“Just because you can sell toilet paper and groceries and other things very, very well does not mean you can easily translate that into health care," Ateev Mehrotra. He studies retail health care at Harvard Medical School.
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Ding. Ding. Ding. Give Ateev a kewpie doll.
Walmart is closing its healthcare clinics. Amazon? Same. Walgreens? Worse. They paid $6B to buy Village MD a few years ago and shut the whole thing down.
On the surface it made so much sense. Retail is a fixed cost business. They pay for the space in the store whether people shop there or not. They need to use all that space all the same or the fixed costs cripple them. Like that airline that has to pay to fly the plane whether the sell the seats or not. Last-minute seat sales and all sorts of pricing schemes are meant to squeeze every last dollar out of that flight. In theory, filling space with any stuff should work just fine. But, American Airlines doesn’t lug much cargo and FedEx doesn’t shuttle people around. Empty space is anathema to media too.
The stuff that fills your space matters. Before theater businesses were memed to near-death, the people with big brains noticed they had big, empty boxes. They pitched corporate types. “Hold your next meeting at our place. Come for the comfy chairs, stay for the giant tubs of popcorn.”
That same thinking is what led Walmart to clinics. What can they do to squeeze more juice out of their floor space? What…? Another snack aisle? More TVs? Seasonal stuff? None of the above. So, Walmart played connect the liver spots. A clinic in the store. Some chairs, a reception desk, and a few broom closets stuffed with pre-fab cupboards, Formica tops, and a uncomfortable massage table topped with rolls of the stuff that separates your butt from public toilets. Yessiree. That says, “Hold your next checkup at our place. Come for to say, ‘ah…,’ stick around to shop for the giant bottle of ah-cetaminophen.” A synergistic paradise sure to eke out more dollars per square foot.
This is so deeply warped I totally get it. Delivering health in retail has ad fever.
Delivering health isn’t like selling pickles. You can’t just drop a palette of packaged products in a place and price and promote your way to prosperity.
Context matters. Business models matter.
People aren’t cargo and ads for Tide don’t mean JAK. I work with people who suspend disbelief every day and pretend it’s the ad; and not the science and guidelines that are the primary drivers of prescription use. For about a decade, there’s been dis belief that you can put drug ads for doctors anywhere.
You know how this works. The people who run the internet have an inkling who you are and they follow you around. So, they know a doctor is a doctor and that She/he/it goes to ESPN.com. Then, some formulaic thingy puts a drug ad there.
Here's the thing. Doctors tell us when they’re on ESPN reading about why the Lakers, even with LeBron, need a new coach, they’re not in the mood to read about how a JAK inhibitor deals with a pathway to do whatever it is a JAK inhibitor does. That JAK ad does best (by far) when it’s placed on a site like the New England Journal of Medicine and the doctor is reading about JAK inhibitors. Go figure.
That’s just problem one. Context. The business model problem is worse.
Mixing service and outcomes is an unhealthy problem. Advertisers used to pay to show ads. Then, they paid for clicks. Now, they pay when they think an ad sold something. “I paid 2¢ to show this ad. I want to know it got X dollars of sales.” That’s like saying, “I bought this frying pan but my eggs don’t come like the celebrity chef I saw on TV.” Frying pans don’t cook and ads don’t sell.
We pay something toward our healthcare. Insurers pay the rest. These days, insurers, like advertisers, don’t want to pay for service. They want to pay for outcomes. It’s not enough for a doctor to see you. That’s a service. They want to pay when you’re better.
Which reminds me of this story. When I was five, I had a cough. My mom took me to the doctor. Dr. Gruson. He did the tongue depressor thing, the stethoscope thing, told my mom I had a cough, scrawled a prescription for cough medicine, and gave my mom a bill for service rendered. I told him I needed, “Romilar 3.” A 70s-era over-the-counter cough medicine I had seen an ad for on Scooby Doo.” Had this happened today, had I taken my own advice, I wouldn’t have gotten better, my insurance company wouldn’t have paid Walmart’s Dr. Gruson, and Walmart would be shuttering all their clinics because selling toilet paper and groceries does not mean you can deliver health.