Years ago I remember participating in a round table at a state leadership conference. The topic? Mental health, but more broadly health care transformation and the role of the private sector. For whatever reason we got on the thread of market dominance and how that could be leveraged for good by the private sector.
An executive from Walmart told a story that I still remember to this day. They were describing how they wanted to do something about obesity, a problem plaguing so much of our country. Apparently, Walmart was the largest seller of tortillas in the United States, and found that a lot of these products contained lard, which has been shown to contribute to obesity. Walmart decided to do something about this pressing public health issue. They told their tortilla makers that if they wanted to keep selling at Walmart they needed to have a new recipe that didn’t use lard.
And I bet you know what happened next.
You got it. All the tortilla makers went back to the drawing board and got rid of lard in their recipes. When I heard the executive finish their story, I was both inspired and stunned. If they had so much power to influence something as simple as a tortilla ingredient, imagine what they could do if they got into mental health.
Recent news of Walmart's decision to shutter its health centers and virtual care service made me think back on this story. If you didn’t see this, Walmart, who is relatively new to the health care game, decided to close “51 of its health care centers in six states and end all virtual health care services.” This story sheds light on the complexities non-healthcare companies face when venturing into the realm of health care. It also made me think about the other times businesses tried to get involved in health care.
Do you remember Haven? Haven was a health care venture formed by Amazon, Berkshire Hathaway, and JPMorgan Chase. It was the hottest thing going when it launched. I remember being blown away at the possibilities - strong leadership, resources, a massive platform! However, despite all of this and the backing of expertise of these corporate giants, Haven disbanded in 2021 after three years of operation with not much to show for that time.
Amazon is still in the game though. Recently, it acquired One Medical. I mean what’s not to like about a $9 a month fee (with Prime membership) to access basic medical care? I knew One Medical before the acquisition and can say that they were really trying to do things like primary care and mental health well! Will Amazon make or break this pretty unique model? Only time will tell, but it’s definitely something to pay attention to.
In general, and perhaps an overgeneralization, but it seems that businesses find it challenging to navigate the health care landscape. Of course there are standouts. CVS Health has been pretty successful, but even there, one could argue that they already had a toe in the health care water.
I’ve been thinking a lot about this, and have found a few themes that keep coming up. These are both a warning to those who are looking to get into health care as well as an observation about those who have already been there and failed.
Business doesn’t value the relationship as much as it should: At the heart of effective health care functions like mental health or primary care lies the relationship between patients and their clinician. Beyond medical expertise, these relationships nurture trust, empathy, and understanding — qualities that are indispensable in fostering adherence to recommendations, satisfaction, and ultimately, healing. Business, for the most part, are about transactions. This makes sense for so much of industry, but it doesn’t make sense in health care (as much as it is still done). These relationships are our foundation and without them, it’s hard to see anyone wanting to stick around whether that be the patient or the business.
Mismatched business tactics: The health care landscape operates within a framework vastly different from conventional industries. While principles of efficiency and profitability remain universal, health care's intricate web of regulations, ethical considerations, and diverse stakeholder interests necessitate a tailored approach. Non-health care companies, accustomed to streamlining processes and maximizing profits, will definitely encounter roadblocks when confronted with the multifaceted nature of health care delivery. Strategies that yield success in retail or technology may falter when applied to health care, where prioritizing cost-effectiveness can sometimes compromise patient care, quality, and outcomes.
Complexity of health care: Health care operates within a complex ecosystem involving various stakeholders, including providers, insurers, pharmaceutical companies, and government entities. This ridiculously complex web of relationships and regulations can be daunting for businesses accustomed to operating in more straightforward industries. I can imagine that Walmart and Haven faced difficulties in coordinating efforts among its partners and aligning their interests within this complex environment. These are new relationships that often require finesse and time!
Data Fragmentation and Privacy Concerns: Health care data, like its delivery, is notoriously fragmented across disparate systems, making interoperability, data quality, and data sharing challenging. Moreover, stringent privacy regulations like HIPAA (Health Insurance Portability and Accountability Act) impose strict requirements on the handling of patient information. In so much of business, data are foundational and worth a lot of cash so when you can’t easily get the data you need or use it, there may be problems! This is a major hurdle to anyone getting into the health care space.
Treating diseases vs. people: There’s an innate tendency in businesses to simplify things down into manageable bites that can be fixed or solved. Call up your favorite customer service line and you’ll find a myriad of ways that they can help you fix whatever might be happening to your cell phone, lap top, car, or even washing machine. There’s an algorithm for that! But people and their health? Well for that, it’s not that easy. In health care, the challenge extends beyond merely treating diseases; it encompasses the holistic care of individuals with diverse needs, preferences, and circumstances. Unlike troubleshooting a technical issue or replacing a faulty product, addressing health concerns requires a nuanced understanding of the individual's physical, emotional, and social well-being. While algorithms and standardized protocols have their place, the intricacies of human health defy simple solutions, necessitating personalized care and more empathetic engagement.
You see, businesses are often in “the middle” trying to make something happen that’s unfamiliar to them. I do think there’s a future where businesses can do good at health care. Maybe it will Amazon with One Medical or CVS Health - whoever it is, I know that the above issues warrant major attention.
Hey, don't write yourself off yet
It's only in your head, you feel left out
Or looked down on
Just try your best
Try everything you can
And don't you worry what they tell themselves
When you're away
Ben, Thanks for your thoughtful discussion of the ways that "business" can be structurally out of sync with the relationship base that should be present in healthcare. I wish that many of the primary care practices I consult to held their relationship base in as high esteem as you and I do. So many administrators feel that they need to run their health center as efficiently as a business like Walmart. That means that every new program (I am usually helping them add behavioral health) has to be profitable from the beginning. To do this, they set unreasonably high "productivity" targets, leading to a culture of impatience with their BH clinicians, leading to high turn over, leading to the loss of access that the program was supposed to provide for patients. Primary care behavioral health is a different arrangement of the skills used to succeed as a mental health clinician, like taking your finely honed dance moves and having to do them on roller skates. It's about understanding the process of learning of the clinicians who will be in the relationships, first they have to learn to do it, then they have to learn to do it well, and then they learn to do it efficiently. In the exemplar sites, where clinicians build healing relationships with patients efficiently and more than pay for the cost of the BH service, the start up (3-7 years) was usually a revenue loss that was supported by the health center. These are also the centers now with very low turn over who spend less time on searching and on-boarding new staff. Alexander Blount, EdD Professor Emeritus of Family Medicine and Community Health, UMass Medical School.
Excellent piece, Ben, and especially great use of Jimmy Eat World lyrics!