Unraveling the Funnel Wars: Walgreens’ Pivot and What It Means for Primary Care

Stephanie Wierwille: [00:00:00] Welcome to the NoNormal Show brought to you by BPD. This is where we leave all things status quo, old school, traditional, boring, in the dust and instead we celebrate the new, the powerful, the innovative, the bold while delivering the future to healthcare’s leading brands. I’m Stephanie Weirwill, EVP of Engagement here at BPD and I’m joined by Desiree Duncan, VP of Health Equity and Inclusion.

Good morning, Des.

Desiree Duncan: Morning stuff, how are you?

Stephanie Wierwille: I’m good. I’m a little sing songy apparently. I got a laugh from, from Chris on that sing songy intro. Hi, Chris Bevelo, chief transformation officer here at BPD. How are you doing?

Chris: Yeah,

Stephanie Wierwille: Sing songy.

Chris: It was nice. It was like you were singing the intro. I thought

Stephanie Wierwille: Good morning. Good morning. Um, so.

Chris: Monday

Stephanie Wierwille: Monday.

Chris: so just keep that in mind.

Stephanie Wierwille: It is, it’s Monday and I’m really trying to caffeinate myself because we have a lot to cover. Um, we’re going to cover [00:01:00] several headlines, one that’s breaking news. So we’re going to cover a breaking news piece about, um, some Interesting happenings at the HHS.

We’re going to talk about a piece we saw in ad week, which is around the modern CMO playbook. We’re going to hit the state of the funnel wars. And, um, we’ve talked a lot about the funnel wars on this podcast. It’s covered in Joe public 2030, but there’s even more action happening with Walgreens going private and some interesting, um, things that we’ve seen in the primary care space.

So that’s our agenda. But first, before we get into it. We were talking last week that our last few podcasts have gotten a little bit dark and Yeah, not so sing songy, so,

so I’ve, I’ve actually been noticing, I don’t know if you all are noticing, you can, you can weigh in here, Chris and Des, but I’ve been noticing and talking to our clients, it’s just, it’s a challenging time.

I think a lot of folks are feeling that darkness, a lot of folks are feeling the [00:02:00] volatility, they’re feeling the tension, um, and so in the spirit of a caffeinated Monday morning, I wanted to see One, are you all feeling that? But more importantly, what are you doing to combat it? Is there anything that’s keeping you inspired, keeping you excited?

Um, anything that you’re doing to try to combat this somewhat, maybe very volatile 2025 thus far? I will ask you first as.

Desiree Duncan: Yes, definitely feeling it deep in my bones and they hurt, uh, but there’s, there’s pain relief for that. I think for me, it’s, I limit the news that I intake, like I get my like quick dose in the morning with Up First and PR’s little just kind of quick hits of what’s happening, so that way I don’t feel like I need to be paying attention to it all day. And then I’ve gotten back into my photography, uh, took a little bit of a hiatus there, and just the opportunity to just kind of be present and like take in like what is around me instead of kind of worrying about the future, which is what I [00:03:00] always do has been super helpful. What about you, Chris?

Chris: Uh, yes, though I will say it helps to be old, helps to be an old person. Uh, at this point now, I have been through 9 11, which not everybody’s experienced, which was a very, very I’ve been through the 2007 2008 Great Recession, which was extraordinarily volatile. I’ve been through 8 years of political turmoil. least 8 years, is that fair? Uh, some wars, all that. So, each time this stuff comes around, it feels, it feels less big than it did the last time. so that helps, but I’m also just totally my news and the channels from which I get my news, uh, and music is my thing. So, I think I already mentioned I have a playlist, um, I’m old, so I call it Funky 2025.

It’s got Kendrick, it’s got Dochi, it’s got [00:04:00] some other stuff. We already went there. I also, interestingly, have a playlist called Folk, is Which I created immediately after seeing a complete unknown. You think that would be, you know, like, opposite? Because it does include Puff the Magic Dragon, I’ll be honest. But also, it’s got a ton of uplifting, kind of rebellious music, particularly from our friend Bob Dylan. Uh, if you listen, obviously everybody knows him for a lot of that, but it’s not just things like blowing in the wind, which are kind of soft. There’s some, some rock and stuff in there. Like he, he brings it.

And so it is interesting when I work out, I’m, I never know which one to go with. And sometimes I’ll just mix the two. Uh, and now Apple with its AI. capabilities. It’s creating a playlist just for me. Um, and at first it was all Puff the Magic Dragon, so I had to fix that immediately.

Desiree Duncan: you work out to folk music?

Chris: Have you ever heard Highway 61 Revisited, Des? [00:05:00] Go listen to that. Go listen to it.

Stephanie Wierwille: The rock album.

Chris: Highway 61 by Bob Dylan Revisited. And you tell me whether that gets your blood pumping just a little bit. bit. And also there’s times where you have to, like, rest and stretch and, so, so there’s a playlist on Apple called Energy, which is usually what I listen to when I, when I ride the Peloton. It’s

Stephanie Wierwille: Okay. I think you’re going to need to, you’re going to need to link out all of these playlists because now I’m hungry to listen to them and, uh, and work out to them.

Chris: Well, I, we’ll see how you feel about the folk one. Des has got a

Stephanie Wierwille: Okay.

Chris: there. You don’t, you don’t get a lot of energy from, Puff the Magic Dragon.

Desiree Duncan: I could see yoga, but not, uh, weightlifting. But hey, you know, teach his own, I guess.

Chris: Yeah, I almost, I’ve been tempted to knock it out of there a couple times. my wife won’t listen to it because it makes her so sad. I mean, for those of us of a certain age, [00:06:00] it does remind us of our youth. it’s a very, very sad song. So, saying, maybe, maybe it needs to be pulled.

Stephanie Wierwille: Okay, the, the emo, well, well, first, I think actually similarly, I, I turn to music in times that are, that are harder. There’s an, there’s an emo girl inside of me that nobody really gets to see, but it comes out in the music space. I work out to classical music. I don’t know if that’s even weirder does to you than folk.

Okay. Classical music. Let me tell you, we’ll get you pumping like nothing else. Classical music is like. It’s the, it’s the EDM of the 1700s, and it is raging.

Desiree Duncan: It okay. Yes, it can rage. I was in marching band in high school and there, there’s definitely some songs that really just get the heart pumping. So I, while the EDM of the, you said the 17th century,

Stephanie Wierwille: EDM of the 1700s is, you know, a little bit of, yeah, we’ve, [00:07:00] we’ve got that, you know, our, our boys, Bach, Mozart, and Beethoven, and then Beethoven really brought on the emo era in the 1800s, but I won’t bore you with all of that. And Philip Glass is my current, Um, guy today, he has been for several decades and Philip Glass will get you sitting back and thinking about the state of the universe like no one else under the sun, so.

Desiree Duncan: We actually just saw the, I think it was the 50th or 60th anniversary of Twyla Tharp. And the second act was set to Philip Glass. It was

Stephanie Wierwille: Oh, see? Oh, beautiful. Um, Des, I did want to mention though, your photography is stunning. And Des has been sharing her photography from her travels recently. And Des, you are a professional photographer. You are beyond.

Desiree Duncan: Working on it. Not there, but thank

Stephanie Wierwille: I think you’re there. Um, all right. Well, with that little bit of levity, we’re going to go back to to darkness, a really quick whiplash, which I think is the theme of these days, these times. Anyway, so a little bit of breaking news headline that Chris [00:08:00] shared with us this morning. So there was an email that was sent out on Friday night, apparently, to 80, 000 employees at the Department of Health and Human Services, which was a voluntary separation incentive payment, that’s a mouthful, but basically 25, 000 voluntary Um, so Chris, I think you saw this first by WTOP who broke the news in the DC area, but now it’s since been covered, uh, yesterday by NBC and MSNBC.

So I, I will toss this one to you, Chris, if you want to talk a little bit more about what you saw and, and how it made you feel.

Chris: Sure, and just to keep in the spirit of this podcast, each time I introduce my point of view on a topic, I’m going to tie it to the title from a song in my folk playlist. And I think this one does, by the way, if you have not heard the man comes around from Johnny Cash, another one is a phenomenal song that’ll get your blood pumping. [00:09:00] Also completely appropriate for this particular story, I think folks have already, to your point, heard about the different, it’s called the fork in the road email because apparently Elon Musk uses a Twitter to basically tell people, take a buyout or you’re fired that went out to all the world. health and human services workers on Friday. So they were offered 25, 000 to leave now. The name of this offer, the email was called a voluntary separation incentive payments. There are 80, 000 employees in Health and Human Services. Obviously, they oversee the FDA, they oversee the CDC, uh, National Institutes of Health, CMS, like you name it. Let’s say they cut 10%. Gonna have an effect on those folks at, our friends at Health Systems, um, let alone the patients they serve. Let’s say they cut [00:10:00] 25 percent or, God forbid, 50%. Like, this is gonna have, if they follow through, if they’re allowed to follow through, because there will undoubtedly be lawsuits, uh, huge impact on everything from government reimbursement to research that is focused on everything from Alzheimer’s to cancer.

It’s, it’s gonna be a, a big deal. So, an eye on it, see where it goes, uh, we’re actually going to be launching very soon, uh, a service that will be tracking this stuff on a daily basis, called Policy ICU, uh, for us this feels very reminiscent of March 2020, all the upheaval that COVID caused for our health system clients, they’re feeling that, uh, upheaval today from all of the policy changes, uh, the tariffs, the economic issues, all of that is, is happening right now.

So we want to keep our finger on the pulse and share it with our friends. So [00:11:00] for that.

Stephanie Wierwille: Okay, I’m excited to watch for it because things are changing by the minute these days, and not just by the day or the week, but by the minute. And that’s a good example of one of those, which we are watching and monitoring. Our next headline, a little bit less breaking news, I think, on a topic we’ve been following for a while, but has some really good data points that, um, that folks may find interesting.

So there was a article in Adweek around the modern CMO playbook and had some really good stats and facts and figures from some recent studies around the role of the CMO, the role of the Chief Marketing Officer. So as folks know, we’ve been watching the, the role and the future of Chief Marketing Officers.

through at health systems, especially through our Rome is burning platform. Um, but this has some, some, I think new ish stats. Um, and some of the key pieces here are that the day of vanity metrics are gone. So marketing leaders are [00:12:00] now measured against growth targets. 54 percent of marketing leaders say they’re measured against growth targets and 51 percent are accountable for driving operational efficiency.

However. Fewer than 30 percent of CEOs actually believe that CMOs are driving that growth. So we can, we can get into that, that gap and whether it’s surprising or not surprising. Um, and, and so really, you know, this playbook lays out a few specific. key skills, such as the importance of data fluency and financial acumen.

Of course, if you’re being measured against growth targets and operational efficiency, data fluency and financial acumen are more important than ever before. And also cross functional leadership is critical, especially with CIOs that’s a topic we’ve been talking about a lot over the last six months or so, is the importance of collaboration with the rest of the C suite.

And then no surprises, AI strategy is a critical role of this. Um, and in fact, a recent, uh, BCG [00:13:00] study showed that 70 percent of CMOs actually are leading their company’s generative AI initiatives. So it’s, it sounds like based on that stat, leading it for the entire company or leading out on it, or at least at the tip of the spear.

However, Only 33 percent believe they’ve mastered existing Martech. So I can’t wait to dig into that gap with you all as well. Um, so I just thought this, this had some really good, you know, stats and, and really carries on that conversation we’ve been having, which is, what does it mean to be a chief marketing officer and a marketing leader today?

And, um, and what skills do you need to have? So I’ll toss this to you first, Chris, if you have thoughts as you’ve been keeping your eye on this, on this space.

Chris: Well, I’m going to say, um, stay tuned. That’s all I’m going to say because a lot of what you just reflected, uh, from that, from that study reflects what we have heard over the last 18 months from CMOs who we’ve talked to, um, many, many of them. And in fact, we will have a report [00:14:00] out, very in depth report out on everything you just talked about relative to the health system CMO next month. stay tuned. I don’t want to give anything away. I don’t want no spoilers. I’m not going to spoil other than a lot of that sounded familiar.

Stephanie Wierwille: Okay. Yeah, it, it, I think it sounds familiar too in what we’re seeing in general and the one thing I’ll say, I haven’t seen that report exactly in super deep dive, so I can’t spoil it. So I think some of what I’ve seen though and heard, um, in conversations is the pressure is higher than ever, right? The pressure is being turned up.

Um, what it means to be a marketer in general is expanding more and more. And I’m not surprised by a lot of these stats. I think it has the same type of pressure vibes that we see. Um, but what I think is really interesting is those gaps. So responsible for driving effectiveness, but maybe not, uh, getting believed that way or.

responsible or driving AI, but [00:15:00] still, you know, we still haven’t figured out and by we, I mean, health system industry, which is not so much on the CMOs, it’s on the industry still haven’t figured out things like CRM and Martek and personalization. And so how do you do both? I think that’s something that we’ll probably cover throughout this whole year is how do you both leapfrog into AI while also making sure you’re making the progress you need in the digital space.

Any other takes on that before we jump into our key topic?

Desiree Duncan: I mean, this is kind of a, uh, a hot take. It’s, I guess, outside of health care, but I think about like, when I’m listening to CMOs and some of the, uh, strategy podcasts, it’s talking about how, um, their influence on product and product delivery is that opportunity for them to really stand out as that, that growth, uh, leader. And I guess within health care, we don’t necessarily have products. We have services. Um. But I guess if there is this sense of the CMO is kind of falling at, I guess, that a, a way to lead into product as a way to say, Hey, we [00:16:00] are a part of this and a lead strategist in this way from our market research and all that good stuff

Stephanie Wierwille: Yeah.

Chris: right there. The experience. Spoiler alert.

Desiree Duncan: Well,

Stephanie Wierwille: Yes.

Desiree Duncan: So my bad.

Stephanie Wierwille: No, it’s, Des, it’s like, it’s like you’re, it’s like, uh, I think that was the conversation for three, four hours during the Joe public retreat in December with our, with our health system CMO friends, which is how do you broaden into, like Chris said, experience. So yes, yes. And yes. And to me, the headline is just expansion, expansion, which is exciting.

Inspiring and also perhaps stressful. So let’s move on to our main topic here. We have a lot to get into in this main topic. Um, so We’ve talked a lot about the Funnel Wars, um, the Funnel Wars as part of JoePublic2030 predictions for the future of healthcare and the Funnel Wars prediction from the [00:17:00] book is really all about how.

The top of the acuity funnel, so acuity funnel being, you know, wellness, um, primary care, urgent care, ED, all the way down to specialty, subspecialty, tertiary, etc. That funnel, um, that top of the funnel had been really leaned into by new entrants. Think, um, think Amazon and One Medical and Walgreens and CBS.

Big retail or big retail in addition to new entrants, the forward health of the world, Village MD, who was bought by Walgreens, that whole realm. Um, and so at the time of the prediction, our prediction was that that the new entrants, would continue to lean into the top of the funnel and what would that mean for the legacy players?

Well, since then, we’ve been talking a lot about how on our predictometer, which you can find on our website, the funnel wars is probably the only prediction that’s not a nailed it. That’s not a dead on. And in fact, it is, it is sort of, uh, the, [00:18:00] the, the wars are, well, they’re very volatile to use the word of the day.

Um, and so we, we have a headline here that we’ve seen in the last week along those lines where Walgreens is actually going private. So they’re being, um, they’re moving into the private space, moving into private equity in a deal valued at 10 billion with Sycamore Partners. Uh, and Sycamore Partners is buying Walgreens Boots Alliance and taking it private.

And VillageMD seems like it may actually be sold. There’s some headlines around that. And if you dive deeply into the press release, it suggests that shareholders could get, um, payments based on the sale of some of those subsidiaries, including VillageMD. So this tells us the funnel wars are. In an interesting place, which we already have called over the last few months.

Um, so I’ll just leave it there. Um, does, I know you had been watching this, you’ve been watching those new entrants, you’ve been watching big retail. What was your thought when you saw [00:19:00] this headline?

Desiree Duncan: You know, I’m looking at this mostly from that consumer standpoint, not necessarily, you know, our healthcare background, but I’ve really noticed and especially going to Walgreens all around the country. Um, the past couple of years is that there has been a bit of a decline. And the consumer experience, and maybe perhaps, depending on what neighborhood you go to, um, you know, all the everyday products are locked up, uh, regular products are no longer available.

I specifically go to Walgreens because I, you know, I need, uh, ethnic hair care and beauty products. And, you know, they’re usually the top ones to deliver that. And that has been really declining. Um, so I guess in thinking about the business behind it again, haven’t, um. deep into it, but for me, it feels like a, hey, there’s definitely been something going on that needs to be addressed outside of health care.

And I know that there’s been the conversation of a getting more into health care, but in reality, I haven’t seen much of it beyond, [00:20:00] you know, covert testing earlier on. It has not really improved, but that’s my consumer take.

Stephanie Wierwille: Yeah, it’s really been more, uh, industry, um, talk to your point and, and more business strategy as opposed to their move into healthcare through all of their, um, partnerships and acquisitions actually showing up yet. And I, I, I did dig into the numbers over the weekend and I’ll share a little bit about what I found there, but, um, want to hear first from you, Chris, as you’ve been keeping your eye on this funnel war space for quite some time.

How do you feel about the Walgreens news?

Chris: um I think des is being kind when she says the noticed a kind of subtle drop in the experience or however you put it uh There is super interesting because a couple years ago. I don’t know if you guys are familiar with the show industry It’s incredible, by the way, and if you haven’t seen it, you need to watch it. Season 2 had a thread was about, I [00:21:00] don’t know, I think he was a hedge fund guy. It was some super rich billionaire, uh, and one of the main characters was trying to sell him uh, virtual care, essentially. It was phenomenal. It was, it was right in line with our business. Uh, and they had a conversation at a bar around Walgreens and it was quite derogatory and I wish I could find, cause I actually clipped the scene to, to remember what the guy said. Uh, but to me, Walgreens has become kind of like a, a little bit bigger convenience store where nobody works at unless they’re behind the. The pharmacy counter you walk in there and there’s literally nobody Like the counter is right up in front of nobody’s checking out. There’s nobody within sight.

There’s no employees Uh, it’s just it’s it’s not great. So, uh, they really tried to make Healthcare the future of the organization which in theory makes sense But they would have had to do a complete overhaul of that [00:22:00] experience For anybody to consider walgreens the center of their care. So that’s my take luck to them

Desiree Duncan: when you mentioned industry, it also reminded me of like Theranos with that whole, uh, debacle and how it’s just like, wow,

Stephanie Wierwille: Oh. Yes.

Desiree Duncan: of. Yeah, yeah, it was it was really interesting just to kind of see how these folks you think like, oh, they’re going to make these logical business strategic decisions, but that they were essentially sucked into this particular thing

Stephanie Wierwille: Mm hmm.

Desiree Duncan: or

Chris: I found the,

I found the, I found the exchange. It is, it is, it goes like this and we know behemoths like Amazon and Apple are looking to consolidate in the healthcare space and part of that is. is circling these slow death high street retail spaces with nosebleed short bases. Uh, and then he, he says, um, the [00:23:00] fictional company they’re talking about is Fast Aid. And he says, Fast Aid is the traditional brick and mortar physical pharmacy, right? Oh yeah, like Walgreens, an eyesore on every corner.

Stephanie Wierwille: Oh, oh, ouch. Oh, it hurts.

Chris: brutal the brutalists

Stephanie Wierwille: Yeah. Yeah. I mean, here, I have to say, though, that like I was. You know, and I think we were, collectively, in the Funnel Wars prediction, pretty optimistic about big retail, big tech, new entrants, in general. Um, and, theoretically, aside from the eyesore state, which is very, very true, the retail strategy of having all these brick and mortar locations within, what was it, 95 percent of Walgreens or within 5 miles of every American, or something like that, that’s not the right stat, but it’s, it’s, it’s the general idea, was the strategy, and so the thought was, if, if they could, move down the funnel through home care, telehealth, urgent care, primary care, and get [00:24:00] out of just pharmacy and retail, then, you know, there, there we go.

But that’s not what played out. Partially because of, I think, what you all are calling out. So I want to just dig into the numbers a little bit because I geeked a little bit into their earnings reports. And I was like, I was curious, like, how, how, how, what are their numbers saying? And is this a, is this an opportunity story or is this like a failure story?

Um, and the numbers I think are interesting or both.

Chris: That’s the

Stephanie Wierwille: Right.

Chris: today failure Opportunity or both

Stephanie Wierwille: Ooh.

Chris: because you can’t just pick a side

Stephanie Wierwille: No,

Chris: you got everything’s got to be balanced So balance it out for us Stephanie

Stephanie Wierwille: okay, so the financial performance says that over the past 18 months or so Revenue has actually increased Sales has actually increased so top line you’re like, oh, okay But it’s glowing growing at a slower rate than before and [00:25:00] as part of that the profitability has really been the failure story The issue has been More pressure on pharmacy reimbursements, no surprises there.

Um, and so lower profitability in the pharmacy space. Decreased demand for top of, uh, or front of store. So that’s what you’re seeing, Des and Chris, that, you know, just nightmare of a state where nobody wants to go in and get their, you know, retail. Things anymore. And so there’s decreased demand plus inflation happening, so right.

Raise prices, um, and just general competition rising on that. Um, and so that’s some of what’s been happening in the profitability, uh, side of things as well as they also cited the normalization of demand post covid. So Walgreens of course, hit its high, um, in COV when everybody was coming for vaccines.

And they really did a big push there. And since then there’s been a big falling off. Um, so since they are a public company. I think what’s important to note [00:26:00] is their earnings per share has been falling, and thus their stock has absolutely tanked since its all time high of 2015. So there’s a lot going on here, and also one last note, given the point about the health care assets, you know, there’s a lot of capital that went into those acquisitions and partnerships, and so they just barely got into the green again.

on the health care side of the business in 2024. So maybe that’s the opportunity piece poking its nose in, which is okay if they’re turning green, perhaps in the health care sector. Maybe there’s an opportunity, but there was just so much capital put in. So I think if I look at this, why are they taking it private?

Well, one, maybe because of public scrutiny of being a publicly traded company. Um, they need to continue that capital intensive shift into health care. That’s the opportunity. The failure, though, is will they divest their health care assets? Like the press release, um, hinted at, will they be able to increase pharmacy margins and focus on pharmacy?

The press release called it a comp, they had [00:27:00] confidence in the pharmacy led model. So that suggests they may just focus back on pharmacy with a backseat of retail and health. And they will likely continue to close stores because they’ve got to cut costs to improve those margins. So that’s my whole summary of my little, you know, finance deep dive.

Chris: Fancy

I think that. To me, the fundamental miss in this, particularly for someone like Walgreens is, right, we knew they were never going to go beyond top of the funnel health care. They weren’t going to open hospitals. It just makes no sense to them, right? And we also know from working with health systems that Top of the funnel is, is oftentimes, other than the ER, a loss leader, financially. Primary care is a loss leader, right? You’re not making money on primary care, and if you are, it’s barely. Uh, and it’s probably because of Medicare Advantage, to be honest. So their, their whole theory was, if we can Build a health care relationship with somebody they’re gonna buy more skittles and dr. Pepper. I mean literally that’s That’s what it was. It [00:28:00] was a play to lock in consumers with something that Is more inelastic in terms of their Their ability to move around what that obviously misses is, you know, I can get everything that I need at Walgreens from Amazon or from Costco delivery or, or whatever.

And so, know, they also found out the hard way, as everybody knows that it’s not easy. primary care is not easy, for example. So I don’t, I think if, if, if they’re going to move forward, it’s likely to be with a limited healthcare footprint. It is not going to be the future, unless you count pharmacy, but pharmacies under its own tremendous pressures from some of the same things I just mentioned. Um, Amazon is a great example. Um, so I don’t know, I would, I would, um, Other than the fact that their stock is terrible, I would not be shorting. It would make a lot of sense.

Desiree Duncan: as you were talking, I was thinking about their placements and that oftentimes they serve as a, [00:29:00] um, like you said, that couldn’t the convenience store. Oftentimes they are in a bit of a food desert for various neighborhoods. So they kind of serve that purpose of like, Hey, quick place for me to get, you know, Quick essentials, snacks, what have you, um, which does not always lead to the best, uh, type of health and health care.

But yeah, I was just thinking about if they’re, they might lean more into that because that’s a big part of what they’re serving, um, their communities. Oh,

Stephanie Wierwille: this actually raised an even bigger question for us as we were, as we were looking at this and just the funnel wars in general, which is the state of primary care. So, you know, Walgreens, Walmart, Amazon, all of those players and many, many more had the big dreams and goals to move into primary care along with urgent care, home care, et cetera.

And. Seeing all of this, I would say, failure from [00:30:00] that group in the last year plus of where one after another. You know, closed clinics for Walmart. Amazon one medical is now having a little bit of flailing forward, closed all of its entire business down. Um, and so on and so forth. The question came to us around, you know, is.

What does this mean for primary care? Is primary care dead? Is it changing? Is it evolving? And it’s not just the fact that this is shifting in the new entrance space. We’ve seen some health systems, um, some health systems going even further in to primary care and the top of the funnel, and others. Pulling back or changing or, you know, we’ve seen staffing shortages affect, um, some health systems and they’re actually having to close clinics.

All kinds of things are happening here and there’s just again, volatility in this space. And so it raised the question for us, what’s going on with primary care? We’re seeing these initial signs of some [00:31:00] leaning in, some leaning out, new entrants failing in this area. Is primary care evolving? Is it dead? Uh, what’s happening and what does it mean for health in this country? So big questions on the table.

Des, I’ll, I’ll pop the big questions to you first if you have a take.

Desiree Duncan: oh, wow. So I think, again, coming from the consumer, uh, perspective, when I think about primary care and I think about folks that are, you know, kind of, more in and out of care, um, older folks, those with multiple health needs, you know, you really need that quarterback. So if primary care is going down, then what happens there? And I know that this is a part of the Copernican consumer where essentially healthcare revolves around the one person, not everyone has that access. So then does it pull in a bit of that disparity dystopia of who actually gets to, uh, access This sort of thing and who really needs that primary care that person is really looking out for them. [00:32:00] but we know also that doesn’t always happen within health systems where and specialists are making decisions putting on meds without actually consulting with anyone else about how it’s going to affect The other meds you’re taking. Um, but there needs to be that something that somebody I don’t know what that looks like if primary care ain’t it? So I guess chris, do you have answers?

Chris: Well, first of all, I miss my, I miss my folk song intro on Walgreens, and I think if I had to title that, it would be It’s All Over Now, Baby Blue by Bob Dylan. Uh, and I will

Stephanie Wierwille: Okay. Okay. Okay. Okay. Okay.

Chris: is anything right? We talked about a I and technology platforms. filling a void for a lack of primary care, but also [00:33:00] maybe delivering it in a better way. Right? We even had some people that we talked to for the book that said, primary care should be real time.

Why should you see your primary care doctor once a year or twice a year? Like you should have that data should be real time. And depending on the way that data is entered, your claims, your, uh, you know, your Apple watch, all that kind of stuff that should allow you to. You know receive input and advice and care when you need it The other thing we talked about was self service And I think we’re seeing I think the the decline in primary care need is is a real thing.

We cited that then um This is back in 2022 Where there was a reduction of 25% primary care visits between 2008 and 2006, uh, millennials and Gen Z are foregoing primary care. Uh, a lot of that is because of their age. They’re not foregoing it, they just don’t need it. But millennials are at an age now where they would typically need primary care.

We’re [00:34:00] not seeing the adoption of it. A lot of that is just because they, it is self-service. Why do I need one doctor, unless you have a chronic disease? Why do you need one doctor? I’m just going to, I’m going to go to urgent care. I’ll go to the emergency room if I need to. I’ll get care through my coach. Uh, interestingly, even talked about in, in the Copernicus Consumer, um, some new professional roles we might see. There was an article that we cited that, that listed potential professions, such as lifestyle strategists, uh, to guide patients with their health data, a patient assistant, helping patients navigate the healthcare jungle, or a VR therapist, treating patients with new realities. Um, and so all of those things I think are in play here. You’ve got, you do have Walgreens if you want it, or CVS, or Walmart in some cases. Uh, you have a ton of online resources you didn’t have before. So all of those things, call it death by a thousand cuts, I think do portend a different future for primary care.

There will always be [00:35:00] a need for people like me, who have multiple chronic issues, to see one doctor on a regular basis. there are plenty of people that do not need that. so, you know, you can get a physical checkup from anybody. And yes, Des is right. You need to have all of that information in one place to maximize your health. Uh, but hello, technology should allow for that, right? Your data shouldn’t be stored in the Epic records of this system. then also the Cerner records of that doctor. Blockchain and other capabilities should actually allow all of that to be brought together. So that’s the Copernican consumer side of it.

Desiree Duncan: I was actually just getting ready to ask about the blockchain, if that would help support that’s where their technology could be used. this lifestyle strategist, where can I go get that? I’m ready to sign up for that. I need it. Millennial aging definitely need the help and I have not bothered with PCP [00:36:00] yet.

Chris: got to be something out there. I mean, have you, you Googled

Stephanie Wierwille: Yeah, yeah.

Chris: I mean, it’s got to be everywhere. Walgreens offers it just go down to the like. Pop and crackers aisle and then like go past the toothbrushes and then there’s a kiosk there

Desiree Duncan: Pop and crackers. Wow, you’re definitely from the

Stephanie Wierwille: Pop, pop, soda pop. We’re gonna make fun of you on that one. For, for, for me, everything is, everything is Coke, whether it’s Sprite or, you know, it’s all Coke. But anyway. Um, okay, so here’s my Bob Dylan song, Chris. I’m gonna follow your lead on this one. Mine is, a hard rain’s a gonna fall. So, I, here’s my, I, I have been sounding the alarm bells in my brain and my moan my little mind quietly for several.

for quite some time and I’m ready to do it out loud. And I think that primary care is, I think that we’re walking into a major crisis and I haven’t heard others sound the alarm bells quite yet. So you laid out a bunch of factors, Chris, and a bunch of things that need to happen. Totally agree with all of those.

I [00:37:00] think just seeing the staffing shortage that is not new news, the lack of primary care physicians, it’s almost like, it’s almost like people are so tired of hearing those stats that we don’t even talk about them anymore. But it’s a big deal and it hits patient access. It hit me personally. I’ve been trying to get a PCP.

I’ve had one before, but for various reasons that were not in my control, I was cycled out of multiple PCPs who either left or residence changed. And then I was left in a lurch with no PCP. And I’ve been that way for over a year and have tried. and tried and made phone calls and booked appointments and I cannot get a PCP.

I can’t get one, no matter how hard I try. So that has huge implications in all kinds of ways, um, for health, for how people use health systems. Obviously, our new entrant friends were going to save us all and they couldn’t, um, and I think with the, you know, alternative medicine. debate sparking up, people may turn towards more towards that or towards the Copernican consumer.

I just think [00:38:00] primary care, I’m not saying it’s dead, but I think a hard rain is going to fall and we’re not, we’re not sounding the alarm bells as much as we should. So that’s my prediction on that.

Chris: We’re in fact, we talked about that in Rome is burning to circle back around to something else when we talk about you know, the idea of supply and demand and it’s record Demand for health care because of the boomers and there’s a real crimp on supply of care, uh, for all kinds of reasons, um, again, not to, not to tease too much, but in the upcoming paper, we cite, to that point, to your point, Stephanie, uh, the AMA stating that there are 83 million Americans who do not have access to primary care today.

Stephanie Wierwille: yeah.

Chris: a quarter of the company. company or the country that is a quarter of the country. So that’s a lot. The question is, do they all need that access? You sound like you need it. [00:39:00] Um, but there will be plenty of people that don’t, or for whatever reason, because they can’t get it, we’ll patchwork something together.

Stephanie Wierwille: Yeah, and just one little anecdote, and then I think we can, we can wrap here on this maybe dark note. Whoops. Another dark note, uh, when we started inspired, but the, where, where are the implications really come for a health systems, business standpoint. I know we’ve talked ad nauseum about the funnel and where people come into the funnel is typically through the top.

But for me personally and not having a PCP and needing to get to a specialist, I actually had to do a weird workaround of to go to an urgent care to get a get a referral to a subspecialist because you can’t get your own referrals, right? So if you don’t have a primary care physician, how do you get into the system?

You have to make up your own little Loopholes. So I had to make my own little loophole, but I think I know the system pretty well. Um, and so I think there’s just major implications for, for the business of healthcare. [00:40:00] So anyway.

Chris: challenges bring opportunities. We

Stephanie Wierwille: Yes.

Chris: Here Comes the Sun, my final title from my folk. The sun always rises and you can

Stephanie Wierwille: Doo doo doo doo doo.

Chris: as a health system to figure out how do you fill in the gap for people, even if you can’t find primary care doctors.

Stephanie Wierwille: I love it. I love it. Okay.

circled back to our sing songy ness. So with that, we’ll wrap on Here Comes the Sun. And for everybody listening, Check out our newsletter, it’s where we um, share a lot of these themes and dive even deeper into some of these discussions from the NoNormal show and you can always shoot us an email if you have a question or a topic at nonormal at bpdhealthcare.

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