With Walmart Health Shuttering Its Doors, Retail Healthcare Has to Rethink Its Role & Strategy in Primary Care

Hello, everyone, and welcome to another episode of Experts Talk, MarketScales' premier debate and discussion roundtable where we sit down with the main voices, the top thought leaders timely news, the the market movers, really, that are shaping your industry. And again, hearing from the thought leaders, the experts, the professors and professionals, and everyone in between that are shaping the industry, and hearing from them to get actionable with our analysis, so you can walk away from our show feeling a little more knowledgeable and a little more action oriented about how to engage with some of these major industry defining trends. So welcome again to the show. My name is Daniel Litwin, the voice of b two b. I'll be your host for today, per usual, and I'm excited to be back in the studio to talk shop with these great panelists, which we'll introduce here in a sec. But if this is your first time or you're a returning audience member on Experts Talk, then you know what I'm about to say. Make sure you get all of our content, because we've had a ton of fabulous conversations here hosted by myself, by some of my colleagues, covering a variety of different industries. And more importantly, sitting down with a variety of key voices in each industry to get really granular about critical, critical trends. So head to market scale dot com for, previous episodes of the show, as well as access to future episodes and an overview of all the content that we're going to be exploring here on Experts Talk. Again, you can find all that and more at market scale dot com. Alright. Let's get into it. As you see below, we're going to be talking retail health care today. That's right. Retail health care, especially with the context of Walmart's health clinic closures, which we will unpack a little more granularly here in a second. But to paint a broad picture here, the state of retail healthcare is a bit uncertain, I guess you could say, with both some strategic failures as well as massive expansions defining the ecosystem. So it's hard to really say, you know, if you can give a grade to the whole ecosystem whether things are looking great, things are petering off, or how we can really gauge the health of the retail healthcare ecosystem. Walmart and Walgreens have both faced some setbacks recently with big headlines being that Walmart is closing all of its health centers, and Walgreens is taking some significant financial impairments, which is prompting, some clinic closures. But then on the flip side, we have Amazon's One Medical and CVS's Oak Street Health, which are expanding and seeing a lot of success in the market. Which obviously this, you know, signals a variety of market forces, but at least on Amazon's and CVS's side, some strong market demand for their primary care models and their approach to retail health care. So what's really up here? Right? Where does retail's health care, or excuse me, retail health care's primary care model, as a market model and as a, node in the larger health care ecosystem, where does it really stand today? Right? Is it a wise investment? Is it, you know, maybe not so much in the current state of the macro economy or the current state of the health care industry. What is making some retail care centers a success while others flounder? And regardless what role should retail healthcare play in providing necessary care to millions of Americans across the US, and helping the industry meet some of its larger goals, like, you know, value based care, for example. And just some of the major, shifts that are happening, regardless of retail health care in the health care ecosystem? Well, let's let the experts talk on Experts Talk and share their perspectives here. So I'm pleased to welcome our panelists for today's conversation on Experts Talk. Welcome to the four of you. It's a pleasure to have this squad here with us today. We've got a variety of perspectives and I'm excited, to cut it up with them and really talk shop. So let's go ahead and go down the line and welcome each of them. We're joined first by mister Steve Welch, CEO and cofounder of Restore Hyper Wellness. Steve, welcome to the show. How are you doing today? Great. Thanks for having me. Absolutely. Welcome. And, it's a pleasure getting to pull from your perspectives today. We're also joined by I'm a little offended. You you wait real quick. You talked about the growth of the industry. I'm a little offended. ReStore, we opened up sixty four locations last year. Yes, sir. There's been threats of downsides, but, you know, I think there is a lot of growth out there, and and ReStore certainly represents a big portion of that. Definitely. And that's why we're excited to have you on here because you're gonna be able to give us that really granular, pulse check on retail health care's growth and the strategies that are working, considering that Restore is seeing, a lot of success and is expanding its footprint across various US markets. So welcome. Thanks for joining us. We're also joined by mister Sean Nason. He is founder and chief experience officer at Mophie. Right? Or is it Mo fi? Mophie. Mophie. There we go. Got it right the first time. Sean, welcome back. How you doing today? Doing great. Great to be here, and, looking forward to this panel discussion. Absolutely. Pleasure having you on. We're also joined by Matthew Herrera. He's VP of sales at Carrington. Matt, welcome to the show. How are you? Good to be here. We appreciate it. We're looking forward to, today's panel for sure. Absolutely. Yeah. Definitely. Thanks for joining us. And last but not least, mister Brian Urban, director of innovation and emerging markets at ThinThrive. Welcome, Brian. How are you? I'm good. Thanks for having me on here, Daniel. This is gonna be a good show. Absolutely. You're my podcast host compatriot here today. So, you get to play guest today and not host. So good to have you on, man. Alright. Steve, Sean, Matt, and Brian, we've got a stacked panel, and they're all ready to, you know, really dive in and throw their weight, in this larger discussion. So let's get right into the meat of the discussion, folks. I want to first just get a little bit of y'all's, I guess, immediate takeaways from the major news that's defining our conversation today, which is that Walmart is closing all of its health clinics. Right? What was y'all's initial response to this Walmart health clinic closure stack of headlines that came not too long ago? Right? Was this a surprise? Was this a unexpected divestment from Walmart? You know, did this signal something you already saw coming in the industry? Or was this seen as more of a a big, but, you know, focused outlier in the industry. Give us y'all's takeaways as you saw these headlines hit. Well, given Sean's been so close to Walmart, I'd love to hear his perspective first. Yeah. Yeah. Yeah. I'm seeing I was gonna let you all talk about it first. Yeah. Listen. I think the press release from Walmart Mart hit about five o'clock in the morning. Well, they didn't do a press release. It hit their corporate page. And by five zero two, my phone was blowing up. Yes. We at Mophie were very involved in in the coming to life and bringing Walmart help to life. Life. Does it surprise me that Walmart has made the choice to divest and not move in that space, going forward. It does not surprise me knowing current leadership within the organization. Does it bother me greatly? Absolutely. It bothers me greatly. I think the model that was built there and the price transparency and the patients and humans it was serving are going to see a great loss, in this space. And, I'm very interested to see where retail health is going. As you mentioned in the opening, you know, Daniel, with CVS and Oak Street and Amazon with One Medical, the realization even in those is those organizations bought massive, massive retail or massive organizations and are bringing them into retail, retail, and I really hope they don't screw them up. Yeah. Right? Like, let let let's be honest about it. It's not like it's not like that CVS came up with this idea and built it. They bought something. Where what I am at least proud to say with Walmart is Walmart went in and built something, did a ton. I know Brian's is a qualitative researcher. I think we did, you know, thirty thousand hours worth of qualitative research. So what Walmart brought to market is what consumers were wanting and needing in the space, and and it's sad for it not to be there anymore. Yeah. I'm not but for me, I my heart's got to this. A lot of employees that are without jobs and and, you know, if nurses that are out there, especially nurse practitioners, I encourage them to go to restore dot com. We would love to have you join the team. You know, there is a need out there for more people in health care. I think one of the big challenges a lot of, the people who are scaling quickly have is is getting the right talent in the right place. You know, what what didn't surprise me, you know, and I have not been nearly as close to it as Sean has been, but there are not a lot. I mean, if you think about it, health care is arguably the largest industry in the United States. However, there's basically zero scaled health care providers retail in this country. And the question is why, and I think there's there's two reasons for it. Number one is kind of the more cynical, which is, you know, we have created a very difficult to operate in health care system. You know, the insurance companies who've used regulatory capture, it has been very fragmented. There's fifty of them medical boards. There's fifty of them nursing boards. There's fifty of them pharmacy boards. There's fifty of insurance company, insurance boards. So for people to scale in that space, it becomes very difficult, and I think that that's part of it. But I think the bigger issue is actually the companies are not where the consumer is. And what I mean by that is it it Dreamit, you know, which is a venture fund. You know, a decade ago, we started to see consumer sentiment go to a totally different direction than the health care industry. The consumer started to think about health care not like, hey. I get sick. What we would call sick care. And we lump the two together. And even in this conversation, we've already lumped the two together. Sick care, hey. I have a problem, is very different than where the consumer, at least a significant portion is, I wanna stay healthy. I wanna be able to do the things I'm doing today deeper in life. And I think we've conflated those two together and not understood the consumer has a very different mindset. Yes. If you have cancer in this country, we are amazing. Our traditional healthcare system is amazing. However, if you're just trying to stay healthy, our system's not set up to design the to support the person that's really trying to be invest in their health and be proactive. And, like, one of the reasons Restore has saw seen so much success is we are focused on that consumer. That consumer while they're healthy, not trying to address once they're sick, but to keep healthy longer. I think health Walmart and most of the others that have tried to scale in this space have missed where the consumer is and the education the consumer is desperate to get. Yeah. Yeah. Steve, I think on top of what you're sharing, what was interesting for me just as a reaction to the closures of the fifty one locations for Walmart was, first, I thought of the economic challenge that exists. And and in US, not only just the deficit that exists between frontline, midline, mid level practitioners, but, you know, primary care, then oncologist specialty as well, is the actual payment infrastructure that exists in the US for primary care specifically. So for a retail organization to want to have a speed to scale for a point solution that's primary care that may not have a connected throughput of a service model that's end to end for other care needs, like what CVS is able to do right now because they have an insurance arm. They have a PBM arm. They have more of a throughput for someone that is needing primary care upstream services and then downstream as well, and then the insurance coverage on top and drug. So it's it's such a different setup that they have, and it's not necessarily a speed play, but it's an end to end play. So then the the payment side is a little bit different from an economic perspective for a CVS than a Walmart or a Walgreens. And then taking the step back, aside from the payment infrastructure not being in place, I really think the actual data and technology enablement infrastructure navigation of that, following that that visit. But the actual ongoing touchpoint of what other needs are, needing to be addressed for the individual patient and how is it interconnected into the rest of the ecosystem. So, we can't simply push the value based care methodology on primary care without supporting them from a a data and technology enablement perspective for the consumer at the end of the day. Those two things hit me immediately, that the economic challenge is there and then the actual support of the the provider too. Yeah. And Yeah. Go ahead, Matt. Let yeah. Let's go ahead. Let's hear from Matthew to round out this initial thought. Yeah. I don't know. I I just had, you know, my initial review, honestly, being in the telemedicine space for as long as I have over a decade. I I fully expected Walmart to with their acquisition of MeMD, I thought it was gonna be more virtual. I I I personally believe they kinda went too quick from acquiring a virtual health care company to getting brick and mortar stores in place. That model, in my opinion, it just wasn't really sustainable, in the long term with with jumping in and diving in so quickly. I I believe, you know, just being in this space for as long as we have, the the cash pay situation was probably the main issue here. You know, if you're getting a lot of Medicare or in particular Medicaid customers trying to come to your clinics, they simply can't afford some certain certain things. So probably going Walmart probably should have taken the angle of going towards the actual Medicare companies themselves, partnering up with maybe some over the counter, type companies, the OTC cards, and sticking on a benefit there saying, hey. If you're an OTC card mem you can go to one of our in store clinics, use your funds, which is three to four thousand dollars a year, and go get those services that way. So there's a there's a lot of different ideas that I think could have potentially saved them. But jumping in too fast, opening the clinics that way, you're not really seeing the Teladocs of the world, the American Wells of the world, the Dial Cares of the world, which is our company, go that route. That's that's why MeMD didn't do that either. So I was a bit confused at how quickly they jumped into the market going for brick and mortar. I understand the prescription drug side that they have competing with CVS, competing with Walgreens, but those are two different giants that have been in the health care space for quite some time. I think there was just too much. I think, you know, when you go to Walmart, you think of you know, you got grocery store, takes up fifty percent of the store. You got clothes, takes up forty five percent of the store, and you got pharmacy, which pharmacy probably is one of the biggest cash revenue, areas for Walmart. But, I think it's just rolled out a little too fast. We we Brian, I'm curious why the the the kind of advantage if you kinda take a step back and if you're in Walmart shoes, the biggest advantage you have in a space that's pretty crowded online is the retail footprint. So, you know, why do you think that they I I'm surprised. I I would have said move faster in the retail because that's your competitive advantage. And from a dollar per square foot, I've I've never been to Walmart. I've never been to a management Walmart, but I suspect they look at, you know, cents per square foot in that that facility and I you know, and profitability. And I'm sure that the profitability on the health care side, the pharmacy side is substantially higher, I would guess, I should say, than the food side. So if if they weren't gonna use that advantage, you know, how are they gonna compete without that using of retail footprint? So I think the the main thing there was going after, you know, MeMD had a massive customer base. They were very heavily involved in the employer market. So it it was very confusing to see such a big competitor in our space with Teladoc and DialCare and American Well just dive into the individualized consumer space, you know, going from I mean, they had me and D had several Fortune five hundred companies under their belt. So I it it was it was very surprising. I would have probably taken it to targeting the rural employer groups in in the Walmart areas if they wanted that clinic space. But, you know, just diving in and and also rebranding it Walmart Health, I think, you know, I'm I'm not trying, to be, you know, but play devil's advocate here, but a lot of people don't go to Walmart. A lot of people go to Target. A lot of people go to Walgreens. A lot of people go to CVS. So I think I would have branded it a little different that way as well. It just when you go into an employer group of, you know, let's say, a hundred thousand people and you say, hey. I want to offer you Walmart health. You know, go to a Walmart and go get your doctor visit. It's just it's just not something that a lot of people are really thinking about when they think Walmart. That's that's just my personal opinion. Sean, was there when you guys looked at the data, was there a stigma? Was there an issue with the brand Walmart associated with health? Well, so there's a whole lot of things that I want to say that I can't say, still to this day. But I think everyone here needs to get some real clarity. First off, you know, Matt, MeMD's acquisition didn't happen until two years after we opened the first brick and mortar. And the acquisition of MeMD was not for consumers. It was actually So consumers did not want another telehealth platform. What they wanted was a clinic that met them exactly where they were, and the the demographic that we were building were for the Walmart shopper. So it was no perfect more perfect thing than to be able to put a health care clinic inside the store that these people were going through. A hundred and forty three thousand people cross a Walmart threshold every minute of a day. So the clinic was built very specifically for that consumer. The payment model for sure if diagnostics, diagnostics, behavioral health, dental, audiology, optometry, obviously, pharmacy, any point of care diagnostics. So the model was built on a forty five minute visit with either a nurse practitioner or a doctor, and I don't know anyone else in the country that offered dental at the price that we offer dental. It was cheaper to it was cheaper for me to go to my Walmart Health to get dental work done than it was to use my dental insurance. Yeah. So caring to that's that's what we do. Our our dental plan, we actually, were in talks with Walmart several for several years about, providing a Walmart dental plan. So we we are that. We have a cash pay dental network called Carrington where our customers it is not insurance. You pay a membership fee like a Costco or a Sam's, and you go to one of our in house dentists and you save fifty to sixty percent of the time of service. So you could literally go into a dental office, one of our providers, and pay, sixty dollars out the door for a cleaning X-ray and exam. So, you know, that model And yet we were but at the same thing, Matt, Barrington wasn't even willing to talk with us at the time because we were offering it for twenty five to forty dollars. And it didn't need to be a membership for a dental cleaning and and X-ray. Yeah. Twenty five dollars for children. Amazing. No. That's incredible. And it was forty dollars for an adult. And I actually tried to get the chief dental officer, Daniel, to to be a part of this, who is no longer there as well. Like, there's a there the whole piece there, we didn't want to play with insurers at the moment. Yeah. And insurers were begging to come to the table and wanted to play with this, but we didn't wanna get tied in with PBMs. We did not wanna get tied in with the big insurers, and we controlled the conversation. Yeah. So let's let's expand out just just just a little bit for a second. I'm I'm just gonna expand out the the conversation. Just, you know, because, obviously, Walmart's sort of the impetus for our conversation here today, but is just one of many players in the larger retail health care space. So as we think about Walmart strategy here, as we think about the other big players, I wanted to get y'all's pulse check on, especially post these closures, what role you see retail health care playing in some of the nation's, current larger health care goals for primary care accessibility, the expansion of, the US health care market, and the improvement of, primary care, at the point of service, and care, for patients. Right? So if we just expand outward and and and look at, again, Walmart in this context, what role would y'all say we should be seeing something like a Walmart health clinic or an Amazon One Medical playing in the larger ecosystem? And how should that color some of the strategy conversations we have, around Walmart's closures? Well, I I one of the questions every everybody in retail has to deal with is, am I gonna do cash pay or am I gonna use insurance system? And that colors everything going forward. And there's advantages and disadvantages both to both. You know, at Restore, we have chosen to go cash pay membership based only, simply because, we think the infrastructure cost and the inefficiencies that are created by paying having the take insurance out you know, adds too much cost. We think we can actually drive the cost down for these things by staying outside of the insurance industry. So I think that's the first question. The second question is just going back to this, are you sick care or are you health care? And I think where the retail place places that people are gonna do extremely well going forward is those are focusing on helping consumers invest while they're healthy. It is a totally different model, to wait until you have heart disease to to address these things. Then, hey. Let's let's invest dollars to make sure you don't end up with heart disease going forward. I that is the kinda the the the difference out there is also, you know, the the reality is there's a lot of money going in right now to online only solutions. I think those actually have a place, absolutely, but I think it is the retail physical location. Because health is so complicated, it is not like, Hey, I want to go buy a pair of shoes, and I can do that online. It is you wanna talk to somebody. You wanna have a relationship with somebody. And it is those that are using the retail outlets to create that relationship with the consumer. I think those are gonna really change outcomes for the consumer going forward. Yeah. I think, Steve, you have one one really good point there. From other things like that that are more on the wellness nonmedical side. In terms of, in insurance infrastructure, primary care, it's just it's not going to scale as fast as you want going through a model like that because it's not as high paying. We're still RVU based off of fee for service, large part across the US. And there are some larger care systems that are straddling pay for performance and fee for service. But, from a medical clinical perspective of providing care, if we're talking primary care services, I think rural health from a retail perspective and then also aging and home and wellness and home from a technology enablement perspective such that, you know, that's remote patient monitoring, is personal emergency response services and tech. That being Best Buy Health's biggest strategy right now and starting to unroll that with IDNs all the way down to federally qualified health centers and then in home services kinda layering on top of the PACE model. That makes, I think, really good sense where retail health can play that's close to the primary care space that's enabling the providers with more insights from a tech perspective and helping the consumers at home. So that population of aging in home, senior wellness, and rural, I think for me makes a lot of sense of how you could scale in a thoughtful way. But the physical locations like brick and mortar from a payment infrastructure, it makes sense for those ancillary services that a large part of what your organization covers and some of the other places that we're talking about here today. But for primary care, like, you better be a CVS that has insurance, PBM, and physical locations. But if you're just a Walgreens right now and maybe Tim Wentworth coming from Cigna background will maybe sell Walgreens to Cigna, that will make sense in their portfolio. But trying to drive speed and scale for primary care or stand alone physical places, it just doesn't make sense just yet the way that we're compensated in terms of providers giving care to people. Yeah. Yeah. And listen. I I will say this, and I'll say this in the most political, way that, you know, I don't get a phone call from a lawyer, in the next, twenty four to forty eight hours. The scale is what caused Walmart closures. The footprint when it was first designed and when the CEO, who designed it and we worked with greatly, The scale was to actually have a thousand of those clinics in the first five years. Wow. It was, like, eight thousand overall. Right? It was just it was crazy. It was mad. Yeah. But so imagine if if Walmart would have stayed on that track to do a thousand of those in the first five years. And profitability for Walmart in that space was more around making sure to break even. Because what Walmart had that no one else had and what the model was built off of is you could walk directly out of the clinic, and go with a dietitian and go grocery shopping for healthy foods. Again, my journey in working for three years with Walmart, and I learned a ton around how even grocery works in that, space. And what was funny, Steve, is you were talking about, you know, pharmacy being more profitable than grocery. Grocery is actually the most profitable part of their business, for a Walmart. It also takes up half their footprint. It also takes up half their footprint. But Walmart has more healthy skews and foods in their grocery area than Whole Foods does in their whole store. The problem is they also have unhealthy stuff. So the the goal was to drive price per basket up. And although I love the model that you've built, Steve, I I I actually Walmart consumer. So my so my different. There's no question. We're our consumer is not a Walmart consumer. So my so my biggest concern in retail health is who's gonna fill this space, because I don't think CVS is gonna do it with Oak Street. I don't think Amazon's gonna do it with One Medical. There is this whole space that Brian's talking about around rural health that has got to get figured out, and Walmart had the foot print to do it. Yeah. They did. Every party in America leaves within ten minutes of the Walmart. So Yeah. Yep. Yeah. And, you know, I I wanna go back to your you know, I know you you mentioned the MeeMD acquisition. That's where that's why I was a bit confused because if if you were targeting the rural area, that acquisition was huge for that because there are no doctors in small little towns. They got people have to drive far. So I was confused with that when you when you mentioned that it was purchased for the associates. That's a that's a massive acquisition to buy a benefit for the associates. So, I was I was confused by that, but, I think, you know, with the current infrastructure of the the direct primary care, which is kind of the new word for direct primary care plans, I think the providers are really taking note of what's happening in the dental space. I know that's kind of a different different topic here, but the dental space has really been focused on the providers and the dentists having owners that are creating their own membership plans and selling them to the consumers that are coming in. They're going to employer groups. You're probably gonna start seeing DSO type dental plans for sale in the retail outlet, say, saying, come to my dental office for a cleaning for twenty five dollars or it might be a free cleaning if you pay our membership fee of, you know, fifteen dollars a month or whatever for the household. So, I might you're gonna probably see that trend in the provider world for the primary care where physicians are starting to create in house plans disrupting the insured space and selling these fee for service type organization or plans to employer groups. And then you're probably gonna see a lot of private equity companies coming in and saying, oh, I'm gonna buy a network of five hundred doctors in Dallas Fort Worth because there's American Airlines, Southwest Airlines, Toyota, and I'm gonna sell this type of program to these larger employer groups to say, come to my doctor office. Your your first, annual checkup's free. You know? There's can there's gonna be a lot of creativity moving into that space. And and as far as the retail side, I just don't know how sustainable it is. I think if I was, you know, if I was Walmart, I probably would have come to a company like Carrington or Teladoc or some of these other organizations said, hey. Let's put a SKU on the in the RX aisle that says purchase this health plan. You know, it's it's, fifteen dollars a month. Go to a doctor in network, save x y z percentage, go to this dentist, go to this optometrist, make sure you use the Walmart RX card, make sure you buy glasses at Walmart, you know, maybe maybe tie it in that way. They still can. I think Walmart still has the ability and the footprint to create an actual SKU, take one off the shelf. We did that with Sam's. We we were very successful with Sam's, over the years. So they've they've done it before. I think that those types of products need to come back in the retail space. I think you're right, Matthew. If if they woulda had more collaboration with a health plan, and you think about I think about where the quality goes, the money flows from a HEDIS perspective if you're closing quality gaps and you're hitting from a Medicare Advantage member perspective, if you're hitting appropriate caps, surveys, If you're getting high scores, you're getting a quality bonus per month, per member, per year. So that's a huge new revenue stream that Walmart could take advantage of if they had a really strong health plan partnership. And even if there was just their employees too, like, that could have been a better play through a collaborative model for retail. But I think the other the other side of it is Walmart was approaching ChenMed. So ChenMed is now famous for having, taken on value based care risk methodology in their provider contracting for over fifteen years now. They're in hundred locations across twelve plus states, I think. So Walmart was suiting them in an acquisition, fell through probably for a variety of reasons that is maybe more on the, you know, outside of the business world, just the relationship side. But, I mean, those models, ChenMed, CityBlock, Everly, they're they're niche. They're they're solving problems that have a very strong social health connection, and they're taking on risk too. Like, that quality piece, if you don't hit that, then any primary care is gonna fail, and you're just gonna be based on getting money from from volume or fee for service methodology, which doesn't make sense. So yeah. I I think it's if it's not is is Amazon the last one that has a chance to make it work? Depends on how much they wanna spend and how fast they wanna go, I suppose. Yeah. I would buy I would buy Walgreens. They're for sale right now, man. Their stock price is still quite low. They're taking six billion dollar plus write offs. You can go back before that. Thermos was one of their biggest failures before, they were trying to invest in the health corners across the US, which is a little space in the retail settings that have more of a health and wellness play, kinda like what your model does, Steve. It's they were just their strategic vision is just very blurred. If I was Amazon, I'd take a gigantic bet and buy a huge portion of Walgreens and maybe see what Well, I mean fix it. You know, Walgreens and and they they do not have a great history of rolling out innovation and technology across system. Amazon does. I mean, that's that's the the reality is you have a a a leader in Amazon that most spaces they've gotten into, they've made good acquisitions, and they've been able to scale very quickly. So, you know, if I look, you know, it's one of the kind of the question that started with is, you know, how is this gonna affect the long term kind of market evolution? Amazon's the only one left that I would look at and say they they have both the balance sheet to do it. I mean, the problem with some of these players is they don't have the balance sheet at this point to do it. They have the innovation chops, and they have the ability, and the scale you know, parts of the scale in place with the one medical acquisition. And they have the ability to do omnichannel. Again, they've shown the ability to do that with the Whole Foods integration and I think they're probably showing it at some point. They'll show it here with one medical. So I don't think they they don't have the footprint, that Walmart certainly had but, you know, again, I if you take a step back, who's gonna win here? And I I don't see any other player that's left standing. I'm gonna jump back in here, folks, and and frame up a new question just to keep the conversation flowing. I wanna talk location. I feel like this is a a critical part of the conversation. It's a critical part of the strategy. And it's something that maybe raises a question mark over, you know, why did the Walmart Health Clinic endeavor, kind of implode in on itself, considering they have some of the best footprints possible. I mean, Sean said it himself, we all live, a stone's throw away. That's an official metric from a Walmart. Right? So, you know, if anyone had the physical footprint in the locations to capitalize on to successfully launch this kind of strategy, it would have been them. But when we look at Walgreens, for example, Walgreens also has a plethora of locations across the US. They recorded a five point bill five point eight, excuse me, billion dollar impairment charge related to its investment in VillageMD recently. They plan to close over a hundred sixty of their clinics, focusing instead on, quote, more profitable locations in densely populated areas. So I wanted to just pose this this question of how important is physical placement, the location of, these, you know, retail healthcare clinics to the success of the larger endeavor. Right? And how does that maybe create some friction when we're thinking about, primary care, retail health care being sort of one of the levers the industry might pull to increase accessibility of primary care across the US, when you're also sort of balancing, well, I don't know that these locations are all that profitable. We're going to close them. And then you've got a Walmart example, which has, you know, countless locations, and is now shuttering all its locations. You get into this, you know, question mark of a strategy. What are y'alls takes on how to think about placement? Physical geographical location of these, clinics in terms of larger success? And I actually wanna start with Steve on this one, if you don't mind since you have some physical locations yourself. So how does that factor into your strategy? And then I'd love to hear from everyone else. Yeah. Yeah. I think, again, it depends on what you're trying to accomplish. Primary care is quite different than being in retail where, you know, our goal is to be in the fabric of everyday life. That means we wanna be in the center where the grocery store is because the grocery store is where somebody is going, you know, frequently multiple times a week, and we think that is where the services and things we provide. What is quite different about Restore versus, you know, a traditional primary care is the average person sees their doctor once a year. The average male doesn't even know who their primary care doctor is. They have no relationship with the with the doctor. We see our average member three times a month. So they're in the studio often doing services, you know, investing in their health. And so for us, physical location is is paramount to to selecting a location that is in the community where people are. It's easy to get in and out of because often they're there for, you know, fifteen minutes. Primary care, you know by the way, there's premium rents that you pay for being in those centers. Primary care, when somebody's sick, they're they're gonna go to a doctor. They don't care if it's sitting right next to Whole Foods. They're gonna go to wherever that doctor they have, and there is where I think real estate probably doesn't matter as much. And I think what what has happened on the pharmacy side, and we've seen this in urgent care, for example, in Texas. This is probably the best example. They're just overbuilt. They just they simply put too many CVSs and Walgreens on opposite corners of each other and competed. And, you know, the the the supply grew faster than the demand grew. And I think they're suffering the the consequences of that right now. And then that's that's true in a lot of the health care industry where they just they overbuilt over the last decade. Yeah. Yeah. I think it's really interesting what Steve was saying is, the the location is one piece, but I think also the the service and the therapeutic fit is another. So thinking about Walgreens, right now, probably their biggest value add to the ecosystem is their access to limited orphan disease side of their house, which is formerly known as ARX, which is now, I think, Walgreens AllianceRx, something to that that branding name. But, like, the interesting thing is there's a lot of drugs that are going infusion injectables at home, and that service still needs to have some literacy gap closure. So those that are taking an injectable like a Dupixent, for asthmatic condition, They need to still learn how to appropriately inject that into their bodies and not have risk at home for infections that can have more downstream challenges and also health care costs too. So I think if you can have the right placement from a pharmacy perspective with Walgreens of having the right population that that you're helping in the right location that is taking a drug of high cost that requires high literacy, like infusions, injectables that need some primary care support, or prescriber support with pharmaceutical science, like, that makes sense to go deep in those investments from a geographical location with the population you're serving with the therapeutic overlay. But, otherwise, the primary care, you know, still stand alone is gonna be really difficult. But if you put those all together, it's less point service, and it's more throughput, in my opinion. Yeah. And remember, Walmart Health was not built to be a primary care place. Yeah. It was everything. It was kinda all encompassing. Right? It was everything so you could do what Brian's talking about. When you start talking about stores and retail, if I were a betting man, which I am, So, if if I were a company right now that wanted to go out there and tackle this population and do it, I would be looking at Dollar General, because you wanna talk about, an organization that's in rural America and about as big a footprint as Walmart does, is Dollar General. You you still gotta meet the people where they are. And we keep talking about throwing technology at them. We keep the top. That's you know, I spent nine months in the state of Mississippi in two thousand twelve. Drove six thousand miles in that state. And if you know anything about the state of Mississippi, six thousand miles in that state is a lot of miles. I can tell you where every, you know, public bathroom is, non public bathroom, fried chicken place, gas station. And that that demographic still wants high touch health care. They do not want more technology. And we've got to remember, we have to meet them where they're at. And and listen. I would say this. If different leadership were in place in Walmart and came in and brought the vision back to life, Walmart could still do it. Yep. Yeah. I think, that's very good very good points. I think, you know, going kinda where you're you're targeting the demographic, I think, you you know, it just depends. You know? We're seeing massive trends with our younger generation really purchasing our virtual primary care program. For some reason, the younger generation doesn't mind speaking to a primary care physician over the phone. They don't mind speaking to a mental health counselor over the phone. The usage They don't like to talk to people in person, so it works There you go. So we gotta follow the trends. We gotta follow the trends, and that's where the money is. And I think right now, that trend is continuing to rise, and I think it's going to continue to rise. And you're seeing, this younger generation really focused on wellness. I mean, they are hyper focused on healthy foods. They're hyper that's why Walmart has their their healthiest option more than Whole Foods. I didn't know that. That's news to me. That's very interesting. But, you know, I think when you're talking about the senior market, you've gotta have locations where, you know, some of these, like, driving organization where they drive seniors to physical locations. I'm not sure that big box retail is the space for health care. I think when you're when you're trying to look into that, it's more of, no. I'm gonna go there for my for my groceries. I'm I'm gonna go there to buy clothes or, you know, my my prescription comes in the mail. You know, there's a reason you're seeing shopping malls close around the entire country. When when you have too much in one building, it's too much. You know, I think we're we're kinda losing sight of, you know, let the experts be the experts in that space. I think you're just you're you're seeing just because Amazon does something or just because CVS does something, we all have to jump in and try to provide the same. I would rather see Walmart focus on what you said, healthier options. Like, come up with something new in the big box retail space. You know? Make yourself different than than Amazon. What's next out there? You know, that that's again, that's my opinion. That's why I'm here. I'm here to talk about my opinion. And I think for big box stores, health care is extremely difficult. And we've kinda seen some of that happen. Funny, Matthew, is and I didn't even our high our number one when we launched, the number one service in the space was actually dental. Yeah. That's Yeah. That's a We we could we we were booking dental eight and twelve weeks out, and the very first location that we opened in Georgia in Dallas, Georgia, it had six dental bays. Wow. And they were booking eight weeks out. We we couldn't it was a surprise to all of us. We knew the need was there, and we had seen it. But I I I still I I still challenge everyone on this panel and anyone listening. Go walk a day in the life of someone in Dallas, Georgia or in the Delta of Mississippi because we are still talking very health care ish big system. Yeah. And we are not understanding where that demographic that demographic lives. And I worked for the big insurers, you guys. I my started my health career health care career at Humana. Worked there for four years. I think they're the reason we're in this trouble. So I don't wanna see CVS and then buy something else, because it's just gonna get turned into traditional health care model. You need to get out there and walk a day in the life of some of these consumers and go, what is it that they really need? And I know the big box model doesn't make sense to some people, but for grandma Roberta who lives twenty minutes or twenty miles and she goes you know, her primary care physician is actually the emergency room in Greenville, Mississippi that she goes to after she goes to church on Sunday, goes and eats a fried chicken dinner, and twelve people go to the emergency room. Like, it's a whole different demographic than we really understand until you walked it. Big box is going to have to be the one to solve it. That's why Walmart Yeah. I mean, the re the reality is this I I agree with you, which is first I actually agree with both Matt and Sean there, which is, you know, Restore is not gonna go into those areas. It's just it's not a market. Like, a cash pay market is not gonna work for us. And I don't think anybody's gonna be able to go into that market without having scale of other things to put into that market. That's why I was hopeful for Walmart. I'm I'm hopeful for some of the other players that are trying to scale the space, because that is a demographic that is underserved, and the people that are working kind of on what's called they're not gonna get there. It's just the economics aren't gonna work out for those for us to get there. You're gonna have to supplement that with other products and services to make it economically viable for whoever's in the market. Yeah. Yeah. I mean, you're right, Steve. I think those that are of a lower socioeconomic status drive the most health care utilization, but also have the most, I'd say, challenge in health care literacy and also their access and actually navigating the payment side of it. So then you see health care taking on a lot of medical debt, bad bad debt, and then you'll see individuals eroding trust as a currency really from what they would, you know, go forward with an access and care that they need at the appropriate time. But backing up to something Sean said, I think was really interesting. Dollar General, I have never liked them. I think they have a predatory model. They go after consumers to buy very low end goods, bad food, and and and then they pay their employees not well enough to be able to have a a good impact for their for their own families. So I don't like them at all. I won't even get started on the food side with McDonald's and those those people. But this is the one beacon of hope, I think, that Dollar General has. They have a new chief medical officer, doctor Albert Wu. He's put together a health care advisory panel. They're starting to have, like, what what Matt was saying, better choices inside their stores specifically for food. So this is probably the one thing that could help big box retail, and I'm still sticking to the predatory model name that I put out there of what Dollar General has had and how they've scaled their impact, now acquire Dollar Tree. If they make a good conscious choice to help those of lower socioeconomic means improve their health simply starting with food, then kudos to them because then they can have a better collaboration with health plans and downstream medical care. Like, I hope they I hope they fix where they've started and add into the health care ecosystem, like, with a positive contribution. And then maybe I won't use that that term. But that's what they stand for. I think a lot of if you look from a consumer perspective, those that are higher socioeconomic means, they look at them down like that. But great opportunity to fix things. And, Sean, you're right on it. I didn't even think about Dollar General, and so you you threw them out there. But I hope they can start fixing it. Steve, going back to something you asked earlier on around why we use the name Walmart Health. Mhmm. Because for that demographic and that consumer, it's actually a trusted name. Because when we started out, we wanted to separate completely from the name. Now what I did find out through the grapevine, in this closure, because, obviously, I'm an experience related guy. That's why I got involved with this. I come from a Disney background. I don't I I bet you if you look at, and I don't know what your NPS or if you track NPS in your company, Steve, or map. We have an eighty seven NPS off the charts. Yeah. You know what Walmart Health is? I don't. Ninety two. Oh, wow. Wow. That's that's unheard of in healthcare. We took it from the high sixties to the low nineties, and it's consistently been there for five years because of the model that was built. And we listened to the consumer. Yeah. So listen. Again, I'm gonna say this. This. Different leadership in place in Walmart. Walmart Health can still be successful. And I don't know any other health care company that has a ninety two consistently for five years in their income. Definitely not health plans. So That's incredible. I'm sad that they closed, but I'm also proud that the model that my team and that team built has consistently stayed in the nineties for five years. That's amazing. Yeah. You I mean, you guys were definitely a direct competitor of ours. I mean, you know, when when when you started, I we were like, okay. Well, this is gonna be interesting. You know, Carrington has that demographic you guys were speaking about. We've got thirty million customers that purchase a fee for service plan from us on a individual retail basis. So the market is there. We were nervous because we were like, oh, all of a sudden, like you said, there's a Walmart within a stone's throw away. You know? Are people gonna stop drop Carrington, and then go buy this Walmart portion because they have an in store clinic? You know, it's like you said, they could still be successful today. I just think when you're talking about consumer, they need more options. They need more. Well, my doctor, I've been going to him for fifteen years. I really wanna still see him. Is he in the Walmart plan? My dentist, I've been seeing him for four years. Children's, pediatric, those types of questions, you know, really probably could have helped out. Maybe Walmart could have built their own BPO networks of of fee for service networks outside of the clinic to help, you know, also drive utilization outside the clinic. I think those are all things that, hopefully, Walmart could you know, maybe they will come back, like you said. So that's that's something to be proud of with the nine two score. That's impressive. Here's my last question for y'all to to close things out. This has been, I mean, probably one of my favorite discussions on Experts Talk. So thank you to the four of you for your analysis, your expert opinions, and your breakdown of the strategies here. The the last question I wanna pose then is kinda pulling from stuff all of y'all have said on this panel, which is thinking more about what role again, kinda taking it back to one of my first questions. What role should retail healthcare play in the larger primary care space? You know, Sean mentioned that one of the challenges that Walmart had was around scale. And, you know, when we think about Walmart's approach here, it was providing a one stop shop for a variety of different health care needs. Taking on all of that responsibility and then scaling out from there. That may have been one of the challenges that it had. You know, we've been looking and talking about some of the other retail players that focus in more on, well, you know, we're providing, you know, food for our consumers, so let's think about how our role in the larger healthcare ecosystem ties back to where we're most profitable already and, you know, our role in the community or in the larger ecosystem. So like y'all said, this opens up a lot of opportunities for creative strategies around, you know, if I'm a Walgreens, a CVS, an Amazon, a Restore, or a new player on the block. If I'm a Dollar General, let's say, you know, they open up a medical clinic or something. What role are we playing for our core demographic and community? Right? So I wanna hear from each of y'all, just kinda one final thought from everyone. How should, you know, existing or new entrance into this retail health care space be thinking through that conversation. Right? As they assess the field, they assess their consumer, and they try to decide what service, what offering, what plans should we be giving to our consumer that is going to be profitable for us, is going to be a good investment, but is also going to seamlessly fit into what they're looking for out of their health care needs. Again, how should they be thinking through that conversation and actually executing on, some of those strategic necessities? Well, I'll I'll start real quick, which is I think you you kinda said it in the question, which is good companies focus on understanding who their consumer is and what their consumer wants. So it it starts with that. And and what a restore consumer wants is quite different than a Dollar General consumer. So we we go at it totally different. We are focused on we know our consumer is proactive in their health. They are they are not the person that's eating fried chicken every night for dinner. They are the person who's waking every day, think their exercise, thinking about their nutrition. And what we're trying to focus on is making sure we add value to our members above and beyond the services. So we have VIP member nights where, literally, we do an hour long, or a video chat with all of our doctors, and people can ask them questions. And it is amazing, number one, how many people get on, but last of a full hour engaged with the doctors. I mean, you can't get people to spend an hour in this country doing anything. All of a sudden, we would get on eighty percent of the people that would start the conference call would be on the conference call at the end, or I should say, the the education seminar to the end. So I think everybody every business, I don't care if you're in health care or if you're selling, shoes, understand your consumer, understand what they're looking for, and try to fill that need for the consumer. And and for us, we I think we have a really good feel for who that is, and it's it's quite different than the traditional market. But I think more and more of the consumers are moving into this space where they wanna understand their healthcare and and they wanna invest in it. They're they're looking and they they realize waiting until I have heart disease is too late. This generation and, you know, I think as Brian said it, this generation is investing in their health way earlier than previous generations because they are now seeing the impact of their parents making bad health care decisions for long periods of time. Yeah. I love it. Obviously, know who your demographic is. I I I wanna post something to the world out there. Let's redefine what the PCP model just very thirty seconds, I no longer oh, I do have a primary care physician because you have to have one. But my primary care physician now in my life is my oncologist because in twenty twenty two, I battled colon cancer. So I don't do anything in my health care journey unless my oncologist is guiding the way, because it's what's best for my health. So we have to understand again the consumer the consumer, journey and what they want, and we've got to meet them where they're at. And, you know, that that it's pretty basic to me of of what that looks like, but we overcomplicate the system a lot. Yeah. I I would, kinda surmise my my strategic, suggestions to retail health relative to primary care in in three ways. Your payment strategy, your partnership strategy, and your point solutions being end to end. So So from a payment perspective, if you're in a retail health care setting and if you're going with primary care, you know, what what does your payment structure look like? What's your payer mix look like? Who are your health plan partnerships if you're going to actually scale this and not do a subscription model that wraps in ancillary services, and wellness services or specialty as well. So what is your payment structure, and how is that actually gonna give you operating margins to actually go from one clinic to ten clinics to a thousand clinics one day? How does that how does that look like in your ecosystem of payment? The partnership side of that has to come from, like, the health plans that you're working with, the employer sponsored groups. If it's a large employer sponsor group or if they're doing a fully insured play, how is that going to work for you scaling or you just having a special play for a given population? The last side of it is, I think, point solutions not being end to end. I'm gonna go back to Best Buy Health. They're not investing directly into primary care medical, but they're the technology enablement services that has the tech as a device and then also the data feeding back to every major and small EHR vendor out there. So then it's more of a triggered piece of data that a physician can take an action on. And then separately, they work with life science organizations, clinical research organizations. So they're taking the tech enablement point solution, but a throughput of everything they can they can provide from an experience perspective for someone aging in home and then how that feeds back to a primary care, provider. So I think, to a primary care, provider. So I think that makes a lot of sense. That's the beacon of hope I see for primary care relative to retail having a play in the space. Yeah. It's good points. And I think, you know, when you're talking big box or just retail play in general, you know, the CBS, Walgreens of the worlds, I I do I do believe there is some things coming, with those guys as far as your Walmarts, your Targets, your Costcos, your Sam's, your your Walmarts, your Targets, your Costcos, your Sam's, I believe starting small, starting to sell, other partners, building a plan, with those guys, maybe white labeling it, calling it Walmart Health, calling it Target Health, whatever it might be, selling membership style plans in the pharmacy, just having it as a SKU. Again, I brought that up earlier. We did that with Sam's Club for many years. In their first three months at Sam's Club doing a big box plan, they sold three hundred thousand dollars worth of dental plans on an annual benefit. So that model works. It's just getting the big box stores to understand that start small. If you wanna open clinics, build your membership base, understand their consumer, understand their journey, their health care journey. I do I do still think Walmart does have a play, mainly because I think they they do can it can encompass everything with the vision, the optometry, the prescription drug. Hearing the dental statistics was very interesting. I think that is, something they should be very excited about for the future. So I think just partnering with other folks and, not trying to do it all themselves out of the gate. I'm not saying partner with an insured carrier. Definitely not. I think there's a lot of other networks out there, that they could take advantage of and build a comprehensive plan for their members. I go to Walmart three times a week. I do all the shopping in my house, and I never saw anywhere, when I was checking out, when I was, you know, know, walking into the store getting my prescription drug card, I never saw buy this Walmart glove plan. You know, there's a lot of creative ways to do things and, I'd say they they that might have been a better way to target some people. And then also in the employer space, we we ran into Walmart health a lot at broker conferences. So that was that was a space that I think they were gonna be some headway there too. So I was surprised to see the closure, but I honestly didn't understand, why so quickly. Alright, folks. I think on that note, we'll wrap up today's panel. Thank you again to the four of you. This has been incredibly insightful, actionable. I think our audience is walking away from this conversation. Better understanding the dynamics at play here for the the larger market and the strategies that are gonna work for retail health care to play a constructive and productive role in our primary care ecosystem, specialty care ecosystem as well, but also to be, a profitable and useful extension of the existing brands core value proposition and go to market strategies. So thank you again to the four of you. This has been fantastic. Again, we've been joined today by Steve Welch, CEO and cofounder of Restore Hyper Wellness, Sean Nason, founder and chief experience officer at Mophie, Matthew Herrera, VP of sales at Carrington, and Brian Urban, director of innovation and emerging markets at FinThrive. Y'all have been fantastic. I'm looking forward to further follow ups on this topic because to some degree, we're just scratching the surface even though we had a good hour on this. So plenty more where this came from. But till then, thank you again to the four of you. This has been great. Thanks very much. Thank you. And thank you everyone for tuning in to today's episode of Experts Talk. If you like what you heard and saw, and you wanna tap into previous episodes, head to market scale dot com for a full catalog of Experts Talk content, as well as a breakdown of upcoming episodes. We are going live tomorrow with an episode on real world asset tokenization. Basically, blockchain technology, but its role in the supply chain. How is RWA going to impact logistics? Where does it pose some benefits? And how can logistics players onboard this technology in a productive way? We're gonna break that down tomorrow, and we've got plenty of, quality conversations here on Experts Talk coming up next week as well. Till then, I'm your host, Daniel Litwin, the voice of b two b, and we'll catch you on the next episode of Experts Talk.