The Impact of Retail Disruptors on the Healthcare Consumer Experience

Webinar

Featuring

MultiCare Health System
Studio North

Description

Healthcare disruptors’ razor-sharp focus on convenience and transparency will take market share from traditional healthcare organizations. The result? Healthcare organizations will need to make consumer experience a top priority to compete—offering experiences that match, or exceed, those of retail health.


In this webinar, you’ll get a first-hand look at what Walmart Health & others doing now and what they’re planning for the future. You’ll also hear from health system leader MultiCare about its aggressive innovations aimed at competing with retail health providers.


We’ll discuss:


  • Get an in-depth look at how Walmart and other retailers (Amazon, Walgreens) are approaching the healthcare market, including information you won’t find anywhere else
  • How MultiCare has improved the consumer experience while facing competition from multiple disruptors, including Amazon, One Medical, and CVS
  • Hear practical lessons you can apply at your own organization


Let’s move beyond the buzz lines “Disrupt the Disruptors” and “Offer the Amazon Experience” and see how it’s done!

Shari Campbell

Shari-Day Campbell

Marketing Director, Retail Health
MultiCare/Indigo

MultiCare
James Gardner

James A. Gardner

Sr. Marketing Strategist 
Studio North

Studio North
Chris Hemphill

Chris Hemphill

VP, Applied AI & Growth
Actium Health

Actium Health logo
Audrey Wyman

Audrey Wyman

Manager, Customer Success
Actium Health

Actium Health logo
1

Transcript



Daniel Nieman:
Hi. I’m Daniel Neiman. On behalf of the Forum for Healthcare Strategists, as well as our Partners at Symphony RM, welcome and thank you for joining us for today’s webinar, The Impact of Retail Disruptors on the Healthcare Consumer Experience. As retailers like Walmart Health, Amazon, CVS and others continue to enter the healthcare market, traditional healthcare organizations are challenged to compete.
In short, they will need to make the consumer experience a top priority, offering convenient, transparent experiences that match or exceed those of retail health. Today you’ll hear insights on the trends and success strategies from a panel of experts.
A couple of notes before we begin. First, although attendees are in listen only mode, you can still ask questions. Just enter your questions into the question-and-answer pane at the bottom of your screen at any time. Our speakers will respond to as many questions as they can in the time that we have.
Second, we’ll be conducting some interactive polls during this webinar. Be sure to participate by clicking on the answer that best reflects your views. With that, I’ll turn the program over to Chris Hemphill, VP of Applied AI and Growth at SymphonyRM who will be leading today’s discussion. Chris?

Chris Hemphill:
Thank you. Thank you for the intro, Daniel. Hello, everyone. Hello, healthcare. So happy to have such excitement over this topic. We’ve gathered a conversation not just to be talking heads. We do have some presentation that will help elucidate the landscape of healthcare and I’ll actually be delving into my personal experience with one of these retail health experiences with Walmart Health, actually, and then we’ll delve into Shari Campbell. What she’s going to bring to the table is the actual experience within a healthcare system.
But I want to make sure that everyone understands, like Daniel pointed out, there’s a Q&A section. We wanted to have you as close to this panel of experts as possible. So, if you have questions for myself, James, Shari, Audrey, or if you have stories or just comments that you want to share, bring them to us. Everybody is going to be able to see that. We’ll all be able to share in this experience, so just wanted to point that out and just make sure that you know hey, if there’s anything on your mind, stories, questions, comments you want to share, pop that in with us.
To go over this topic, as I pointed out earlier, we have some presentations starting out. What we’re going to kick it off with is James. We’ll go a little bit deeper on James in a minute but his work has been featured on CNBC and his research within retail health. Basically, he’s a healthcare strategist by day, retail health strategist by night and he’ll go deeper into the overall landscape of the CVS’s, Walgreens, Amazon Health and news all the way up to last week because this stuff is developing really fast.
Then I’ll spend a few minutes just talking about in preparation for this webinar, and honestly because I needed a primary health checkup, I went to Walmart Health and documented the experience. Did that so we could share and understanding what are the building blocks of the experience that they provided, and for all the folks out there who don’t live in Georgia like me, who don’t have access to that, an idea of seeing what their expansion plan is going to be.
Then, a part we’re really excited about is Shari Campbell is director of marketing at one of the major health systems retail health efforts that’s an answer to a lot of these innovation and consumerism challenges that we’re looking at addressing. I know it’s a big theme this year on how to address the consumer experience, so Shari is actually going to be able to talk about the nuts and bolts on how that’s getting down.
And then for the final part of the discussion, a lot of times we log onto webinars and then at the end, there’s maybe five or six minutes at the end for questions in case there’s any time. We actually wanted to make this more of an open panel so we’re going to spend the last 25 minutes of the session having it opened up, having the floor open for you to be able to ask questions and communicate with the presenters here.
So, to kick things off, we’re going to be asking a few questions. Daniel indicated that there will be some polls that happen throughout the webinar, so kicking it off with the first poll, is the grand question on all this innovation, all this stuff that’s happening, is it going to actually improve the consumer experience in healthcare? We’re curious is all this innovation just for show? Is it just a big market share grab or are these innovations really going to improve care, access, consumer experience within healthcare, so I’ll give you a couple of seconds to answer that and we’ll start with James.

James Gardner:
 Thanks so much, Chris. If you could just jump to the next slide.

Chris Hemphill:
And James, just wanted to give you a chance for a proper intro. There’s a lot of work that James is doing to connect these dots, connect this information. Oh, and we just got results from the poll as well. The overwhelming majority of respondents say that the consumer experience is going to improve. James, I’d like to hear your thoughts on that and jump into your section of the presentation.

James Gardner:           
Thanks so much, Chris. Jumping forward a little bit, many of you know me and I certainly feel like I know many of you, but if I’m a new face and a new voice to you, I’m in the healthcare field quite extensively and have been for 15 to 20 years. I bring a background primarily in consumer marketing. I’ve worked with P&G and McKenzie and some other organizations along the way.
And as Chris alluded, I am a marketing strategist by day, a retail health analyst by night and my interest in retail health obviously stems from my background in consumer marketing. I’m drawn to all things new and innovative that improve consumer experiences. I fell into the orbit of tracking Walmart Health specifically back in 2019, and immediately saw that it’s just a potentially disruptive force on an epic level and was fortunate to get in early enough that I became a defacto expert in it.
As Chris said, I’ve been featured on CNBC, Med City News, MSNBC and I’m a go-to person for a lot of organizations looking to understand what it means when organizations like Walmart enter their market or when Walgreens drops a primary clinic next to your clinic. So, it’s been a really interesting experience for me.
Just a plug for me on Twitter, I tweet pretty extensively using the hashtag Walmart Health and/or Retail Health, so if you’re interested in tracking the conversations that I’m part of, that’s where you’ll find them happening.
Jump forward if you could, Chris. So, why does primary care matter? Well, primary care has a special place in everyone’s heart. Maybe affectionately, we remember the glory days. Maybe it was our parents who had truly a primary care doctor. It seems like a quaint notion because it doesn’t really exist in a meaningful way but primary care was important to the system for a couple reasons.
One was, just as a patient, they were the guardian of your longterm health. You would have had a physician and stuck with them for 15, 20, maybe 30 years and they had that longterm perspective of caring for your health and wellness, not just caring for you when you were ill. But, more functionally, they were also a gateway to the healthcare system. That was your point of access to get specialty care.
All that’s changed. Really I would trace it to two factors. One is just there’s a national shortage of primary care physicians. It’s a really underappreciated field. It doesn’t pay as well as it should, so in many parts of the country, even in urban centers, it’s hard to actually get a primary care physician, even if you wanted one.
But there’s also a generational factor in play that more and more millennials and Gen X’ers just are impatient or dissatisfied with the traditional experience of primary care. It’s hard to get appointments. It’s hard to accommodate a life-work balance and getting access to care, so for a lot of reasons, millennials and Gen X’ers have gone down different paths.
Jump forward if you could, Chris. This is where primary care disruptions are emerging. We’re going to talk about retail health as one of the disruptors bu this could be everything from urgent care clinics to telehealth to employer clinics. There’s any number of solutions out there that are blowing up the quaint notion of a primarily care physician who you stick with for life. So, boom.
Jump forward, Chris. These are the players that I’m going to focus on. There are others, but these are the big four. They should all be familiar to even most of us. We may actually have them in our neighborhood or just down the street. CVS we know well primarily through the success of their Minute Clinics, but they’ve got other things going on, which we’ll explore. But, they were an early entrant into the world of retail health and have accumulated what I would consider a first class set of assets and also just a really strong strategy.
Amazon is in the news obviously with the Amazon Care rollout, which is primarily a telehealth solution right now, but I feel like we’ve all seen this playbook executed by Amazon in the past with their Amazon web services and other business units where they started with an employee-only model serving the 300 odd-thousand employees that work for Amazon. Then, they’ve extended it publicly and I imagine we’ll soon see actual hands-on care being delivered beyond telehealth. So, we’ll get into that a little bit.
Walgreens I consider a bit of a lagger because of some strategic decisions they made years and years ago, but they’re now in a very extensive and exciting partnership with Village MD to parachute clinics into their stores, so I would never count them out just given their size.
Then Walmart with their Walmart Health Clinics, which is a passion of mine only because I see their strategy as being the most disruptive and the most exciting. So, we’ll explore actually in more detail than the others what they’re doing and talk about their recent moves.
So, I think we all know Walmart. They’re huge, they’re competitive, they’re relentless. We’ve heard tales of their success in traditional dry goods retailing where they changed the landscape of America in small towns and large towns by bringing low priced merchandise to populations that desperately needed it.
The more recent success story that I would point to is their success at groceries. There’s a lot of parallels there with health in that it’s an extremely complex business. Walmart didn’t actually do grocery retailing until the early ’90s and many people did not think they would be able to pull that off, but as the story goes, they started small with one store, their super center in Missouri. Within 10 years, they were a top 10 grocery retailer. Within 13 years, they were the number one retailer of groceries.
If you can sell avocados, as they say, in January in Nebraska, retailing and health retailing all of a sudden becomes a little more plausible for Walmart.
But let’s jump forward, Chris, if you could. I want to just highlight what they’re actually doing in the world of health because this may not be familiar to folks. This is the Walmart Health Clinic in Dallas, Georgia. It was the first, and I’ll just point out a couple things. One is that it’s a standalone clinic. This is not a minute clinic embedded into the Walmart store. It’s actually a standalone center of about 8000 square feet adjacent to their super center.
So, they’ve got a couple things going on. One is just a strategic location, right? The foot traffic that goes into a super center over the course of a week is immense so they’ve been very deliberate and intentional about that. It also tees them up for expansion quite nicely because they own those parking lots, so expanding is just a matter of dropping these prefabbed clinics, because they’re all built in a factory … if you can imagine that. So, the expansion capability is built right in.
But then the clinic itself is really interesting. As you can see, they’re offering primary care but they’ve also got adjacent health services. Dental, which occupies about a third of the store actually, is very important to the business. They’ve got counseling, so mental health which is a breakthrough in a lot of markets where it’s incredibly difficult to get access the mental healthcare. They’ve got onsite labs and x-rays. They’ve also got hearing and optometry.
So, this is a very disruptive model to have all the services adjacent to one another, which I find very, very exciting. Chris, jump forward, if you could.
Perhaps even beyond the offering in the clinic itself, what people find remarkable is the pricing model. As you can see, an annual checkup, $30.00. So not only is the pricing transparent … This is posted on their website and it’s made very clear when you enter the clinic … what you see is what you pay. And, as you can imagine, this is very, very disruptive. They’ve got full-on primary care with high quality, fully certified physicians onsite. They’ve got incredible pricing going on and they’ve got this convenient model where they’re adjacent to where you might be shopping. They’ve got extended hours, free parking, weekend operations.
So, they’ve got a killer three-pronged strategy which I just find very exciting and if you were to be competing with them, perhaps you’d find worrisome. I know Chris is going to share firsthand his experience with his clinics, and I’d be excited to just hear if they’ve lived up to the promise. Jump forward, Chris. I just want to make sure we move forward and use our time efficiently.
As I said, they have been piloting these stores in Georgia. Dallas was the first location. As of today, they’ve got 20 clinics circling Atlanta, so that’s where they’ve got the greatest density of operations. They’ve got one store in Arkansas adjacent to their headquarters so we can all imagine why that was built. They’ve got two in Chicago in stores that were disrupted last summer during our civil unrest, so they rebuilt their super centers and added clinics. And then, they’ve got about 10 more coming in Florida. Jacksonville and Orlando.
So, a real exciting model. I put a bit of a question mark against them, and we can get into this in the Q&A, only because the efforts are actually stalled at the moment. They’ve had some organizational turmoil and they’ve pulled back on some of the expansion plans that they described. So as exciting as they are and as much potential as they have, I’ve put a bit a question mark and I’m not sure what 2021 will hold for them, whether they’ll get to 30 stores. I think that’s going to happen, but whether they get to 100 stores or the 3000 clinics that potentially could exist and that the board actually signed off on three years ago a bit of a question mark, but nonetheless, watch them and if you’re in Atlanta, definitely be paying attention to them because they’re probably circling your clinics and your hospitals.
Let’s jump forward, Chris. I want to just use the time we’ve got. I want to touch on Amazon Care. You guys may be familiar with Amazon’s offerings. As I described earlier, they began by offering care solutions for their employees, which is the model very familiar to those who follow Amazon. More recently, they’ve expanded to multiple states and are absolutely on track to offer its telehealth solution nationally, probably within the next three to six months.
So, very exciting to see Walmart competing on the physical assets and real estate they have and Amazon competing based on the technology that’s so familiar and comfortable to them. You’ve got two parallel but very different strategies in play.
Audience wise, I think we can all imagine Walmart catering primarily to the underinsured and the uninsured with cash pricing. Obviously, that’s going to be very, very appealing. Amazon just in contrast is targeting those with commercial insurance, so also a differentiator based on the audiences they’re pursuing. So while we like to think of there being a clash of the titans between Amazon and Walmart, and there absolutely is in the world of retailing, in the healthcare field, they may well exist and coexist alongside one another for the time being, which I find quite interesting.
Jump forward, Chris. I just want to use my time carefully. CVS, as I described earlier, obviously has got a very advanced retail health strategy. They’ve got pharmacies across the country, the largest of its kind. But they’ve accumulated adjacent assets. One of which is Minute Clinics, which we’re all familiar with. We probably have been in one and seen them at our local stores. These are urgent care facilities, not staffed by primary care physicians, so they’re offering a different level of care. But obviously a very convenient model if you’re looking for a flu shot or a vaccination, so services that a nurse practitioner or a physician’s assistant can offer but different from what you would find a Walmart Health Clinic or what’s offered through Amazon.
More interestingly, they’re now rolling out what they’re calling Health Hubs, which is carving out a section of their stores and devoting real estate in the clinic to those with chronic conditions and you’ll be able to get access for instance to a dietician if you’re suffering from diabetes, or COPD or another chronic condition. They’re going to have services and merchandise that would be very spot on for your condition.
Alongside of what’s going on in their stores, we can’t over look Aetna insurance that they acquired a few years ago as well as the Pharmacy Benefit Managers that they acquired. It’s an incredible collection of assets. Perhaps the strongest of its kind in the world of retail health. I watch them with great interest because they’re moving very quickly and are building on a strong collection of assets that are now working more and more in an integrated fashion.
Jump forward, Chris. Last but not least, I would point out what Walgreens is doing. As I described here, they’re a bit of a lagger, a little late to the party, but they now have announced a partnership with Village MD which will carve out space in their stores and build in a primary care offering somewhat similar to the Walmart offering but not nearly as disruptive. These are not standalone clinics. They’re much smaller. The pricing is not at all as exciting as what Walmart is doing but nonetheless, it’s a large partnership and they’ve got a big, big footprint of stores to build into so this would be another competitive offering to be aware of if you’re a hospital or primary care physician.
I want to pause there, Chris. That’s where I was going to end. I know you’ve got a poll that you want to move forward with. I will be manning the chat if there’s questions that are immediately are rising to the surface, and then absolutely I’ll field questions when we get to the end of the discussion. Thank you.

Chris Hemphill:
 Appreciate you, James. Appreciate all the research that you’ve done and I am a loyal follower on Twitter and I advise everybody else to follow your advice and follow on Twitter as well. Good stuff here, so thank you for that.
So, we voted overwhelming that the consumer experience is poised to improve partially by these services. The question is now with the anticipated improvements in consumer experiences, can conventional healthcare systems keep you and catch up? That’s the one that we have out next and are really excited to hear the results and response.
What I’m going to go into is a little quick intro on myself. My role focuses on data science and analytics with SymphonyRM, particularly on the end use side. So, just a little bit of background on me. There’s going to be a little bit of data science in this presentation about what we’re really focused on here. We’re hearing about these experiences at Walmart Health, what was my personal experience, just so that everybody has that blueprint.
But real quick before we jump up, Daniel, could you flash the poll results up? Okay, great. What we’ve learned today is that overwhelming we believe that consumer experiences will improve and that there can be meaningful change within health systems within the existing infrastructure to improve those experiences. That’s excellent to hear. Thank you for the poll results, folks.
So, I’m just going to jump right in to my experience with Walmart Health and I’ll start with their website. Going on, scheduling an appointment, extremely straighforward. You go to Walmart Health right now, and big sign allowing me to schedule an appointment, pretty clear on the services that they offer. The same picture that James showed with the location in Dallas, Georgia. You get more detail on the website here, but what was really surprising, really interesting to me was of course I can schedule my appointment, I can see my location, but it’s the price transparency that James was talking about is integrated into the experience from the get-go.
The prices, I saw a question in the chat about whether or not these prices were applicable to uninsured and if these were cash prices or if it was cash only. Answers are yes, they do have insurance available. I went the uninsured route just because they didn’t accept my particular insurance, but right there on the website, I knew what my out the door cost was going to be before I even clicked schedule appointment.
So, with the scheduling process itself, that was an easy experience as well. It asked me what service I was interested in. I chose the annual checkup and they even … allowing me to select my date, they even had Sunday availability, which was with my schedule extremely convenient to me to be able to schedule on Sunday, which isn’t everywhere.
Going into the clinic, this is the location in Marietta, Georgia. The standalone nature of it, this one was actually integrated into the rest of the store so I noted that this particular location, walking to the door, you can actually see the store on the outside, and I thought, “Wow, that’s a really big opportunity to take advantage of that foot traffic” and it was adjacent to the pharmacy that was also in the store.
One thing to note as well is that the reception was extremely friendly and they were extremely focused on what my experience had been just walking into it. They were asking questions specifically about the experience, so it’s clear that they’re collecting data on what creates a better experience. They’re doing that from the top down.
I arrived at 11:02. My appointment was for 11:00. I arrived two minutes late, but it was still an easy and fast, convenient experience. Everything that I filled out on the website was pre-populated into an iPad that they handed me so there was no fuss or anything like that about the registration process. At the same time, there were things that they were doing to build community around their store, around their offerings. I noticed that they had a Wellness Wednesday program and some various other that pull in that interaction.
This was a continuation of what I had selected on the website, I knew my pricing and everything like that before I even walked in to be seen. So, I finished registration at 11:10 and then three minutes later, I was seen. As far as the experience goes, I was asked standard questions like it was a typical primary care visit until the physician started suggesting labs. I have these numbers down here, 8, 8, 10, 20. And what really stuck out about the experience was that any time I’ve asked about price ahead of time, they’d look at me like I was completely insane.
But the physician knew all the prices of the labs and knew all the prices of the shots and different things that he was recommending just ad nauseam off the top of his head. That translated to an easy and fast billing experience. This was out the door as I was walking out. Again, I took the uninsured route and paid with my credit card right there. Sorry, I think Siri is talking to me. Sorry about that.
Yeah, so easy, fast experience. Price transparency all the way throughout and I was able to handle the transaction just completely within that one day.
So, my final verdict, I’ll be back. And the reason why I liked the experience so much, and again, I’m no advertising for Walmart, I just wanted to highlight what the experience was, but it was convenient and it was inexpensive and even the next couple of days, all my follow up has been through text messaging which I just indicated as a preference and they called and followed up with relevant advice on my labs. I’m happy to answer more questions about that as they come in the Q&A section.
And, I promised some data science. I can’t do a presentation without it, so this is a study we did on about 1700 reviews from One Medical. What we wanted to learn about One Medical is we wanted to look at these patient reviews and understand what was actually making their experience so great. So, we looked at the terms. We used natural language processing to look at the terms that were associated with great reviews, and a lot of those were focused, like you heard James talk about video visits … video visits, and this was over 10 years. Video visits have been huge, so it’s going to be interesting to see what Amazon does in this space.
But the ones that were applicable to Walmart were the desk staff, the appointment time, basically the fact that they were able to do everything extremely fast and that they had a nice waiting area, so it was really interesting to see how that Walmart model, the things that One Medical is doing to satisfy line up with what Walmart is doing.
So, we’ve got another poll. The next question is when thinking about the consumer experience and what factors to potentially improve, what’s the biggest barrier to focus on? We’ll give a minute to answer that, and while we’re doing that, getting into the part of the presentation I consider exciting is really hearing about what MultiCare is doing with their Indigo brand.
Shari, you ready to take the stage?

Shari Campbell:
 Yes, thank you, Chris. I am ready to take the stage. I have about 10 minutes to talk to you about Indigo and I feel like its something that I could talk to you about for about 10 hours, but I’m going to try to go through some quick slides to give you a sense of what’s different about Indigo and retail experience within a healthcare system, and I will also try to show you, because I think that’s really helpful too.
Indigo was born about five and a half years ago. Our CEO and leadership really wanted to disrupt within our system and was really looking at the landscape, and our system, I should mention, is in Tacoma, Washington so we are virtually 30 minutes from all those big office buildings and towers with Amazonians in Seattle. We’re also a place where One Medical, Carbon Health, Forward and Zoom, another disruptive brand, are all in our space.
So, I think it was a smart move to do that. He wanted to have some disruption within our system, disruption within urgent care as well because we operate at urgent care clinics, but I think they were in many respects born out of primary care and born out of a physician extension and how do we take care of patients after hours short of having them land in our emergency departments.
I’m often times asked, and a lot internally in our system, why do we need Indigo? And, I think this is really the question that my millennial daughters say and a lot of Gen X moms say. Why can’t I get the care I need when I need it? And that means quickly and conveniently too, much like Chris described with his Walmart visit. It’s got to be around my lifestyle and if I’m a full-time working mom and have a couple kids, like Audrey from Symphony, I need weekend hours, I need after hour hours, so all those things need to be available to me.
We really look at Indigo as trying to channel consumerism and disruption, and again, we’re very connected to MultiCare. I don’t want to imply that we’re not but how do we take out some of the traditional culture that exists within a traditional healthcare or hospital setting? First of all, some of the things that we look at every day, and again, this is every day, these are the four KPIs that we’re really focused on. And that’s probably again a little bit different from my peers that are running a hospital. We’re looking at employee engagement. We’re looking at that for two reasons. I think we feel like when our employees are really happy and satisfied and engaged within our clinics that they’re going to give service.
But we also look at something that James alluded to. There’s a shortage of physicians and there’s a shortage of nurse practitioners and PA’s so we’ve got to become an employer of choice. We always look at door to door time. Biggest satisfier and biggest dissatisfier for our customers is the speed of the visit. Does it start on time and do they get in and out the door quickly? Because again, when you’re a millennial mom, Gen X mom or just a lot of us that are busy, we want that appointment to start on time and we want our visit to be efficient. We’re looking at the number of visits we have per day. There’s just not a lot of margin in urgent care, and our urgent care platform I’ve noted, it’s in person and on line.
Then finally, net promoter score. So how do we compete? If we can deliver a performance that’s better than Amazon’s and better than Starbucks and right now, our NPS scores are better than both of those organizations, then we feel like we have an opportunity to compete. So we’re looking at that every day. Another thing that we really focus on and that was started before I joined the system, and it just keeps getting better, is what we call the Indigo Experience, or creating Wow moments one patient at a time. If you look at that picture that I’ve put in there very intentional, one of our staff members is handing a water bottle to a patient. Each of our Indigo’s has a coffee bar with a little refrigerator, so we’ll make hot coffee, tea, apple juice for the kiddos and in addition to that, we usually have Goldfish crackers. So, one of my friends says that her daughter actually likes to go to Indigo when she’s sick because she runs and goes straight to the little coffee bar and gets her Goldfish crackers.
Our Indigo experience, though, is much deeper than Goldfish crackers and water bottles. Every employee, myself included, goes through not that traditional healthcare NEO, but through what we call Indigo Experience Training. What we’re trying to do is very intentionally train our staff on customer experience so that it’s part of their care from the moment the patient walks in the door. We actually train, if possible, for our folks to open the door for patients. Again, think of the mom who’s got a baby in her arms and a toddler by her side and is getting out of the car, and if our staff is at the front, they will run and open up the front door for the patient. So it’s again creating that experience.
The other thing we do that I talk about a lot is we use very specific language and words. So, that employee that I mentioned and is in the picture, she’s a medical assistant but we don’t call her a medical assistant. We call her a clinical concierge. When our team talks about it and we have social pictures or we’re running a campaign, we say that she’s a guide, or he is your guide, and that they’re going to be there from the moment you walk into the door to the moment you leave our clinic. They’re going to guide you through the visit. Unlike a traditional urgent care or maybe even a primary care setting where you might have 14 to 15 people touch you, we only want to have a provider and that concierge so it reduces the handoffs and it reduces you communicating your story to a lot of different people.
Another thing we talk about, and I’ll show some pictures in a few minutes, is instead of saying, “Sit here in the waiting room”, we’ll say something like, “Have a seat in our lobby,” as we’ve handed them some water, “And, we’ll get your room ready for you.” We actually don’t even say room, we say your suite. So we’re using really language to talk about an experience that we want to be more like going to a hotel or a spa than a traditional primary care/urgent care visit.
I wanted to show you this because I think some of these images really create a different picture. It’s funny, the welcome mat was something we decided to do in a photo shoot because we’re channeling … Chris, to your point … we’re always looking at our reviews and one of the comments that we see over and over again is welcoming and friendly, so we took this picture and when we run it … And, it was taken three or four years ago, but when we run it with 10 other images in our social media campaigns or in a digital campaign, it always is one of the top one or two images clicked on. So that sense of it’s a different experience … You can see staff that look really friendly. If you look on the bottom right, you see the caregiver and the person waiting, you can see that we have these really bright, open lobbies. The colors are different.
There’s some value prop language on the wall, so it’s just a really different look from the moment you walk in the door. We talk about the front desk. Think about going in a primary care office where they sit behind the desk and then they slide open the glass when you walk up. We have a place where folks are trained to stand and be there, and it’s a desk so there’s no barrier, and the desk also allows our staff to quickly run out and open the door if they’re not helping a patient. So, I just wanted you to see that visually.
Of course, one of the things that you have to do with a disrupter is you have to always be adapting and evolving. I think in the last, like I said six months, Carbon Health, Forward, One Medical wrapped up in our backyard and as Amazon continues their expansion. I think a couple things we’re really focused on is how can we keep disrupting within our own organization and how do we evolve. The reason I showed this picture is of course we’ve all been living through COVID, and Washington State was one of the hotspots for COVID and really where the first case in the US was identified. Our clinics have really become COVID testing sites and recently brought on 19, 20 different of our sites have rapid testing.
So, it’s something that we can do to, again, meet a consumer where you’re at. If you’re concerned about whether you have COVID, you want an answer right away. Rapid testing allows us to do that. We also are seeing as more people are getting vaccinated that folks want to find out are they COVID-free if they want to travel or if they want to go see their relatives. I have an 85 year old mom so when I was in the clinic all the time, I wanted to make sure that if I wanted to go visit my mom, I was okay. So, it’s another way we can meet our patients and our consumers where they’re at right now.
One thing I should touch on is that Indigo started as the first clinic in Tacoma where we wanted to disrupt ourselves. We now have 32 stores, a few under construction and some that are in architecture or loose negotiations so we probably will be at 40 stores by the end of the year.
Again, we’re always trying to disrupt ourself. We’re really trying to increase our online appointments. We have a very simple, easy way to do appointments. That’s for a couple reasons. It’s really easier for the patient if they can schedule. We find that we’re always going to offer walk-ins but if your schedule, we use the example of getting a reservation at your favorite restaurant. If you have a reservation, you get to sit down right at whatever that booked time is. If you walk in, you might have to wait a few minutes so it just allows us again to take care of them.
We also have linked registration to that goal of being paperless. If people register online, we’re actually able to capture more of their insurance information, payment information, all those kinds of things right away. It depends on who you talk to, but we’re doing a lot of studies and we feel like we’re cutting off at least two to three minutes from each patient when we can register them online as opposed to walking in, so again, it just saves time. Continuing to try to drive down, again, what we call door to door, so the moment they walk in the door is how we measure it til when we print what’s called the after visit summary.
Again, we find those are the biggest satisifers if we can decrease that. It’s also the biggest dissatisfier when patients have to wait longer. And then finally, Chris and I have had a discussion and he’s done some analysis for us but we’re always trying to listen and learn from customer feedback so we’re paying attention to NPS scores, to Google Reviews. We have a pretty hardwired process not only for our staff to triage those but also for each clinical manager to get back to patients and try to do service recovery. And, we’re really trying to look at how we anticipate what’s the next best thing for us to do is look at that data and say, “How can we anticipate what are the things that we should be doing for our customers?”
With that, I’ll turn it back over to Chris.

Chris Hemphill:
 Appreciate it, Shari, and thank you for sharing that experience. In the conversations we were having before, I think there’s going to be a lot of stuff that people are excited to hear from you so I’m going to just get through the next poll question as fast as possible. I didn’t comment on the previous question, but the top answer for that one was … the question on what are the barriers to delivering the consumer experience that people desire, and the most people answered was creating that “Know Me” experience, contextualizing based on people’s past experiences and the information that they’ve learned and shared. I thought that was interesting, and to finish it off, it’s basically a question on the organizational barriers that might be causing that.
The basic question of do we find them as primarily cultural or primarily technical, or we’re already there, we’re already doing it? So everybody go on and ahead, and what we’re about to jump into is the panel. We’ve prepared some questions because what if nobody was asking questions in here, we would need a way to go through, but you guys are hitting us with so many questions, so many great questions and we want to try to get through as many as possible. But, what we can’t get right now, we’ll try our hardest to follow up on.
So, the poll on what are the biggest challenges, are they organizational, are they cultural or are they’re technical, what I was expecting there is that the biggest challenge to getting to deliver these consumer experiences and thinking about the consumer is related to the culture of the organization. Any questions about that, there’s a lot to discuss there so we’re happy to hear it.
But, thank you everybody for hanging with us so far and I’m going to get to the live questions in a minute, but just wanted to start with a general question to everybody, which is that on LinkedIn, we asked whether health systems would lose primary care and urgent care market share to these new entrants in the market. Overwhelming majority said that there would be market share loss in the conventional sector. So in competitive regions, what’s the difference between organizations that maintain market share versus organizations that may ultimately lose market share. I’ll throw that one at James first.

James Gardner:
 It’s a great question. The answer’s complicated, but we can look to Walmart Health, for instance, where it’s pretty clear with the pricing model, they’re appealing to the uninsured and underinsured. And, we’re been going back and forth in the chat, but there’s roughly 90 million Americans that either don’t have health insurance at all … Obviously, they’re locked out of the system pretty much, but the underinsured is an equally significant problem. These are folks with high deductible plans that effectively keep them from accessing preventative care. You would only use that kind of insurance for catastrophic situations. That’s the cash paying audience that Walmart’s appealing to.
A lot of health systems don’t necessarily see that as a head on threat because these people aren’t participating in the traditional system. Most hospitals and clinics are geared more to populations either with either government care or commercial insurance. Now, if you do have a large population that fits that criteria of being underinsured or uninsured, yeah, Walmart is definitely a problem just based on the appeal they have to that audience.
I would see Amazon Care is actually being more of a head on threat to traditional health systems and clinics. They’re pursuing those with commercial insurance and while it’s only telehealth right now, we know their aspirations are to deliver hands on healing. How exactly they’re going to do that, we don’t precisely know but they’ll figure it and when they do, they’re going to becoming right at traditional systems.

Chris Hemphill:
 Shari, your thoughts?

Shari Campbell:  
I have two. One of them is I think you’ve got to be doing something like Indigo. You really have to be not traditional because I think we had the traditional urgent cares and the wait times were two and a half hours plus and we weren’t as customer focused as we need to be. I think that you really have to be looking at that. I think that we every day look in the mirror and say, “How are we disrupting ourselves?” So, I don’t think you can by any stretch of the imagination just sit back and say, “We’ve arrived” because when I look at Walmart, Forward, Amazon, all those folks, they’re changing every day and if we’re not doing the same thing, we’re going to lose out.
So, I think we have continued to have year over year growth so I think we’ve built more because we’re having success, but success can be fleeting.

Chris Hemphill:  
Thank you. Audrey, you had a great question from yesterday. Audrey, you’re on mute.

Audrey Wyman:
Thanks. I was sharing with Shari that I used my phone and did a quick search for, I think, sore throat Tacoma. And, I was able to find one of your Indigo clinics. It was the top result and I noticed that within two clicks, I could make an appointment. On my third click, I saw a list of options of specific locations I could go to and how many people were in line. Just allowing that amount of choice with that few of clicks, I think is tremendously hard, so how has that journey been evolving your digital tools to get you there?

Shari Campbell:  
Thanks for that, Audrey. It’s funny because I think of the last poll question that talked about culture, and that is … It’s your own organization sometimes because you need to play in that sandbox and yet, we’re always trying to channel the consumer. We really did partner with an organization called Solve that’s an amazing tech innovator, and we continue to look at other tech innovators that we can bolt on to our Indigo platform so that we can really look at what’s good for consumers. It really was a previous leader who said we can’t use those traditional tools. We really have to look at how are we making it super, super easy for the consumer.
I think in marketing, I wasn’t the one that made that decision, but I think I was certainly one that supported here’s what consumers are telling us is important to them and here’s what the competitive landscape is looking like, and I continue to do that all the time with leaders. Here’s what’s happening in our market, and if we’re not really honing in to what those other folks are doing … And, I think Carbon Health is one example of really being a tech company that decided to do healthcare.

Audrey Wyman: 
You also have glossed over something that I just wanted to underscore. When you were putting up your KPIs, your first KPI, you’re measuring NPS, which is tremendous, but you’re also measuring employee engagement, and I think that was really, really critical. I know when I walk in the door, and the experience that you have as a consumer really depends on who that person is that greets you. So, I was thrilled to hear about that and I would encourage that for everyone.

Chris Hemphill:  Thank you for that focus, especially with employee engagement. There was a question that came in from the audience that I was pretty excited about that was pretty related to that. It came in from Eugene [Posnoikov], and the question … There’s several great questions, but what impact do you see on positions in nurses employed by these companies, again with the impact on compensation and retention of quality staff? I want to throw this question to everybody, but just speaking to my experience, one of the things that I did while I was having the visit was I just asked my physician … For everybody who was asking and wondering, it was a physician that saw me at Walmart Health, and I asked him what his experience had been and he basically told me simple experience with reasonable hours.
So, it sounded like a decent experience to me. I’m not sure that he would have gone down into the nitty gritty depth, but the fact that he focused on the hours was a pretty important standout to me. But, I want to throw it at James and then Shari for this question, for what do you see as the impact on physicians and nurses, and again, the impact especially consideration around compensation and retention of staff?

James Gardner:
 I would say from my conversations, the jury is still out on the experience of working in a Walmart Health clinic. It’s definitely not for everyone, but your experience, Chris, is fairly typically that there’s a sizable population of doctors that want the predictability and stability of a job. They don’t want to be entrepreneurs running their own clinic. They don’t want to be on call. They don’t want to be working unpredictable shifts, so Walmart can deliver a stable career experience, which is quite appealing.
Interestingly, a lot of their stores, as you can imagine, are in remote locations and I had assumed that they’d have sizable recruiting challenges attracting physicians to those remote towns surrounding Atlanta. Turns out that’s not necessarily the case. There’s a sizable population of physicians that actually find that appealing. So, cross that off your list if you were imagining just the headache of tracking talent to some of those locations where Walmart finds itself.
Where I think the question mark is still in a lot of people’s minds is just the day-to-day experience because you can imagine with Walmart’s pricing, they’re looking for some efficiencies and obviously, you can’t pressure people’s compensation. There’s a market rate for physicians, so they’re paying market rates. We get that, but in terms of the throughput of patients, the jury is still out on whether it’s a grind or whether they find that it’s working well and they’re happy with the number of patients they’re seeing per day or per hour.

Chris Hemphill:
Thank you, James. And Shari, I was curious about your thoughts on that question as well, among physicians and nurses and retaining quality staff and compensation.

Shari Campbell:
I think a couple things. Our model is that we use both physicians and PAs and nurse practitioners so it really is a blended model and I would say that we probably have three-quarters of our staff are APPs and one-quarter physicians, so it’s really a little bit different. I do think it’s a fine line, and I think we have to do better on the front end when we’re recruiting to really talk about what the environments like. There is always that pressure because speed is important to patients to be pretty quick. Now, part of that you can control with what you’re seeing. Even in an urgent care like ours, it’s really minor illnesses and injuries and that’s the same for online care.
So you’re, to some extent, limiting the scope of what people see. You can put a lot of other things around them. We’ve tried to make other efficiencies so I think that helps, but we do see that a lot of folks do prefer … We have a lot of family practice docs who’ve left family practice and said, “I want to work 13, 14 shifts a month. I want to have time with my family. I want that predictability and I don’t want call.” And, we also find the same advantage … We’ve done a lot with our MA recruitment, that they’re working three shifts max a week and that gives them four days off with their family. So, while those three days are long, to some extent, the trade off is I get all that time with my family.
And we’re finding that that’s actually, again, a way for us to recruit. So I think it’s more on us at the front end to do a better job with staff and recruiting and saying this is what it’s like. And then I think just to culture, I guess the last thing I would say in an employee engagement thing, we really do see within the clinics people having a really strong sense of teamwork. I didn’t show pictures, but our physician workstations and nurses stations, they’re all together. It’s not like nurses are here and docs are there. So, we really try to build in a really collegiality and I think when that really works, it does create a really nice work environment.

James Gardner:
There’s a question in the chat I just wanted to highlight as part of the appeal of at least Walmart’s clinics, which is the cash center nature of the business. For a lot of doctors, insurance companies are the bane of their existence, and to the extent you’re seeing cash paying customers, that brings a lot of satisfaction to doctors, I’m told. So, thanks to Eugene for that question.

Audrey Wyman:          
 Lucas asked a great database question that I want to ask to James. What three things would need to be true over the next decade for Walmart’s current model to take significant market share away from traditional primary care?

James Gardner:           
Well, without going into too much chapter and verse, Walmart is unfortunately stalled right now with its clinic. This became public knowledge probably in the last four weeks. And, it is a difference of a belief and difference of opinion that goes right up to the board level. The Walton family strongly believes that the clinics are absolutely in line with Sam Walton’s vision, bringing low cost accessible care to the country. They strongly believe that you can do well and do good, so it’s a great business opportunity for Walmart. But it could also change access to care at an epic level as we can imagine. There’s 3000 super centers across the country. If they were to all offer these clinics, that would change the complexion of care for millions and millions of Americans.
So, on a macro level, there are people that find it really exciting. The challenge is Walmart’s in an existential fight right now not only with Amazon, but they’re struggling to get through the pandemic. It’s been just a devastating year for all retailers, so faced with a lot of competing priorities the clinics right now are stalled, which is really unfortunate because I think we all can see their potential. But I think it will likely end 2021 with 30 odd clinics, very much shy of the hundreds that we imagined potentially could be possible.
That is number one, two and three of what will have to change for Walmart to really find its footing. In the meantime, the other players that I talked about, they’re moving forward so Walmart’s problems are unique to them. CVS is not standing still. Definitely Amazon is moving forward very quickly, and even Walgreen’s has ambitious plans for 2021. Does that help?

Audrey Wyman:  
Thank you. I have one more because I have a lot of compassion for this question coming from Yvonne. I work for a large healthcare system and this feels like one of our largest barriers. What challenges, Shari, did you face in changing the employee culture? How did you overcome those challenges?

Shari Campbell:
 I would say a few things. It’s not been easy, so I need to be really honest about. At one point, we had three platforms, so you had traditional healthcare, we had another brand and we have Indigo. I think that was challenging for us. I think we’re still on that journey, so again, I want to be really honest. But I think, again, we’re really trying to lean into we really want to focus on consumers and we really want to listen to consumers and be responsive to consumers and when we do that, when we really listen to them, we actually think that’s better care.
I think on my first slide, I really didn’t channel much that tagline we use, a better way to get better. We use that as an external rallying cry, but internally we really are trying to say when we’re valuing decisions, whether it’s technology or the way we offer services, or the hours we offer services, we need to say, “Is it better for consumers?” So if you really want to be part of that, then Indigo’s the place for you to be. If you don’t, we’re probably not the right place to be.
I think when I look at marketing, that’s really what it should be. It shouldn’t be about trying to be all things to all people, and when we recruit physicians or we recruit MA’s, we shouldn’t be trying to be all things to all people. We should really be trying to hire for culture and fit and say, “This can be a really fun experience. This can be a really cool place to work. The clinics are modern, they’re cool. They’re working limited shifts. Your scope of practice.” I mean, I saw in the chat somebody talking about professionalism being important to some healthcare providers. It is, but I think other healthcare providers, like I said, we have a lot of people that really value their lifestyle and they deal in a traditional family practice. They deal with some heavy stuff.
If I can do 12 hours of having great relationships with people, making them feel better in 20 minutes and they’re out the door and I’m onto the next thing, I like that. So, I think it’s really we’re still on that evolution but I do think hiring for what we’re offering and really hiring on the front end for both staff and physicians and providers about what kind of care we’re trying to offer and how we’re trying to meet consumers where they’re at is really important.

Chris Hemphill:
 Thank you. Thank you for that. We’re going to go a little bit over time, sorry about that, but I do have time for one more question. Well, it’s actually two questions wrapped up into one. I saw questions from Darren Birch, from Jaime Bell and from others regarding the specialty care experience. It’s interesting because Shari, your scenario is there’s retail health innovation happening and the specialty care is known that’s going to be a referral into MultiCare. But there’s an experience that people are getting from their primary care provider, then there’s going to be a different experience from specialty care. There’s the question of how specialty care referrals roll in from these experiences as there’s uncovered issues that Walmart can’t cover.
And James, just wanted to toss that at you just addressing the overall view. There’s all kinds of specific questions that we can ask, but the Walmart or the primary care to specialty care relationship, how do these retail disruptors change that?

James Gardner:           
So, the referral strategy that Walmart’s using is not completely understood at this point, but the vision that most of us who follow Walmart is actually a potentially even more disruptive idea than the clinics themselves is we know how Walmart deals with healthcare for its employees. If you’re a Walmart employee and you’re hurt on the job, obviously they’re paying for your care and they’re very intentional with where you get that care. They’ve got a very data driven model that looks at both the cost of the care they could be receiving for a spinal injury or cancer or whatnot, but also that they’re using data to evaluate the quality of the care you’re getting.
It’s a very intentional value seeking approach. So we can imagine Walmart applying that same model on behalf of their customers or patients in their clinics where you’re looking for a hip replacement and the primary care physician has identified that yeah, you’ve got to get this taken care. They may not steer you just to the nearby hospital that’s a mile away. They may steer you with a recommendation to the provider that’s actually going to give you the best value for your money.
Why would they do that? Well, obviously for one thing it’s a great customer service model. They’re doing their patients a solid by bringing data to the table with that referral. But they’re also saving you money, which invariably will find its way back to Walmart, right? They have a large share wallet amongst their customers so if they can save you $3000 or $5000 on an expensive procedure, there’s a good likelihood that money’s going to find its way back into their cash registers.
So they can do something that’s great for their patients and they can do something that helps them, but that’s also going to change the face of healthcare because we know the cost of services varies widely in a community for reasons that are unclear to all of us. The lack of transparency is an ongoing problem. And, the quality of care varies widely. There’s definitely clinicians who are better at procedures than others. So to the extent they can bring data to that decision making process, it could also be very disruptive.

Chris Hemphill: 
 And down that same vein, Shari, just with the innovations and work that you’ve done has there been any kind of change or any kind of different experience in relation to the top of the funnel versus the downstream type encounters?

Shari Campbell:
Can you clarify what you mean by that change your relationship?

Chris Hemphill:            
Yeah, knowing that it’s a different experience when Walmart, One Medical or those unconnected from the specialty care aspect, just wondering if knowing where Indigo is top of the funnel, have you seen any changes in terms of receptiveness to specialty care options or referrals or anything like that? I wasn’t sure that there would be a lot to talk about there but was just curious about the overall.

Shari Campbell: 
Yeah, there is. I think I would say one thing that I should note, we have some of our Indigo’s are out of our market, if you will. We stretch on the west and east side of our state and out of our primary and secondary service area, so in those areas it’s a little bit harder to connect, but I would say we have definitely seen downstream and connections to specialists happen very well. I think, again, what happens is when your NPS scores are really hard … Ours are in the 80s right now … when more than 80% of our patients give us five star reviews and say things like, “This is the best urgent care experience I’ve ever had,” that puts you in the position that they’re like, “Well, if I need to go someplace else, where should I go?”
And, I think you just get a lot of trust. I think the next innovation for us will be how can we do that? Right now, it’s more like, “Go see … Here’s the piece of the paper.” It really needs to be on the phone. We really need to hard wire that from an app perspective and that’s in our plans. But right now, it’s through the EHR, it’s through “Here, go see this guy or gal down the street.” We really want to hard wire that. But we do track that in our primary and secondary service areas and we can actually show that even if our clinics are barely breaking even, the downstream pays off.

Chris Hemphill: 
Excellent. I just want to thank you all. I want to thank not just everybody on the panel, but also everybody in the audience for sitting down with us and having this discussion and continuing a little bit past. Just to wrap things up, James, Shari, Audrey, I know that there’s a reason that you came and had this conversation, and I just wanted to give you the opportunity to share your final thoughts, whether that be a wise quote or something that people can do, or just your final thoughts on this issue. We’ll start with Audrey and just go around the table and just give the opportunity for final thoughts.

Audrey Wyman: 
Maybe a bit hopeful, but just thank you Chris for inviting me to be a part of this and I’m hopeful that there is room for both. I think there’s room for traditional and I think there’s room for disruptors. I have young toddler twins, so I think that for certain conditions, if something’s going wrong internally or one of them has a strange virus, I’m absolutely going to go to the hospital that I trust and appreciate. Any other day, sign me up for water bottles and Goldfish crackers.

Chris Hemphill: 
Shari?

Shari Campbell: 
I would say especially to my healthcare friends out there that are part of the system, I’m always saying to folks disrupt or be disrupted. I’m the kind of person that I would rather be disrupting and I would rather be charting my course than have it happen to me. So, disrupt.

Chris Hemphill:            
Love it. James?

James Gardner:           
Oh, I love Shari’s advice. Disrupt or be disrupted. I can appreciate, as we all can, there’s an endless list of priorities for everyone in the world of healthcare. But retail health is one of the bigger disruptors that’s coming. You’ve got large organizations with customer experience or patient experience in their DNA. They’re relentlessly competitive, they’re well resources and even if it’s not Walmart, it’s going to be Amazon, or it’s going to be CVS, or it’s going to be Walgreens. They smell opportunity for many, many reasons and they’re not going to stop until they take market share and deliver care that is different and perhaps better than what people are currently experiencing. So, pay attention to it, friends.

Chris Hemphill:            
And, I just wanted to share some responses from the audience. Let’s take a look at the first poll. I don’t know how to bring it up, but the first poll said overwhelming that the consumer experience is going to improve overall because of this disruption happening. In the second poll, the second poll I believe said that yes, health systems are capable of bridging those consumer experience gaps that the disruptors are focusing on. Then we asked well, what are the biggest gaps? Well, it’s that Know Me experience. In the third poll, it was that Know Me experience that was highlighted as the biggest barrier, but also convenience and the consumer experience.
Then, to finish things off, the final component was well, when we’re looking at these changes, when we’re looking at the things that we need to do, are our barriers more technological or are they more cultural. James, you were just talking about these organizations having this embedded in their DNA. Shari, in past conversations, you had talked about the speed of innovation at which Indigo works just based on what’s being fostered there. So it’s fascinating to see all that stuff come together. Basically, we can improve it, we can rely on existing infrastructure making that better for consumers with cultural change. Of course, there was technological elements within that, too. But that’s what I get, what I’ve learned from you all, and learned from this audience and this conversation.
But to wrap things up, we really appreciate you sitting down and taking the time with us. The Forum for Healthcare Strategies appreciates that as well, and they are doing some really exciting things this year. There’s going to be the conference hopefully happening in Miami, should things provide to be safe, but we’ll be able to have this conversation in person. During that time, James will actually be leading another panel with regards to healthcare disruption and innovators. You can see it live and in person, but don’t forget about us when you watch that, too. We want some recognition, too.
We’ll actually be leading a panel with regards to AI and the consumer experience. So, lots of exciting stuff HMPS is putting up. We’re really excited about that, and hopefully you’ve been able to get a lot from this presentation. There will be a survey coming out that will allow you to give some feedback, some stuff that we can use to address a lot of your questions and things to make it better, but again, we appreciate the time that you spent with us and I’m thankful to the audience, to James, Shari and Audrey, and to Debbie, to Daniel over at HMPS, to Judy Neiman. Thank you all, everyone. Thanks for making this a success.

James Gardner: 
Thanks, Chris. This was this fun.
 

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