Wendy 00:09

Hello, everyone. I'm Wendy Liebmann. I'm the CEO and chief shopper at WSL Strategic Retail and this is Future Shop. This is where I talk to innovators disruptors and iconoclast about the future of retail. Today, the topic is healthcare. It's a political landmine, right? Well, it's more closer to home, as most of us deal with it, and this listening and viewing audience. We're going to talk about the need for retail healthcare to be disrupted. It's being disrupted, or it needs to be disruptive, whatever it is, there's a lot of change coming along. There's so much going on in terms of conversations around self-care, and women's wellness and digital care and incentivizing people to take better care of themselves and food as medicine and all of these extraordinary things. So, I thought it's really time to level set the conversation or at least push it forward. So, I'm really excited today to have with me somebody who has a very unique purview on all of this. She is Susan Lang. Susan is the founder of XIL Health. She founded this women-owned healthcare analytics and technology company. She invests in healthcare startups. In her prior life, she was one of the senior executives at Express Scripts, and really has spent her entire life working in healthcare. So, she has an extraordinary lens on what is going on in terms of the future of retail healthcare. And so I am just absolutely delighted to have her with me today. Hello, Susan. Welcome.

Susan 01:57

Hello, Wendy. Thank you. It's so good to be with you. Yeah,

Wendy 02:00

we had a one of those Kismet kind of meetings along the way at NACDS or somewhere else through the lens of our good friends at Kroger and Colleen Lindholz, which was a great meeting. And so you and I have continued that conversation. What struck me about that, and what's so intrigued me about your background is you have both this extraordinary, I'm going to call it technical expertise. Sorry for that. You'll explain some of that in a minute. But you also have a very personal view to health care. So can you give me the short version of both of those

Susan 02:34

Sure, I'd be happy to so what Wendy is talking about is I ran hospitals, large community hospitals, not for profit for about 22 years. And when I was 33 years old, I was on my way to a hospital board meeting. And I got hit head on by drunk driver. And I had a head injury, serious head injury, about 16-18 fractures, I had to be air vacked to a Regional Medical Center. And I was out of work for a little over a year and in physical therapy for five years after that, and was told that I would never walk again without an assistive device or work again. So I went from being running hospitals to being a patient for a very long time.

Wendy 03:13

And that I think, is so interesting, because if you meet Susan, see, Susan, she's one of the fastest movers, I know, but it's physically. So it's just extraordinary the story. But that's what I mean when I say she has a unique point of view on all of this, because she's been at both sides of this extraordinary ecosystem that we live in when we talk about health care. So, thank you for that devastating but inspiring snapshot of life in Susan Lang world. So, you know, when you think about all of this, you today are very involved with some very large clients and retailers in terms of their PBM business and the way they strategically manage that. But you also are invested in physical therapy clinics. And I think about that, as I sort of step back and think about what role do you see retail playing in delivering better, more affordable health care to people these days? Or do you?

Susan 04:13

Absolutely do. If you think about the shift, there's been a 20-year shift away from hospital systems, to local freestanding centers now to retail and one of the amazing things about retailers is They're everywhere. They're in your neighborhood. So it wouldn't be possible to replicate that footprint today in healthcare by putting a clinic in every single neighborhood. It's just not possible economically and financially. So really, if you think about retail, they are on the forefront of community access to care and hopefully affordable access to care, both for primary care, and then how you really rethink that retail space in terms of people taking control of their health care. So one of the things that happened with me and my care is as a patient, It was a long time ago, but you want to be in control of your care. And we're seeing that now play out in retail, where people want to control, consumers, not patients, want to control their health care. And that's going to be the big shift for retail for the next 10 years.

Wendy 05:13

That's so fascinating to me. Because we certainly hear people we hear our CPG clients and our retail clients talk about self care. And it feels like such an airy fairy term. In fact, it feels like I would say, it feels like Oh my heavens one more chore for me. But the way you talk about it in terms of taking control of my own health, as an individual or a family, that sounds like a very powerful model. Can you talk a bit more about that and what you're seeing.

Susan 05:44

So if you think about just fundamentally, what health care is, or health, your health today, it is your ability to take care of yourself and your family. It's such a fundamental requirement, we all have to live our best life, regardless of your health status. It's how can you do as much as you can do the things that you want based on your health status. And when you go into a hospital system, or you go into a complex system, you lose that personality, you lose that individual drive, and you're allowing other people to make decisions for you. And consumers today don't often want that. And part of the reason is, we have democratized healthcare information, and health data. So when I was running hospitals back in the day, and women and children's hospitals, I had physicians tell me, for instance, women were not smart enough to really learn about and control their own health care. Today, if you Google Health on the internet, you will see 14 billion, billion with a B ,sites on health information. So as that information has spread, consumers really want to understand what their options are, how much it costs, how frequently they have to go, and how much can you do in your own home or again, in your local retailer, or online. So you're not forced into sort of these impersonal situations in traditional healthcare settings, honestly. So that's where we're going.

Wendy 07:07

So that to me, first of all, since we both run women owned companies were thoroughly insulted by that prospect. Right. thank heavens that’s done, sort of

Susan 07:17

we're long past that. That was a long time ago. So we’re way passed that, hopefully,

Wendy 07:21

we hope, right, we know. But those days of WebMD right have now exploded. I mean, we see that in will allow ow America Shops® research, we see the extraordinary number of places people report they go to for health information, you know, from paths to websites to a whole slew of different places. How do you see that when you envision what a retail environment that store on the corner clinic or no clinic looks like? How does that change? Now we play so much store on the portal, pharmacist, young pharmacist, whatever at the back of the store, how do you see that sort of journey evolving now with that access to information?

Susan 08:05

If I actually look out in the future, what I envision it's not exactly here yet, is a combination of a couple of different trends. So the trend of telehealth combined with the trend of wearables, which is consumers that want to see their own functioning, how they're doing in their own body, whether that's their blood pressure, the respiration, their pulse, it might be an EKG machine, whatever they want, they want themselves to be able to wear that and to know immediately. I also see people now it's so interesting, that Libre, there's a device you use for diabetics, you put it under your arm, and you can monitor your blood sugar. People that are perfectly healthy are using this now. Because they want to see what is happening with their blood sugar because they want to stay healthy. They want to keep their energy up. They don't want to gain weight, all these different items. So if you think of a retail store, I do you think the whole front end of that store needs to be reimagined so that you could have potentially a smart store where you had a pod, I mean, if you think about this, you could go into a pod, you could rent the pod, you could pay a fee, you step in like you would an old photo booth, and you get your primary care visit is done. On screen, everything's monitored for you, including your blood pressure, you get your script, you walk out, you follow the script, and you're out and you've just had a primary care visit, right? So that it's a completely different way to think about, again, distributing health care, especially primary care into a retail setting. So somebody could go into the setting and have that done because what are the issues with telehealth from my perspective, so I've tried it just to see what that experience is for the consumer. The doctor said to me, “Oh, do you have a blood pressure cuff? Can you take your own blood pressure?” Okay, not everybody's gonna be really great if that are accurate or have that at home, but if you could step into a pod, all that's taken for you the information immediately sent to you, immediately sent to your doctor, talk to the doctor in line, everything's done. You're in and out in 15 minutes. I think it would be brilliant. So I do think the front end of the stores, from a product perspective has to start moving to service and beyond service has to start moving to data really is the product. People want their data and they want insights on their data. And they want to understand when data is being collected even on their wearable devices, where's it going? And who's using it? And how does it benefit them? So I think that's a whole new challenge to start to think about. But I think it's actually really exciting when you think about that. Yeah. So

Wendy 10:28

do you see anybody beginning to experiment in that space?

Susan 10:33

We do. And we have experimented. So we have, as Wendy said, we have, I'm the CEO of XIL Health, which is an analytics company healthcare analytics and technology. We also own what we call cash axis platform. So the other trend is people moving to paying cash, they don't want to ask their insurance company, they don't want everything through their employer, they are willing to pay cash for primary care, cash for prescriptions, which is advisory health. But we also have invested in physical therapy clinics. We have talked to pharmacies about putting wellness, physical therapy in the front of the store. So wellness, physical therapy would be as you age, you need strength training, you need fall precautions, there's just a balance, you need a few things. It doesn't require in depth physical therapy, but you could come into a store, do a quick class, get a consult and go home with your exercises and not have to do a full physical therapy visit, which is cash, right? Because everybody needs that as they age, and most people aren't getting it. And it would be much more affordable than home health. So if you think about the way healthcare has moved, it's gone from hospitals, everything and a hospital, out into the community. And every time we change the site of care, it gets less expensive, the least expensive care is in your home. But now you could actually say we could do something in retail for the community, that would also be very, very cost effective. And comprehensive. So we are starting to see people and we've had people, Wendy, say to us, we really want to think about that. We want to think about that square footage differently than we thought about that before. We think it creates stickiness. We think people will stay in the store longer. We have that sandwich generation of people care for the parents, maybe they walk in, they drop dad off, they finish shopping, they come back and get dad he had his 15 minutes. It's great. It's easy, they have to go to locations. There's a lot of benefit to that. So that conversation is just now starting, but I think it would be really interesting to see where that goes.

Wendy 12:21

Yeah. And I do think about it within the context of the whole discussion about caregivers, you know, some recent research, I can't remember if I was talking I shouldn't remember the source. I can't remember if I was talking to you or talking to somebody else. But that whole conversation around millennials, and this conversation that 30% of millennials know, anticipate that they will actually be playing the role of caregiver, you know, within a very short frame of time. So that sandwich generation, you know, the urgency for that kind of care becomes even even greater. When you talk about your vision for this, and the store is this, so for the individual who comes to that, I mean, one of the big issues is right, the cost of health care, and who to trust to deliver it to me, we see in a lot of our work that that people say, you know, yes, I go to the doctor, I go to the nurse practitioner, I go to the pharmacist and while I trust them for basic for certain things. I don't trust them as much to give me good smart health advice. So is that what's also driving people to do, from your point of view, so much more of their own homework before they even show up? Is that the other piece, this level of trust,

Susan 13:36

I think it's a level of trust. And I think it's the level of consultation. So if you're going to a doctor's office, so if you think about physician practices, that model was started after World War II, they were not built for the sheer volume of throughput coming through their office. And so we've had care extent extenders, like you said, so physician assistants, nurse practitioners, but you see the doctor for five minutes, the doctor is treating whatever you are in the office for at that moment. They are not saying here's your wellness plan, here's to live your best life for the next 12 months. here's things you can do that will really help you improve your energy level, your sleep, all these things that are so important, right your your nutrition that affects our health. I think people are still looking for the consultation in that. And I think for instance, retail pharmacies, grocery store pharmacies, we know the public really trust pharmacists, we know that those are caregivers, people really trust. It's the same thing with physical therapists, they really trust because you spend time with them. Because you can talk to them because you can consult with them, they can ask questions. So it's a little different and it's not as intimidating as sort of questioning a physician may be in an office or somebody in hospital. So again, I think getting to that local community neighborhood, that neighborhood person down the street from you, you know, I used to tell people my grandmother retired in Florida, small home and her local pharmacy delivered her meds every week. The pharmacist would check on her, you know, and I loved that guy but because it was one less thing if I'm a caregiver taking care of my mom and dad, if I'm a millennial, we also know by the way, even not Millennials right now, there's somewhere between 30 and 35 million Americans caring for parents, I'm one of them, right? My parents are in their 80s are still doing great. They live in their own home, but we still are making sure they’re as healthy as they can possibly be and wanting care. I father just had physical therapy for balance. And it, it's helped tremendously. So if you could get that out in the community to stop people from falling, and you can drop that person off for a short time where you get a break and do your shopping, you're not worried they're in safe hands. You know, they're they're feeling good about where they are they have more interaction. For seniors. That's phenomenal, right? It's a phenomenal idea. The issue is how do you make it work per square foot? Right? How do you make the cost economics work per square foot in a store? That would be the thing we'd have to look at. But I think you can always make the economics work eventually, right? So long as you're not sending people out to people's homes. I saw a model where they were trying to have doctors do office visits, again, to people's homes to snow economics that makes that work?

Wendy 16:02

Yeah, well, that's part of what you know, we certainly saw during the pandemic, how we were doing more virtual health, and people sort of lent into that, because they didn't have other options, and then finding that for a lot of visits as a very viable alternative as long as they got more than two seconds. Somebody was telling me they spent more time with an online vet for their pets than usually do in the doctor's office. So those sorts of things we've learned during crisis, I guess, that really makes a difference. I do think the other topic that we've been hearing so much about from everybody in our client world and from shoppers, but more from the clients is this notion around broad topical women's wellness. And I know this is an area that's also in terms of some of the work you've been doing and the investments you've been making the scholarships you've been working on that I think Bank of America, those sorts of things, people are starting to say to us well, what is women's wellness? You know, is it menopause? Is it prenatal to menopause? You know, is it sexual health and wellness? How do we think about that it feels to me like it's everything in the store. Right? Well,

Susan 17:11

and this is why we started Advisory Health. So Advisory Health, the first component of that is a discount pharmacy card geared toward women who are taking care of their kids, their family, their parents, or community, and who are taking care of themselves. And what we wanted women to know is that COVID was really hard on moms was really hard. And everybody was really hard. Our moms, their kids are in and out of school, the school shuts down, they couldn't work, a lot of people had to withdraw from the workplace to take care of their families. So we wanted them to know that we see them and we hear them. And what they need to do is take care of themselves, because they cannot take care of their parents and their kids and their family and their community if they're not well, this is sort of a passion of mine. I've worked in women's health for many, many years, we have to start thinking about the whole person. And whether it's controversial or not. Mental health for women, autoimmune diseases for women, moms, what is unique commands, what is unique to seniors. So, we always said cradle to grave is what we already said. But really, I think about it women from 16 years old, I think about adults, right? Not pediatrics, but 16 year olds on. So that's reproductive health, that's starting your family and making sure that you start your family and have a safe pregnancy and a safe delivery, which again, I did for years, I ran a women's health care program where we delivered 6000 babies a year, All the way through going back into the workforce, your kids get older, and then how do you take care of yourself and take care of your parents as they age? So, this is an area that it's shocking to me because I had these discussions 30 years ago, and we're back to the same discussion. What are you hearing out there when they were two people telling you

Wendy 18:43

Exactly that conversation. And as you describe that I could instantly see what a physical space in the store would look like. I mean, I could walk with the technology support and the sort of digital experience that goes with that. But we always say follow the shopper to see the future. within that space. I can absolutely see the way a store would be designed when you think about the majority of shoppers who come into any store drugstore, a supermarket, a club, mass merchandiser, any of those department store, that if you think about who that shopper patient customer caregiver is it's generally a woman with lots of things on her plate. As you describe that through her life. It reminded me years ago Target decided that they had baby care all over the store. They had diapers over here and they had strollers and beds and children's cloth and everything was everywhere. And they finally convinced the buyers or somebody in senior management that okay, nobody owns the territory. We're going to bring it together through the lens of in that case, Target guest and everything she needed as a mom was going to be in that one one place and they did that. And then I think Walmart followed suit and things. But then I thought about, well, what about the rest of the store? That's a moment and a long moment. But how do you build that out? So anyway, the long and long of that was listening to the way you described it. And I'm thinking people now are talking about is it a vitamins, vitamins go in women's health and wellness? You know, where do tampons go, woman tells them seems like the wrong question they're asking, as opposed to who is this person? And how can we support her and her whole life. So as you said, cradle to grave seems a very good lens to have.

Susan 20:33

And women make 70% of all health care decisions in this country, which is also shocking. When you think about, I look at the ads on TV for health care. And there's a formula, there's a Silicon Valley formula that you have seen where there's a young guy in T shirt and nice jeans, and maybe a jacket, who's selling everything in healthcare, and it just shocking. So no women, they're not even represented. So that's still surprising to me. So again, that's our company is women on where women lead, we really want to hear the voice of what women need at each stage of their life and how we put those supports in place. We have talked to a couple large healthcare systems, we won't say who it's in development, but could we do care packages through subscription? Okay, so you're having your first baby. What do you need to come every month that you haven't thought about to help you feel better? What do you need to come for the 12 months after you have your first child? What do you need? If you're going through breast cancer? Do you have ice pops in your freezer? Because we know that chemo you know it's going to affect your mouth, All these different things that could be done so easily that you wouldn't have to learn yourself, every new person who gets sick, they're on this journey to discover what does it mean? What's the progression of that care? And what does that mean for them? Could we circumvent that somehow, and put those things in a store where they can come in and get them all in one place? You know, possibly in a package even delivered to them, which would be even better? Those are the kinds of things that you know, we're really thinking about and try to rethink that whole women's health space. So it's not just about having a baby. That's a big part of it. But it's about like you said, pre menopause, mental health. So what happens is you age? Are you taking your vitamin D? Do you have osteopenia? What is your situation? Right? We don't talk a lot about that. I think it's gonna take a retailer with real vision, saying, can they carve out a niche for themselves? Because nobody really owns this space? I also think in retail, we need to start discriminating by demographics, meaning, most retailers I've seen have a single floor layout, right? So doesn't matter if you're in rural, suburban urban, it's maybe more or less square footage, but everything goes in the same place. What if you actually targeted to I'm in a rural community. I'm women in a rural community that's a little different than I'm a suburban Mom We actually haven't done that level of customization. But the way we started our conversation is consumers want control. And that means they want to target into them and customized to them. How does retail adapt to that? Even on a demographic level? So I think that's new territory for most retailers, frankly.

Wendy 22:58

And I think what's interesting about it is you'll get part of that story. And you'll get it in the sense of, you know, we've got busy households, busy families, busy, some things, as part of that discussion. But it doesn't really understand the lifestyle and the specifics of the community people are in ,how much access they have. You're right, there's this open sea of, you know, we carry these kinds of products, we have a pharmacy, we don't have a pharmacy, those kinds of things. As much as retailers who we love, desperately talk about their shoppers. In fact, they don't, it's still very much around the efficiency of the operation. And obviously, the financial efficiency, which I get, not naive enough to think that's unimportant, but that lens of who are the people in my five miles around my store, and what can we deliver to them. And so all the people who are listening to this now in the CPG space are going like, Oh my God, so many services, where are we going to sell our products, right? Feels like the products have a greater legitimacy.

Susan 24:06

I agree. I saw a model I'll just share this really quickly. There was a model, a small community. So if you think about health care in rural America, hospitals have closed, clinics have closed for access to physicians. Same thing with grocery stores, right. So food deserts, pharmacy deserts, hospital deserts. I saw a model recently I think it was somewhere in Indiana, this small town, this entrepreneur decided to put this grocery store in the middle of the town, teeny footprint. It was membership only. You had a card you swiped in, nobody was in there. The product was all in there. Everything was on camera. The cameras were connected to the local police. They said if they got 100 memberships in the first year, they'd be doing great. They got something like 2500. People loved it and they've taken care of it. So if you think about that footprint, catering to that community, people at being able to go any hour. What other products could you add that would be health related that happens to be grocery store model, but I think about could you take that model depending you know where you are, and do something with that model. And that way the product could come from the retailer, the first time that the follow up, purchasing could come online where you just directly mail, right to selling more product, not less, they don't have to go, they just sign up the first time. So I do think there's a model there that I think would be very good for the consumer, lower cost, high convenience, you could customize again, what those products and services are together into a subscription model that would work really for everybody and could solve this issue of being very, very local, and part of your neighborhood. So both your online digital neighborhood and your physical neighborhood space.

Wendy 25:39

Yeah, it does feel like the technology side of things, opens this up to more people. It also feels like this issue around affordability or access and affordability. And then trusted sources. That's the other thing I keep thinking about that issue around who do I trust, we always say friends and strangers, right. And that notion of who do I trust here, myself, as you said, and controlling the information, you know, challenging, being a better informed healthcare consumer. But you're right, when you talk about the complexity of all the people I could be taking care of, and taking care of myself or not myself, because I'm so overwhelmed with everything else, it feels like all the forces are now coming to play in this. So it's pretty exciting if somebody can get their head around. Right?

Susan 26:31

I think it's exciting. I do too. And I also think retailers, you know, there's iconic brands out there, people have been in even if it's a local, if it's Belk’s and there’s still the Belk family in Florida, even if it's local, there's just iconic brands that have been around a long time, people do trust them. So when you combine that with this technology in the convenience, I think there's a lot there that's worth exploring. But it's a totally different mindset, probably on how we thought about things in the past. But again, reimagining that space is what you do best. So this is you have a whole company, that's all you do is reimagine the space. So I think more really exciting things to come. But I think it will keep moving, I think this is not going to slow down, the technology will slow down. People still need the human touch though. And they still need to be able to communicate with somebody. That's the consultation part of this that I think is so critical.

Wendy 27:17

Yeah, it is that sort of what we call the laying on of hands, whether I'm buying a pair of shoes, or I'm getting my whatever my diabetic, my sugar level checked, or figuring out where I've got a pain from lifting too many pots this weekend or things like that. The other thing that struck me just as enclosing is you know, we talk a lot about the pandemic and the impact it's had over three years, I just marvel at sitting in an audience with some people recently, and just going how did we all get back here? You know, we'd lost a lot of people, so horrifically, but here we are. I feels to me like that forced all of us as consumers of our own and controllers of our own health, to really think about what we need to do more. So it feels like that sort of push the conversation forward? Do you feel that way?

Susan 28:05

I do. I feel like it created a lot of momentum. I feel like people felt slightly isolated. So they were reaching out to people, they do trust, organizations they do trust. And I think they're excited to get back out into the community. So I do think it has cemented sort of retails role in a way, but not maybe in the same way it was in the past. So I think again, I think COVID was a great reorganizer. Well, you know, this, the thing about being in a growth industry is nothing is high growth unless something else is broken. If the status quo folks like me, entrepreneurs can't do anything, right, because we get squeezed out. So all these sort of breaking points have allowed new models to emerge new technology to merge and new discussions. And what I hear from people even just sitting at a cafe in New York was seeing their people around me, you know, they talk about COVID, and how isolated they felt. And so their friendships became more important. So then could you do some of these new models with a friend? Can you bring somebody else with you? Can you create a community environment in these places? So like the old if you think about this, showing how old and windy but Woolworths at the counter, right? This community at the counter at lunch, where everybody knew each other, and they would walk in and talk to you and they had sort of had an experience, a true experience, which I think is missing a little bit right now is getting back to what that experience looks like.

Wendy 29:22

Yeah. And so whether it's in New York or St. Louis, or wherever you are today. I think that's they’re great marching orders for us all to think about that. I'm really excited to get a piece of white paper and start drawing something to work on that one and share that with you. So it's always dangerous when I start to wave my hands around with a felt tip pen. But anyway, Susan, this is terrific. Thank you for inspiring me, and I'm sure others to think about what the future of retail healthcare could look like. And well it's time for us to shake a few more trees right and see what we can get done. Okay,

Susan 29:55

thank you so much, Wendy. It's always fabulous talking with you. I appreciate it.

Wendy 29:59

You too. Thanks Susan, cheers. So Susan made it really clear, she painted a wonderful and in many ways inspiring picture about what retail healthcare could look like and should look like. You know, for somebody who's come out of the, what I call the technical side of health as she has, that focus she brings to the role, the arc of how healthcare has moved from hospital and doctors to the opportunities we now see both in physical health care spaces with the technology and data we have. But more importantly, this shopper. patient consumer lens that says I, as a consumer, now feel a greater urgency and demand to take better control of my own health. So it's much less about the sort of hierarchy of healthcare providers telling me what I need to do, and rather myself as a shopper, as a patient, as a caregiver, now wanting to say, this is what I need, this is what I want, and having the tools to be able to do that. And as Susan said, this does not mean that those of you in the vitamin aisle or the skincare aisle or the feminine hygiene aisle, or fill in any of the blanks, lose out on the story, it actually helps you embrace the consumer, the shopper, the patient, in much more realistic ways moving forward and become offers you the opportunity to create real dynamic solutions. And for those of you who are sitting back saying what's women's wellness all about? Well, she really told that story very clearly. All the touch points in a woman's life, a family's life, her parents’ life, really frame up that opportunity of where do I put it and what goes in it? Well, it's everything. And to think about that lifespan is really an inspiring view to the future of not only retail, but the future of healthcare in this country. So great to have Susan help bring that future of shopping for health care to life. Thanks all for attending. We will see you as always in the future. Cheers for now.