’s just call it generational genomics and hopefully that starts to take off. Three D printing has been big, continues to be big. We see it in dentistry, we see it in orthopedics, see it in surgical, and I think it will continue. I’ve seen a three D printers in just about every health system I’m going into of scale at this point are uh, trying to, uh, stay ahead of that curve extended in virtual reality, uh, virtual, augmented mixed reality. Uh, I think you’re going to see it, uh, really continue to, uh, to be driven in things like, um, uh, education, uh, simulation environments, those kinds of things. You’re also going against simulated environments for, uh, patient recovery and, um, and wellness. I think you’ll continue to see it and, uh, you know, Cedars, UCLA, others, uh, leading the way.

Bill Russell: 18:13 You might also see it with, uh, up up, uh, optometry and in other areas. I think there’s, I really do think that’s going to be big. Again, I don’t think it’s going to spike. I just think you’re going to see an awful lot of money. Digital twins is their next one. 5g is their last one. So 5g I talked to, uh, Shafiq Rob at the chime conference. 5g uh, he’s a CIO and, uh, at rush in Chicago and he’s talking to me about the speeds and, and I think 5G is going to enable a whole host of new opportunities in the um, uh, gosh, remote patient monitoring home, home based care agent place. There’s going to be a lot of opportunities there. The question I have in the back of my mind is the speeds we have now on 4g are probably enough to do a bunch of these things and we’re not doing them yet.

Bill Russell: 19:06 So there’s probably something else standing in the way. I don’t think 5G, all of a sudden going to open the flood Gates. I think we’re going to need the creativity of the industry to start to start to kick in. So, uh, let’s these last three stories. So Cleveland clinic, American wealth partner to launch digital digital company and this is going to be high acuity care, a telehealth platform. Uh, I think it’s an interesting play. Uh, they’re forming a, uh, a joint venture company called the clinic and we’ll have to see how this plays out. It could be a partnering opportunity for some health systems and could be a, uh, a new business model for others to, uh, keep an eye on. Uh, let’s take a look. The most emerging stories in fact, so emerging, I haven’t even looked at them. Let’s see. Walgreens may get scooped up by the largest private equity deal in history.

Bill Russell: 19:55 Report says, um, what this is telling you is that the, uh, the normal run of the mill pharmacy, no matter how big it is, no matter how many locations it has is under pressure. They are not selling as much. Uh, they are not making it as much from their retail operations and their pharmacy business as they have in the past. And therefore Walgreens is under pressure. Now, CVS has made this pivot and they are ahead of the curve when it comes to addressing this pressure. I’m not saying they’re out of the woods, but I am saying that they are, uh, uh, ahead of it. Um, you know, there’s, there’s an awful lot of things that are, uh, pressuring Walgreens. You have, uh, Amazon’s entry. You have, um, gosh, uh, generics is pressuring them. Uh, Amazon’s entry a Walmart, Costco, you name it. Um, there are, there are there, they’re really the, the neighborhood drug stores, uh, struggling, but not so much that it can’t be acquired by a KKR.

Bill Russell: 21:01 Uh, I don’t know what KKR plans to do with it. I don’t know what their plan is, quite frankly. Just the fact that they’re coming in with this kind of money makes not a lot of sense to me if, unless they have a plan to somehow turn this around. And, um, I doubt they do. I, I, I doubt they do, to be honest with you. I can’t imagine they do. Maybe they have an ACE in their pocket and I’d like to see that. But, uh, we’ll see what happens. Um, and then finally, I’m already over my 20 minutes. I apologize. Uh, Amazon plans, new grocery store in LA, and it thinks about how to conquer the industry. So here’s what Amazon’s going to do. And there’s a great quote. I’ll just read it. There’s a great quote down here, um, by the guy who used to be with Amazon Rosman Rosman right.

Bill Russell: 21:45 I think his name’s John Rossman. There it is. John Rossman, a former Amazon executive and author of the book, think like Amazon said, he expects the company to combine what it’s learning from its various grocery formats, including the high tech Amazon go stores into a significantly different grocery store of the future. Once they get the technology and operations really pressure tested and proven, then they’ll figure out how to roll it over into whole foods or a chain of another name said Rossman who managed the Amazon marketplace, where third party sell their sell on It will take a long time and it will feel like Amazon is crawling. Rothman said it won’t be like a light switch flipped on and off.

Bill Russell: 22:30 That’s from a, that’s from an insider, a former insider. Uh, but that’s from an insider who is essentially saying it’s going to feel like they’re just sort of inching along. Nothing’s happening. Um, they’re trying some different things out, but once they get the format down and the money behind them and the supply chain behind them, um, it’ll be interesting. Why is this a healthcare story? Uh, I shared the story a couple a month or so back about the, um, the data that has garnered from grocery stores is that powerful predictor of health and a community. Because you have the programs, you have the loyalty programs, which essentially tie the food purchases to certain zip codes. When she tie that to food purchases to certain zip codes and you look at outcome data which is available, you can now create a pretty interesting profile of a community. And Amazon, I still argue that Amazon is a data company and with that data, who knows, they might be the most powerful health company in the, on the planet at that point. Um, yeah, that’s all I’m going to cover for this week. Uh, remember to check back in and we’re going to be

Bill Russell: 23:45 dropping those episodes every pretty much every day for the rest of November. You’re going to have an episode being dropped on the channel, so check that out. It’s going to be either a news day episode on Tuesday or it’s going to be one of the CIO’s episodes. Um, following that in December, we’ll go back to our normal format. Every Friday we’ll have a full interviews and every, uh, Tuesday, Tuesday’s news day, we’ll talk about the news. If you want to support the fastest growing podcasts in the health it space, here are a few ways to do it. Share it with a peer sign up for insights and staff meeting. These are two services on our website. They’re free, uh, designed to help you with your health it career, uh, or healthcare career, uh, interact with our social media content on Twitter and LinkedIn post or repost our content or send me feedback at [email protected]

Bill Russell: 24:34 Uh, you know, your insights. Continue to guide the show. Um, helped me to know what you, what kind of questions you want me to ask of these, uh, uh, industry influencers. Uh, you know, one of the recent emails asked me to start asking them about budgets and how they budget and how they think about budgeting. So I’ve started to incorporate that in some of the questions I’m asking. Uh, so again, just keep providing the feedback. Uh, helps to make a better show. This show is a production of this week in health it for more great content. Check out the website this week or the YouTube channel as well. Special thanks to our sponsors, VMware and health lyrics for choosing to invest in developing the next generation of health leaders. Thanks for listening. That’s all for now.