Advocating for putting individuals in the center of healthcare
Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.
: Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring health leaders. Today I have Marcus Osborne, Vice President Health and Wellness transformation at Walmart. His background is in healthcare at Walmart. Various years as vice president payer relations, senior director of healthcare savings programs and global sourcing even did business development and health care prior to that as a consultant. But many years in health care and it’s a privilege to be able to have Marcus on the podcasts and Marcus welcome.
: Thanks for having me.
: An absolute pleasure. So I wanted to kick it off by asking you number one did I leave anything out in that intro that you wanted to share with the audience?
: No not really. I think he probably had I guess the only thing I would say is I spent a lot of time a lot of my life was actually not in healthcare and so in magic helping I was actually in government and working on Internet policy and had a kind of recent very small step going to do in China trade policy. That’s a lot of my sort of as I sort of think about healthcare a lot of my thinking actually comes with a little bit of bias about what other what happens outside of healthcare. I think health care is a little bit insular as an industry and so yeah. So I think it’s probably the other stuff that I’ve done that I tend to think is more important than my own we’d say for healthcare experience.
: Very interesting. Definitely want to dive into that a little bit more as we as we open up here. So what made you decide to go from your previous expertise now into the healthcare sector?
: I don’t know that. I often say I didn’t decide it was probably not what I would have decided to do. Sometimes make a joke. It was it was bad luck. But in reality it was I mean specifically here with war. It is kind of a bit of a strange thing about Walmart. Walmart is not a health care company but I’ve spent 11 years doing healthcare work in the company my entire time with the company. I was given really kind of goes back to as I was kind of a late entrant to business going into her business and was late entrant. And as I was leaving and looking at opportunities I was intrigued by Walmart intrigued by platforms and the ability of platforms to have impact in people’s lives. I’ve been involved in some other significant platforms including federal government and the White House and new could saw what could happen if you could really leverage platforms and innovative ways to drive value in the market. But when I sort of came on I was given for options those told I could go in and work. Walmart was doing a lot of work in the financial services area and there was an opportunity to disrupting that space and that there was an opportunity disrupt in the food space. But the key leader that was engaged with that time who wouldn’t end up becoming the CEO of a company of U.S. business. But if you’re asked me I think the health of all businesses is the one that has the potential to drive impact. So he sold me on it. So that’s how I sort of got into the role and why I kind of stuck and have stuck with it.
: That’s outstanding. And so this idea of platforms is intriguing you know and as we see more and more MNA activity folks wanting to center themselves around platforms what would you say a hot topic that needs to be on every medical leaders agenda today and how are you guys addressing it.
: That’s a good question. I would say that probably the number one thing that needs to be on a medical leader is I would actually sort of broadened that to think about anybody, I mean particularly if you’re an employer like Walmart or AT&T or Verizon or General Motors whoever it is that you employ a lot of people and you’re paying for their health benefits. I would say you’re a medical leader and so I sort of take that as a very broad if you’re paying for health care if you’re consuming healthcare if you’re providing health care. You know what if you’re producing things that are used in healthcare then you’re in the health care sector. I would say that probably that the key topic right now is I use this analogy a lot that if you start the race poorly you finish it poorly. So I actually think are sort of what I find is that we are starting the race poorly as it relates to healthcare in the US and what I mean by that is we are the kind of analytics and insights that occurs within the service sector and industry to help us truly understand a couple of things. One the real kind of the true healthcare reality of all of us as individuals. What is my source of true healthcare reality in the moment for me. Do I have for crime diseases or do I have any kind of disease or disease risk or if I do have a disease, how is it progressing? You hear all this noise you hear a lot of talk not noise but talk about social determinants and their impact on our health and health care spending. Do I know whether how do I know whether it’s also terminal reality is applying in my life you know. Do I think about terminal very broadly to include things like not only am I employed? You know what’s my financial situation? Have I lost my job? Do I have marital stress? Am I a caregiver for an aging parent? Have I been through adverse childhood events that now might be impacting my health? All those things matter and what I tend to find is we’re blind and that’s because we’re using data very poorly we’re not leveraging the vast amount of data that exists not just traditional healthcare data like clinical data or claims data but thinking about all the behavioral data that exist about us as human beings and leveraging it understand our health. Secondarily we are doing absolutely atrocious job systemically at really analyzing providers of care and when I can what I say is often it should go without saying but people don’t want to say it. There are good physicians and there are bad physicians there are some physicians practices they are doing an atrocious job. They’re providing wildly inappropriate care. They are providing low quality care and they’re doing it at a high cost yet. Yet they continue to practice and in most cases they’re not distinguish within the networks they operate and that I think we are doing a bad job then of enabling our physicians actually understand how they’re performing are we transparently sharing with them not raw data but the analytics and insights that tell them how they’re performing how they’re performing relative to somebody else. What does good look like and what do they need to do to get to it. And so when you think about both sides of it horr job that I think we’re doing around consumer health analytics and the poor job we’re doing around pariter performance analytics I believe everybody in the health care sector whether you’re the payer whether you’re a provider whether you’re a product should be saying we’re starting the race early because we’re completely unintelligent and blind and the solutions out there they are kind of failing. And so the real question is how is we as an organization you know if you’re an organization that leader what are you doing to either change analytic approach or sort of force the system to kind of bring you something that’s better I think more needs to be done there.
: And that’s a really really interesting insight especially around the idea of optics right. We’re starting the race poorly because we don’t have the right information and we don’t understand what good is. So what are you guys doing over there at Walmart? Anything in particular that’s helping you bring Walmart some better optics to get things done better?
: Yeah I mean I guess one that probably not even though I sit on the business side which means I serve a lot of what I do or most of what I do is about helping address consumer healthcare needs or you know how do we address the needs of Walmart customers as it relates to healthcare. The thing that I know that I have really been most impressed by recently is some work is actually coming out of our benefits organization in support of our associates and related to we have one of the oldest programs in terms of going directly to providers outside of our A-S and working with in this case health systems to try to get better care for our associates. And so we really were at the forefront of what now called the centers of excellence movement. So you know groups like Boeing, Lowe’s, and others who have pushed. But what was interesting is if we look at that you know where we’ve now pushed International an over 20 kind of therapy categories are procedural categories so it’s not just like hips and knees in that placement that is now for for cancer for Cancer Care. When we look at the results that it’s just amazing right. I mean what we’re in with the results were really in many ways unanticipated and they were but it was built on the belief that not all the providers are same and that you need to identify the providers to deliver who are the highest value. And one of the things was interesting you look at the results that COE, our COEs individuals who are being directed for hip and knee replacement over 30 percent of them were being basically sent home and put on a new process where they told you know you don’t need to have your hip or any replaced over half of individuals being told they need to have a burn rate fusion after being told. Now there’s a better approach. The vast majority of individuals being sent with first placement were being sent home so you don’t actually need it. There’s a better path. And even on cancer some of them we’ve seen some frightening things frankly but over us are there right of a third of ourselves as being sort of tell that a treatment protocol you’re on for cancer is inappropriate and that you know being told that you don’t need six months of chemo you only six weeks or you don’t need to be on chemo and radiation and a drug you don’t need the drug. And the benefit is one it’s massively improving the health that pushing that model and us are finding that you needed double quick and kind of push on trying to drive utilization of these high value providers because you need to get the most appropriate care at the highest quality at the lowest total cost that the benefit has been one do our associates who are living healthier lives. Getting back to work sooner when they are in work are more productive. That too is driving significant cost savings to us as a plan an employer in doing it. And so I think that’s really kind of pushing us to say you know back in the earlier point which was we need to get our providers to do better for us to do right. And we can’t entirely hold them responsible because they don’t entirely know how they’re performing. So until we tell them where and how they’re performing we can’t expect them to kind of do more because most providers think they’re doing the right things they are not. But yes so that’s one of the big errors were thinking about how you take that idea of how to identify and assess the value of a provider and do it not just for our sources but actually how do we bring that information to our customers and help them make smarter decisions as they are engaging more broadly the system.
: That is a fascinating tweak to something that has provided a lot of value to you and your associates that frankly can help a lot of health care consumers. I think that’s a really great idea and I think you’re definitely paving the way for something really good here for the folks that decide to work with Walmart on this. Can you share with the listeners a time when you had a setback maybe something that you didn’t expect to happen within this space and what you learned from it?
: If you’re really trying to push the envelope and be innovative and try to better serve consumers do I have a whole bunch of failures mistakes. There’s a lot. I think the one that I tend to sort of focus in on goes back to actually when I came in I was involved with trying to get to iterate and think through what is sort of the next version of our clinics business look like they are right about the time when all the retail clinics all the retailers are trying to reach out clinics and now become a little passe with you know Mediclinic VVS and care at Walgreens. But one of the big mistakes we have is we actually sell at one and it still sort of it where we had a very kind of constrained scope of service on the clients that are operating within our four walls. And the reason for that is we were very much kind of listening to the AMA and other groups about what was appropriate not at retail. So we took that to heart. We were inter providers. This is you should only deliver these kinds of services and so on. And I can remember a situation in one of our markets that happened when the Colorado market where we had one of our partners that was operating clinics in our stores that had done a survey and we had constrained their scope of service so they had that we tell them these are only services you can provide you know pinkeye, strep throat, flu maybe some back scoop. But they did surveys and was asked there are existing individuals who would use the clinic you know where they’re happy and where are other services they’d like to see rendered and they actually don’t ask other customers who had not used clinics but maybe were willing to consider doing so were their services that if they didn’t render them they would use them. And one other thing that was interesting was a overwhelming response from both groups were around women’s health services pap smears and pelvic exams particularly and the rationale for it was pretty logical. You had women who were saying these services are really hard to access. And I have to go utilize them every year because if I don’t then I can’t get my birth control free up and all I really want is a simple and easy way to get my birth control every year and not have to go this massive process with a lot of expense to get an appointment with OB-Gyn and have to do all those stuff and get a procedure like it’s just too much like it shouldn’t be that hard. But we we as a business we’re sure. So keyed in on what we were hearing from the metal community and everything else that those kinds of services are not appropriate or that we would hear from leaders within the company who would say well you know women don’t want to come into a retail setting into a clinic and disrobe and have these things happen. So the failure was that caution is that and it’s because I happen to live here and have seen it with other organizations the healthcare system often fails to listen to the consumer and at the end of the day, health care is a direct to consumer business is the exact same as retail. It is a consumer business. It is in the interest of payers, interest of providers, interest of pharma and device manufacturers do not matter all that matters is this right thing, is this sort of what the consumer wants and so I think the failure mistake on our part was that we continued to constrain a scope of service around something that we consumers were saying I’m more willing to do more with you give it to me. And there was no actual reason that we couldn’t do those things other than we were too busy listening to the interests of other parties as opposed the interest of the people that we were trying to serve which were individual consumers.
: Fascinating. So did you guys expand now or are you offering those services?
: We do. Yeah and our primary care client we do.
: Outstanding. So a great lesson to learn from and appreciate you sharing that line. Marcus listeners if you’re approaching things you’re an employer how are you handling your business? Number one and number two to Marcus’s point here it is a direct to consumer business healthcare. So what are you doing to listen more to your patients. This is so key. Tell me about one of your proudest medical leadership experiences that you’ve experienced today, Marcus? Anything you want to share?
: Yeah I mean is probably the reverse of the example I gave you the failure which was I guess goes back maybe about you know a number of years ago and maybe 7 years ago now but we were saying I think about the Medicare Mark and particularly the prescription drug plan space and what we were saying was there seemed to be this kind of push partially from CIMS and partly from the groups that are offering plans the market that it felt like everything was becoming homogeneous that it was all the same like it was hard to distinguish one product from another except for brands. United AARP product and a blues product or Humana product or at that time Coventry product and will start over same with when we actually engage with consumers particularly seniors and said What are you looking for? What we’re finding is that there were whole big swaths and segments of the Medicare population that were being largely underserved by the solutions in the market. And so we start to engage with a lot of the plans are out there and an opportunity at that time to engage with Humana and in the course of service we said we think there’s an opportunity to create a unique product in the market that is designed for a much more cost conscious Medicare consumer who will in fact change their pharmacy of choice and will in fact is very open to considering generic alternatives over the branded alternatives or branded products in the market if they can get that overall plant at a very low cost that is priced in a consistent way and that’s open and transparent.
: Yeah. A
: nd so we sort of work with them and said we would like to launch with launch a PDP point that’s built around that logic around that maybe not for all consumers but there’s a big chunk of them that would benefit from it. So you know as I look back on it we did it we launched what was called the Humana or Humana Walmart plan. It was ended up being far more successful than we ever imagined it would be far more successful. I mean even the first year in our wildest dreams in the most absurd expectation of what we thought would be the total number enrollees in new plan it exceeded that by 2 or 3x.
: Amazing. Congrats.
: But it wasn’t the sheer numbers that came on it was just the fact that you know I think that’s a good example like we actually listen to customers and we’ve built something that was while not perfect was more based around what we thought their needs were and they rewarded us. They told us love your product because over a million of them enrolled the first year. So I look at that as as just a great moment because obviously it drove great business results certainly for Humana that benefitted us. But I look back and there was a study that was done and I don’t remember that for a whole but they look at that when that plan was launched and then what the reaction that caused them has been the market and the Desmet is it sort of say systemically it’s helped drive over savings over ten billion dollars annually. I know a lot of that accrued to consumers individuals and I think about mothers on Medicare, my father’s on Medicare, my stepmothers on Medicare. And so I think about the environment that they kind of enter when they became eligible for Medicare which is right around that time that I think it’s for health that I know that what we did kind of help them even if they’re not on that plan and actually have no idea what plans there are because we don’t talk about it but I know that it ultimately benefit them and so I feel proud to have been involved in that.
: That’s awesome and what a great story and a great insight. And you know it just kind of makes you think you know how do you do better listening. You know one way is surveys, do them online, you stand there with a clipboard like what’s the best way to get feedback from consumers as it relates to their health care?
: Yeah you answered question I think some of it is that I think some of it honestly reduce be prepared, you have to listen, and you have to say it can be surveyed it could be quite you know it could be the traditional way to listen with it. And you have to go out and try stuff. You have to be afraid not be afraid of trying a whole bunch of different things. What also tell you that in health care there’s a reality that some of this we just don’t know until you try because consumers haven’t consumed it in that way. Right. The idea of getting women’s health services at retail. Well nobody is doing it how can you tell me I will like it or not. Right. And you do it if they don’t show up then guess what. They probably didn’t like it or you modify it. Well maybe they did come. And so I think a lot of it is you have to be able to kind of put in an aggressive test to learn. There has been test and learn mentality which as you visit would be willing to go do it. Don’t bet the farm that is going to try it. And then just see what happens. Right. And then there you will learn immensely. You’ll learn about it.
: Man what a great call. Yeah it’s because you know that’s a great point you’re not going to get everything that you want to hear especially if it doesn’t exist yet. So you got to have that culture of trying and failing forward. And I think that’s a wonderful way to listen as well. So you’re working on a lot of things right now. Marcus tell us about an exciting project or focus that you’re most interested in right now?
: Well there’s probably quickly tell you to served going on today as just one that I sort of find really compelling based on the results and thinkers. I think there’s a lot of focus about delivery of medical care particularly in retail settings. One of the things that I’m also kind of interested in is this idea of what we call them kind of ancillary specialty services that can be delivered at retail. So today Walmart is the largest provider of vision center services in the U.S. But we’ve more recently started testing with some partners retail dental services and I have just been blown away at just the sheer uptake of those services by our customers. And what is telling me the reason I’m so excited about it is twofold. One is that I think we have massively underestimated the demand for some of the more basic services and that desire. If you really want to engage consumers in their health give them the services that they actually are looking for not the services you want them. And so I’m sort of excited about the dental test and the success that we had I’m excited by a joint venture that we’ve launched with Quest Diagnostics and the ability to bring health screenings in labs and diagnostics more directly to the consumer as opposed to having them going to have to go around it or go through an arduous journey through the traditional system. So I’m excited about improving kind of convenience and access and know I’m excited by going back to the ancillary part of the thing I’m excited about. As I look at some of the innovation is occurring look for example of some work that Google or Alphabet has done for their Verilli subsidiary where they’ve helped create a technology using 3-D imaging of the retina to do diagnostics where you can now only diagnosed with diabetes but potentially use that same device for a whole range of things. You think about now going to my optometrist. It used to be just about determining whether any glasses or not. What if that optometry visit can now be I can get a whole health screening to determine whether I’ve got brisque for a whole range of chronic illnesses just based on looking at my you know what if going to the dentist I could use as a venue to actually kind of engage you in your health what if every time you sat down in a dental chair I did a health risk assessment where I ran biometrics on you asked you a few questions and use as an entree to engage you more broadly in your house. The answer is you can write the answer is we are. And so I’m really excited about this sort of idea of using things like that or even you know we just had a Walmart wellness which is a free health screening event. We do and all our stores have just this last Saturday and for hours in the summer. Mind you which tends to be not as busy. We did full health screenings for 320000 Americans and within that we over identified ate 10000 individuals who were who are likely diabetic and almost triple that who have hypertension. And so I’m so excited about thinking about these new approaches to care delivery and how they are engaging people and enabling us to kind of start the journey better.
: That’s super exciting Marcus and thinking through these aspects of population health and what you can do to reach these people whether it be urban or rural settings. This could have very far reaching positive benefits to communities
: Yup, I agree. I agree. That’s the hope. That’s the hope.
: Hey listen man you guys keep up the work because definitely exciting work that you guys are up to there. As we get close to the end of this podcast we’re going to do a lightning round so let’s pretend that you and I are building a medical leadership course on what it takes to be successful in the business to health care. It’s the 101 of Marcus Osborne so I’ve got four questions for you followed by a book that you recommend the listeners you ready?
: OK.
: What’s the best way to improve health care outcomes.
: To spend more time listening to individuals or consumers.
: What’s the biggest mistake or pitfall to avoid?
: Not listening to consumers and spending too much time listening to the interests of the payers or the providers or the product manufacturers.
: Strong. How do you stay relevant as an organization despite constant change I think one by truly listening being empathetic to consumers that officers say by not being so isolated to your own industry but looking for solutions in other industries and other markets in other areas other countries.
: Love that. And finally what’s one area of focus should drive everything in an organization?
: At least in our organization. I think it is that when we’re actually at our best we are relentlessly focused on the needs of the consumers that we serve the individuals we serve. And that as long as we’re sort of focused on actually truly serving people and do that in an empathetic way and do as well as we possibly can I think then that’ll sort of enable us to continue to be successful.
: Love that keep listening folks. And what’s your all time favorite book that you recommend to the listeners as part of the syllabus.
: Always been a big fan and I’ve read it many times The little prince.
: Do you know who the author is?
: He’s French I can’t remember his name. I can’t I can tell you but I’ve mispronounced it so instead of embarrassing. I took one year of French in high school. It was abysmal. I performed the worst in that class of all classes I’ve ever taken. And so I don’t attempt to embarrass myself. Little Prince, you can’t you can’t miss this.
: There you go. So little prince it’s an outstanding book. Check that out. And folks you can get all of the things that we discussed today go to outcomesrocket.health/MarcusO as in Marcus Osborne you’ll be able to find all of the transcripts, details, a link to The little prince so you could continue your healthcare education here. Before we conclude Marcus I’d love if you could just share a closing thought and then the best place for the listeners could get in touch with you.
: Sure. So closing thought I think is probably this is sounds like a little bit of a broken record but I think I can go back and talk about this kind of a lot now of it to the extent you can if you’re really looking to address change. Think about what it means to build a consumer only an individual only solution. Like if we build in such a way that the only thing that we took into account were the needs of the individual. What would that look like and start there that may not be where you have to end because other things come to bear but start there. And certainly if someone wants to reach me or walk a mile people have mastered email generally so it’s just marcus.osborne@walmart.com
: Outstanding Marcus. Thank you so much and listeners you have again the opportunity to check out the show notes, go to outcomesrocket.health/MarcusO and you’ll find all the things that we discussed there. Marcus, it’s been a pleasure to have you. And super grateful that you carved out time for us.
: Thank you so much for your time.
Hey Outcomes Rocket friends, thanks for tuning in to the podcast once again. As a leader in health care, you have big ideas great products, a story to tell, and are looking for ways to improve your reach and scale your business. However there’s one tiny problem. Health care is tough to navigate and the typical sales cycle is low. That’s why you should consider starting your own podcast as part of your sales and marketing strategy. At the Outcomes Rocket, I’ve been able to reach thousands of people every single month that I wouldn’t have otherwise been able to reach if I had not started my podcast. Having this organic reach enables me to get the feedback necessary to create a podcast that delivers value that you are looking for. And the same thing goes if you start a podcast for what you could learn from your customers. The best thing about podcasting in healthcare is that we are currently at the ground level, meaning that the number of people in healthcare listening to podcasts is small but growing rapidly. I put together a free checklist for you to check out the steps on what it takes to create your own podcast. You could find that at outcomesrocket.health/podcast. Check it out today and find a new way to leverage the sales, marketing and outcomes of your business. That’s outcomesrocket.health/podcast.
Recommended Book:
Best Way to Contact Marcus:
Marcus.osborne@walmart.com
Episode Sponsor:
