Is Health Care on Your Walmart Shopping List?

[MUSIC PLAYING] Welcome, everyone. You're watching Coronavirus in Context. I'm Dr. John Whyte, chief medical officer at WebMD. Today I'm joined by a very special guest, Dr. Cheryl Pegus. She's the executive vice president of health and wellness at Walmart. Dr. Pegus, thanks for joining me.

Great to be with you. Great to be with WebMD, just great work that this organization has always done, and it feels like coming home.

Well, congratulations on your new role, and I know you weren't at Walmart when this pandemic first started to change life as we know it, but how was it impacted the work of Walmart?

So I'll start off by saying I think this past year, 2020, has caused changes for all of our lives, personal and our work lives. At Walmart, to just think of for everyone, you've had to go get your groceries. Remember the time when we were all hunting down paper towels and wipes? And think of our frontline workers being there every day to provide those services.

We have over 2.5 million workers who are our workers throughout the organization, 5,000 stores. They're ready every day, seven days a week. So, at Walmart, some of the areas of initial investment, ensuring that we have PPE, ensuring that we were allowing our workers to understand that when you come into a Walmart store, it's OK to ask someone to have a mask on. And so really empowering this is for the health of our country. Here is how we can help make a difference, and we continue to do that.

Walmart also quickly recognized, as many of us have, just the impact that COVID-19 has had on our communities. And so early on, over 35 million in investments and working with food banks, in ensuring that, for groups that needed to reach people, be it an Indian Health Services or at other organizations, NAACP, we were providing funding for technology, right? That whole communication where people weren't going out. They were now at home. How do we ensure we're communicating with them?

Walmart is one of the leaders in terms of the delivery of care, and we do know that COVID is going to change how health care is delivered, just not now, but also in the future with really this trend of bringing more care into the home. Yet, at the same, Dr. Pegus, Walmart is building actual health centers. Is there a disconnect there in terms of what we're seeing is going to be the long term impact?

In making health care accessible, there are many conditions that you can manage through a telehealth platform. And I think, as you've mentioned, John, over the last year, in some areas like behavioral health, you've seen a 5000% increase in the use of telehealth for behavioral health, but it's not for every behavioral health condition.

You can say this for some medical conditions. Can I receive an update on my blood pressure and refill my medication through a telehealth visit? You can. But if I'm having pain and I'm trying to figure out what's the best way for me to determine do I need to go to an emergency room, can I wait to just get an appointment, you need some of that in person.

And so what we've really done is we've added more tools to our toolkit. We at Walmart, as I think many of you are aware, have just started doing more home delivery services. We've launched a Walmart plus service that provides many in-home services. And so what we really have to do, because health care is so local, is look at our communities and determine what are the additional services that your Walmart can provide in health care.

There are services. Just look at communities where you don't have enough primary care physicians, but you've got a pharmacist in a Walmart, and you may have a health clinic. We look at underserved and rural communities as areas where all of us in health care have identified gaps that Walmart's already located in these communities. I use this statistic because I think it's just a good reminder.

150 million people a week come through a Walmart.

Wow. 150 million?

Just think about--

[INTERPOSING VOICES]

Wow.

150 million.

You know, we talked before the show. A couple years ago, if I said to people, would you go to Walmart for your health care? People would think I'm crazy and be like, why would I do that? Now if I ask people, will they go to Walmart for their health? They say, I prefer going to Walmart. Why is that?

So there are three pieces, right? One is definitely cost. Every day low prices at Walmart. And health care, one of the great barriers in health care, is cost to people accessing it, but it's the other point that I made earlier. We have 5,000 stores located across the country in your community. It's access. It's being able to-- I can get my groceries, but I can also pick up my glasses. I can get my prescriptions, or I can talk to a pharmacist about diabetes.

And now that we are opening health clinics, I can also see a physician. You have one place where you're receiving all of these services by people from your community.

I want to get back to care that's being delivered at a Walmart. We've seen that in other type of pharmacies. Sometimes there's the criticism. Let's be honest, people will say, it's not as connected as it should be if I'm seeing a different provider all the time, or if it's not connecting back to the medical record. What changes are you making to ensure there's still that level of connectivity?

So the first is our health centers are actually staffed by physicians. They are your physicians. They are physicians in the community. They work for our health center, and you will be seeing those physicians at every visit, but you did also talk about, right, this ability to have telehealth and ensuring that telehealth links to primary care, right? So you have that continuity of information about an individual so that they know-- they don't have to repeat it, and that the correct information to make sure that they're receiving safe quality care is occurring.

We've built out our systems to allow that to occur, and then it's how do you refer so that you're receiving the best specialty care when you need that. And so, within communities, what we're doing is we're partnering with the health systems and the health partners to allow that to occur. Our hope is that we're identifying and finding people earlier on in any medical conditions to prevent their progression. But if they do have a progression, that we're utilizing local health care resources to get them to the right care.

How is it going to permanently change patient's expectations of what they want from health care and health care providers?

So, it's a great point. And it's not just a patient's, right? It's, how has COVID changed physicians? Changed that behavior.

Let's start with that. How COVID changed--

Right? It changed everything. There was a time when we wondered how quickly would physicians adapt to telehealth. Would they make it part of that omnichannel access for their patients to be able to receive care, and we've seen that, yes, physicians will change behavior.

Well, we did change regulations, to be fair, and we did change payment, as you know. That goes a long way.

It definitely, but you're also seeing physicians, you know, I mentioned behavioral health where there's been some good data that has come out that has shown great adherence to medications, people feeling as if they are getting healthier, and so I do think there is this piece of this that is data driven that really says, here's how we may want to care for populations going forward.

I'll step back and just make one comment. One of the things that we saw with COVID-19 is that because many people could not go see their physicians, physician practices have had to evaluate what's the best structure for me to be in business because, at the end of the day, I want every day to pay my staff. We've got overhead to manage, and we want to provide the right services.

And so there is different types of contracting that physicians do, right? There's fee for service versus value based care. And I would just say, in value based care, it is not just about I saw my physician and I got my prescription. It's about, are we helping people understand the things they should do for self-management? Are we helping them understand the importance of taking them their medications on time?

There is much more of a holistic view when a physician is managing you holistically. It's not just you came to see me today. And that shift in value based care payment models I think we again see post-COVID growing because fee for service is challenged if people can't access you. Those types of data driven approaches to improving health care is frankly where we are and where we're going.

Do you think there's also an acceleration to the patient truly is becoming more aware of their care and really in control of their care? Patients are much more empowered now because of the resources they have, part of the retail tools, many of which Walmart sells, that they have. Is health care fundamentally changed, Dr. Pegus?

The way I look at this is, what's the stage of health wellness that you're in? In early stages of health, right, where you don't have many illnesses, you may not even take any medications, that self-management, we've actually always wanted people to do that. We now have better tools and technology to allow that to occur, and we are doing a better job-- you know, you started out just the way physicians speak. To patients, sometimes it's a different language.

We now understand the importance of health literacy, of cultural concordance and the way we speak with individuals. We're investing in what that should look like. It allows us to empower people to help them manage their own mild illnesses. As you move along a continuum, though, where you have more chronic conditions, or you're taking five medications at a time, your needs are very different. And even for us in the health care field, we wouldn't do that without having a physician buddy.

We're learning right now an opportunity of, how do we take our current talent pool of health care professionals and continue to provide care across the country, allowing people who can self-manage with the right tools do that? So how are we triaging? Hey, you can do this. Here is how we'll empower you to do it with technology and with some remote monitoring.

You need a little bit of help in doing this. Our pharmacists actually can help you with your immunizations, understand your medications, as well as manage your diabetes and answer questions, including what you may find over the counter. You just had a heart attack. Obviously, you need to see a primary care physician on an ongoing basis and a cardiologist. And by the way, we're totally aware of the mental health that comes with that.

Can you imagine what data and AI is allowing us to do to segment our populations, our communities, so that everyone is getting the right amount of health care and we can reach everybody? That is the future of health care, I hope.

And that is our goal. But what keeps you up at night? We've talked about all the good things, but what keeps you up?

The things that keep me up the most is, how do we ensure that everyone has equitable access to health care? And I think, you know, I've been asked, joining Walmart, that's the reason. You heard me say we are in every community, particularly underserved communities and rural communities.

And finally, you and I have talked about one of our initiatives at WebMD and Medscape is about diversity, particularly diversity in the health care workforce. Here you are, a woman, a woman of color, a cardiologist who is at one of the most senior roles of health care in the country, one of the biggest companies in the world. What's Cheryl Pegus' story? What was your journey into medicine?

The first thing to my journey is good relationships and mentors. For everyone out there, none of what is possible is as good as when we get support, help, and [INAUDIBLE] of people who are supporting us, and we're asking questions. But I started out, really, with an interest in health care because of family members who had been ill, couldn't get great access, and so it was really a learning for me at a pretty young age of how important it was that when you were sick, you had a place to go, a place that was acceptable and understanding of you as an individual.

So that was a big driver early on, and then I really chose my specialty, heart disease, as an area to focus on because it remains the number one cause of death in this country. And if you look at women and you look at minority groups, even higher rates of disease. So it was kind of an area that, gosh, it'd be great to understand it and see what I could contribute to that.

And so I've really, hopefully, invested time in learning and understanding so that I know how do you truly improve health in a community. I've mentioned mentors a couple of times, and I've done this with an army. Not just my family, but people in other business areas really saying, well, here's how we're looking at health care when we're purchasing it, or here's how we're looking at health care when we're investing in it.

And the time spent in that has made this a very rich journey. I tell everyone, and I think I've said this a couple of times even at WebMD and Medscape before, this is probably the best profession to be in. You can be John Whyte.

[CHUCKLING]

Look at that--

[INTERPOSING VOICES]

--that John has and what he's doing. You can be working in the pharmaceutical industry. You could be doing a new technology startup health care company.

Look at AI and data. Just think about the possibilities of what's open to you, and I think that, for me, has just been a really great way to look at this profession that I hope I get to do for as long as I want to do. And I say to women, to underrepresented minorities, it's work, but everything's work. At the end of the day, every day you get up and you do something that's making a difference, and it doesn't feel like work when you're having such a great time contributing back to society.

Well, my good friend, Dr. Cheryl Pegus. Thank you for sharing those insights. Thanks for your leadership. And a reminder to folks as well that it is about mentorship. It's about continuous evolution, and it's still an exciting time to be involved in health care. Thank you, again.

Thank you so much. Great to be with you. I hope to be working with you for many more years Thank you for your friendship along the way.