Some things are difficult; like folding a fitted sheet. Some things, like long division, are less difficult unless you forget to carry the 1.

The degree of difficulty of healthcare consumerism is somewhere between the two, unless you don’t even try. And not even trying is the point at which most healthcare companies find themselves today. Healthcare consumerism will give up its secrets much easier than say driving to Atlanta and trying to get Coca-Cola to give up their recipe.

At some firms, there is more executive involvement in choosing the menu for the executive dining room than there is in planning to make consumerism a strategic imperative. To be good at anything requires planning.

What if one of those executives learned its dog had arthritis? The vet prescribed a quarter of a tablet of aspirin every day—for the dog, not the executive. What would the executive do—make a plan.

1. Buy aspirin; a 90 tablet bottle
2. Calculate the number of doses; enough for fifty-one weeks and three days. (It still works out to the same number of days even it’s a leap year.)
3. Give the dog one dose each day
4. Buy another bottle of aspirin

See, that wasn’t so difficult.

So let’s skip ahead one full year to see what is going on in the boardrooms of many of the healthcare firms. Several of the executives are worried because four days ago they forgot to buy another bottle of aspirin for their dog.

The boardroom has all of the necessary accouterments for their consumerism tête-à-tête. Eight thousand-year-old bottled water melted from a Himalayan glacier that was transported down the glacier by yaks. Croissants flown in that morning from France—if you hold one of the croissants to your ear you can hear Maurice Chevalier singing “Thank Heaven for Little Girls.”

The CEO addresses the Chief Marketing Officer. It could just as easily be the CIO, the COO, or the Chief Patient Officer. We know for certain that the Chief Customer Officer is not being addressed, because there are no Chief Customer Officers in healthcare.

“When I hired you I gave you three envelopes, and I instructed you about when to open each one. You were to open the first envelope after your first major misstep. And the message in that envelope told you to blame your predecessor.   You were to open the second envelope after your second misstep. And the message in the second envelope told you to blame the budget.

I hold in my hand the third and final envelope.” The CEO opened the last envelope and read this message to the executive who had been responsible for consumerism. “Prepare three envelopes.”

There are always firings when a strategic business imperative fails. In fact, it is statistically difficult for an executive to get fired any other way.

The term ‘patient’ in the minds of consumers are those people in ED, in the hospitals and clinics, and people filing claims. The part of consumerism that providers, payers, and retail pharma often overlooks are the consumers. People who are not quite patients.

They are shoppers, and walk-ins, maybe even impulse buyers. Most certainly they are early adopters and adapters. People who without calling for an appointment want to know the answer to “Am I sick, and can you make me better?” “My son needs a physical.” “I need a prescription.”

And it will only get worse. Millennials, the most frequent users of retail clinics, believe that any industry whose products and services can’t be purchased on a smart phone and be delivered to their doorstep the next day is archaic. Not because they are lazy, but because that is how today’s businesses are supposed to function. And they are right. The model in one phrase—person-to-person service without the person.

My favorite children’s book was Dr. Seuss’s, “If I Ran The Circus.” What follows is the sequel I would write, “If I ran Healthcare Consumerism.”

February 13, 2019.

A man walks into two different buildings—not at the same time. One building’s lobby resembles that of a Hyatt. The man walks to the receptionist and says, “I think I have the flu, and I sprained my ankle.” He shows his swollen, purple ankle to the receptionist. The receptionist hands him a slip of paper on which an address is written. “Four blocks, turn left,” she says, ignoring his ankle.

He pushed the door open and stepped onto the sidewalk. The air was cool. He starts walking; sort of. The sidewalk was concrete, cast in four by eight squares. The squares butted together in black, wide rubberized expansion joints. He could feel the textured concrete through the soles of his shoes. It had been brushed before it dried with a yard broom.

Four blocks later the man entered the second building. Limped past the deodorant and the hair sprays. Ogled at a bag of black licorice in the candy aisle, in the next aisle, he grabbed a copy of the February issue of Men’s Health, found a worn vinyl chair, and sat. He clicked the clinic’s app on his phone, and two seconds after clicking the patient icon on the app he received an SMS indicating his registration was complete, there was one patient ahead of him, and his prescription for Toprol was awaiting pickup.

He was examined for the flu; his ankle was x-rayed, he received a pair of crutches and a script for the pain. The app notified him that he had earned 150 clinic points, and sent him a link to two videos on the clinic’s site, one for dealing with the flu, and one for how to treat his ankle.

In less than three years the model for healthcare consumerism will look like this.

Instead of simply visiting walk-in clinics, consumers will use Telemedicine—services for which Medicare and Medicaid are already covering— for a face-to-face visit with those clinics using a smart device from the comfort of their homes and offices. (Consumers can already do this in many states—and it is a whole lot less expensive than building a clinic.) Those using health apps and wearables will already have much of their health data stored in an interactive and integrated personal health app that resides on the servers of firms like Walgreens.

They will be using a personal health app because people, unlike health systems and their EMR, consumers want to track how they are now, not how they were then.

Clinics will have partnered with major health systems, which may be as close to consumerism as health systems will ever get. Consumers will say they are going to their retail health clinic instead of going to the pharmacy. Screening, diagnostic services, and treatment. In three years, instead of consumers starting their care journey with their PCPs or a health system, the services they purchase from health systems will only be those services not offered by the clinics. And for those drawing journey maps that include an in-path stop at a PCP, that link will be bypassed my many.

There are almost 2,000 retail health clinics. Ten million annual patient visits.   Defining value-based care. Lower cost. And nimble. Presently, these clinics have the luxury of defining the business model. If the model takes an unexpected turn to the left or the right, they do not have to build a new wing to accommodate it, all they may have to do is to remove the aisles that sell deodorants and hair sprays.

In three years firms like Walgreens will likely lead in the provision of basic chronic care services. Why? Look at the statistics. Not only is it a growing market, it is a market with built-in repeat business.

If I ran the retail health clinic circus, I would develop a strategy to own the enrollment business. Like Radio Shack did selling cell phones and enrolling people in their mobile provider of choice. “Would you like Aetna or Anthem?”

(Sidebar. The biggest failure of the Radio Shack enrollment model was their enrollment model. I know that because I met with the Shack’s CEO and told him he should be selling subscriptions, not just phones. The real opportunity was not enrolling consumers in another company’s cellular service; it was enrolling them in their own cellular service. Will Walgreens or Walmart make that same mistake? Of course not. They will design a payer strategy that will work, probably not across states but within states.)

Walmart will be the other Big Dog in healthcare. Go big or go home. And why is that? It is because Walmart won’t have to augment, or amend, or retool what they already do. They will start from scratch, and they will design their healthcare services to be exactly what consumers want. And how will they know what consumers want? They will ask them.

They will be the Big Dog because their entire mindset is tied to being excellent at anything that can be sold, especially those things that most people buy, and those that people buy time and time again. And what else does Walmart know better than anyone else on the planet? Through the use of analytics, they know exactly what people are willing to buy and pay for things.

Their strategy is not based on purchasing items and hoping they will sell. Nothing gets within a hundred feet of their loading docks without Walmart not only knowing that it will sell; they already know how many of them they will sell. You can bet your valet parking that when Walmart commits to selling primary care they will go all out.

Walmart doesn’t sell Gucci or Porches. They won’t sell hip replacements, nor will they be certified to treat the occasional case of Ebola. Why? Not enough demand, not enough throughput.

In less than a day the receptionist at Walmart’s headquarters in Bentonville could search Google and create a list of the most common healthcare needs, by age group, of everyone in the U.S. He or she will document what healthcare services are purchased the most, and how often those services are purchased nationally and on a per-person basis. Calculate by time and by service the average length of each health visit. Using analytics, Walmart will calculate, based on estimated patient flow, how many square feet of space they will need, within a margin of error of one to two feet, to allocate the space needed for their in-store healthcare services.

They will set aside hundreds of square feet of space for walk-in consumer health. Their clinics will have  several exam rooms. And down the hall, I would expect to see an urgent care capability. A little further down will be a complete onsite lab, and of course, they will have the pharmacy. Non-stop healthcare shopping, open seven days a week from 7 A.M. until 10 P.M. Bypassing the need for a PCP.

If I led Walmart’s healthcare strategy, I would ensure chronic care services were also available to treat the most common illnesses. And I would let the consumers pay for everything using their Walmart health plan. The one thing I would bet my house on is that the design of their health plan won’t look like any health plan we’ve ever seen before. It won’t look like any of today’s plans because it would be pointless to come to market with another payer model that mimics the models so many consumers already dislike. After all, nobody wears a T-shirt that reads I love my health insurer.

Walmart’s and Walgreens health plans will put today’s health plans to shame. It will be designed to encourage and reward wellness. It will allow consumers an interactive and digital way of using it, and that way will have a user interface that will provide a user experience that will make using an Apple device seem cumbersome by comparison.

Those same consumers will be accumulating HealthPoints for every dollar they spend at Walmart or Walgreens (already available), and they would receive discounts for purchasing healthy foods and products from those firms.

People say healthcare is in the throes of massive change. It isn’t. The traditional players are not in the throes of change. They are on the sidelines. Maybe those firms should rename themselves to something that starts with a ‘W’.

Anyway, that is how I see it. And since this is my blog I can imagine the future through my own rose colored glasses. Those glasses are half-full when it comes to consumerism.