Walgreen’s RX for Fixing Health Care: Chief Medical Officer Dr. Patrick Carroll on Health Services Growth in Pharmacy Setting

Dr. Patrick Carroll

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Margaret Flinter: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter , a weekly show where we speak to the top thought
leaders in health innovation, health policy, care delivery , and the
great minds who are shaping the h ealth care of the future. This week ,
Mark and Margaret speak with Dr. Pa trick Carroll , division vice
president and chief medical officer for Walgreens Healthcare , where
he oversees the retail health clinic business in one of the nation ' s
largest pharmacy c hains , which are increasingly going to become a
point of care for the American health care consumer.

Lori Robertson also checks in, the managing editor of FactCheck.org ,
looks at misstatement s spoken about health policy in the public
domain , separating the fake from the facts. We end with a bright idea
that ' s improving health and well - being in everyday lives . I f you have
comments, please email us at [email protected] o r find us on
Facebook , Twitter , iTunes , or wher ev er you listen to podcast s . You
can also hear us by asking Alexa to play the program , Conversations
on Health Care.

Now , stay tune d for our interview with Dr. Patrick Carroll , chief
medical officer for Walgreens Healthcare .

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M ark Masselli : Hey, w e ' re speaking today with Dr. Patrick Carroll , division vice
president and chief medical officer for Walgreens Healthcare , a
division of Walgreens Boots Alliance , a major international
pharmaceutical manufacturing and distribution conglomerate. Dr.
Carroll over sees the retail clinic business as well as clinical programs ,
and health systems alliance in the United States. Previously , Dr.
Carroll was chief medical officer of Integrated Care Partners at
Hartford HealthCare and was also chief medical officer for Hart ford
HealthCare ' s Medicare Shared Savings Program. He earned his
medical degree from Dartmouth Medical School , d id his residency in
family medicine at Middlesex Hospital in Connecticut.

Dr. Carroll , welcome to Conversations on Health Care.

Dr. Patrick Carr oll: Thanks for having me.

M ark Masselli: Yeah, I don ' t think a month or two goes by where we ' re not reading
on the front page of trade papers that there ' s a merger or an
innovative partnership that ' s shaking up the health care landscape.
We saw Aetna and CVS, Amazon and PillPack . We see that Amazon ,
Berkshire Hathaway , and JPMorgan Chase just brought on Atul
Gawande. Cigna and Express Scripts , and certainly Walgreens Boots
Al liance as your parent company as known has been pursuing its own
approach to this quest to expand health services having recently

Dr. Patrick Carroll

acquired some 1 , 600 Rite Aid pharmacies.

I wonder if you could share with our li steners your thought about
what th ese trend s speak to and also how Walgreens is using its
market presence to have an impact on t he transformation of care
delivery.

Dr. Patrick Carroll: I ' ve been practicing in primary care for 29 years. I actually still
volunteer one Saturday a month at a Community Health Center in
Downtown Chicago. As a family physician , the traditional practice
mo de was 8:00 to 5:00, you deliver ed health care . You saw that you
have 25 to 30 patients per day. You would have handle d 3 , 000
patients of all ages, I would say from nursery to nursing home. On
weekends , you had some limited hours, you had after hour call
s ervices . It was really a very traditional model of primary care. I think
what we ' re looking at today is a couple of trends that are really
shaking up health care .

The one challenge , quite honestly , is the shortage of physicians .
Particularly, by 2030 , it ' s estimated we ' re going to be down 130,000
physicians. Access to care is a real challenge for consumers across this
country , particularly within ag ing population and the increase d
prevalence of chronic diseases.

One of the ways that we can answer this chall enge of access is really
to provide care at site in your community pharmacy locations across
the country , in addition to bring in digital health care into the health
ecosystem. At Walgreens , the core of our strategy is that intersection
between digital an d physical access points, the 9,300 to 9 , 400 stores
that we have that are really out of the health systems towers and into
the community.

In addition, we have many digital assets that really connects the
consumer through our website and through our apps to direct them
to digital health assets and other access points of care with both
health system partners in and out of store. What we ' ve done very
intentionally is partner with either health systems or national
providers of health care to bring services into our stores. We are
embarking on a pilot around Medicare Advantage clinics in the Kansas
City market that ' s been announced with partners in primary care. In
addition, we ' d set up 15 urgent cares around the country in a
partnership with MedExpress in our sto res.

We are partnered with 13 health systems around retail clinics in our
stores , where they actually run the retail clinics in their market. In
addition, we run over 160 retail clinics by our own model through
Walgreens. Then we also offer services around lab through a
partnership with LabCorp. In addition, on the digital side , we ' ve
created this application called Find Care Now, where in markets

Dr. Patrick Carroll

across the country , a consumer can log on to a Walgreens website,
click on the Find Care Now application , and t hen be connected into
health assets in Walgreens or with partnerships , whether that ' d be
through digital health or through health system partnershi ps. It ' s
really around consumer - centric care and access points to care,
particularly in a way that is this pl ace transparent as possible because
as you know , more and more consumers obtain high - deductible
health plans. They obtain more out of pocket for their care.

Margaret Flinter: Dr. Carroll , you just gave a comprehensive description of everything
you ' re doing . I ' m thinking maybe our health professionals and the
audience got it. I think a lot of consumers are scratching their head ,
going , what , urgent care, retail care, virtual care, primary care, on -
demand care. I wonder if we could back it up a little bit . I think if we
look ed linearly at the evolution we saw maybe 15 year s ago ,
MinuteClinic . You ' re sick . We ' re quick. I think people kind of got that .

Then maybe in the last couple of years , we ' ve seen urgent care clinics
popping up on almost as many corners as there are Walgreens stores.
Help our listeners understand , what is the model of care that
Walgreens is seeking to establish ? Is it whole lot of variety ? Is there
an underlying kind of model of care or health care infrastructure that
you ' re looking to embed into the health care landscape?

Dr. Patrick Carroll: Right . That ' s a great question. What we ' re creating is a health care
hub where consumers can access services in their community. I did
list quite a variety of services, but consumers have different need s.
Take you r diabetic patient who is in and out of a Walgreens , our
stud ies show on average , 30 to 60 times per year , picking up
pres criptions, picking up test strips. The convenience for that
consumer to actually access lab services through our partnershi p with
LabCorp , you can get that hemoglobin A1C that diabetes test s are on.
It ' s really powerful . It ' s convenient because that ' s where they ' re
picking up their scripts . It provides them access to lab services.

In addition, as we build out more of a primar y care practices in our
stores, not only could that consumer access pharmacy services, lab
services , but they potentially could see their primary care physician
right in our store. I think the way to think of it is really access points to
care, really focu sed also on the adult population with an increase in
inciden ts with some of these conditions , such as diabetes and
hypertension , and elevated cholesterol , t o be able to give them a way
to get into the system . It ' s really difficult to navigate health care t hese
days as a consumer and quite honestly as the physician. I think we ' re
trying to simplify it and provide those access points.

M ark Masselli: Well, Dr. Carroll , I was thinking as you we re talking earlier about the
trends that are shaking up the health c are environment. Certainly,
one of the great unmet needs is certainly behavioral health . You ' ve

Dr. Patrick Carroll

partnered with a telemedicine entity , Breakthrough, an MDLIVE
telemedicine company , to increase mental health screening and to
improve access to treatment. You mentioned earlier that you have an
online platform at Walgreens.

I was t rying to think through this sort of waterfront, if you will, of
telehealth, telemedicine, virtual care . Walk us through that model as
well . How effective you think this will be for th e populations that
you ' re trying to serve and deliver access and also modernize the
delivery system as well ?

Dr. Patrick Carroll: Right . I think the promise for telehealth and digital health, virtual
health , is the fact that you can access that care at hom e. You can
access that at a Walgreens store. In Manhattan , we ha ve a
relationship with New York - Presbyterian where in our stores , th ey
have set up telehealth kiosks where someone can come in and get a
visit in our stores directly into the emergency room ph ysicians, or for
multiple conditions , and h ave peripherals , such as pulse oximetry
check, oxygenation, blood pressure, temperature , and provide that
connection.

When we look at kind of that digital telehealth landscape , it really
provides many solutions a t scale. I think a particularly powerful
solution in that area is to behavioral health needs . As you reference d ,
i t ' s a major issue in this country , accessing behavioral health services.

What we ' ve created through a partnership with MDLIVE , but also
throu gh the Mental Health Association , is you can go on our website
and actually get a behavioral health screen , particularly focused on
depression screen , and t hen connect either with a virtual visit through
the MDLIVE platform, or actually get connected throu gh counselors ,
or an access point of behavioral health care . I think many other
systems, health systems , have looked at how they ' re going to open up
access to a really limited resource to behavioral health specialist, and
a growing need for it among U . S . p opulation. We think that virtual
solution is a really powerful tool , when we are talking about
behavioral health needs.

Margaret Flinter: Dr. Carroll , there ' s so many services that we recognize can be
provided virtually or digitally now, but some still see m to require
contact between the patient and a health care person. One of those is
certainly immunizations and vaccines. We think about the flu shot
every year . As it ' s gotten so expensive and also very difficult to
maintain the supply chain , if you will , with refrigeration and
temperature controls and so forth , and t hen you have additional
challenges in terms of patients really getting this information into
their record. Tell us a little bit about how you see this public health
element.

Dr. Patrick Carroll

Dr. Patrick Carroll : Yeah , absolutely . We ' ve been doing that at Walgreens for years. We
have our pharmacist s give multiple types of vaccinations . Many of
them are around flu vaccination , also pneumococcal vaccination. To
me , it ' s a valuable service for consumers . It really g ets to one of the
opportunities in health care, i s we have to go beyond just medical
providers , such as nurse practitioners and physicians , and physician
assistan ts to deliver health care . We need to bring the pharmacy labor
force into health care . I think our first major entry is quite honestly
through immunization. What we also see and value with what the
pharmacist s do , working with customers on major issues , such as
medication adherence. Quite honestly when we start having more of
th ese access points to primary care, retail clinics to connect with that
pharmacist around adherence measures , we think it ' s just good health
care .

M ark Masselli: We ' re speaking today with Dr. Patrick Carroll, division vice president
and chief medical officer for Walgreens Heal thcare , a division of
Walgreens Boots Alliance. I was thinking , Dr. Carroll , as you were
saying that you are working and others are to bring pharmacist into
the health care system. Thinking about the cost of health care and it
seems to be growing at unsust ainable rates. The pharmaceutical
share is risen . I ' m wondering if you could talk about the value
proposition for valuable services for consumers. Talk about the
benefits that match up to the cost.

Dr. Patrick Carroll: Yeah, I think what I ' d like to do to kind of flush that out is to look at a
patient who has diabetes. What we know is adherence is not great
among a diabetic patient. We ' ve seen studies where 50% of diabetics
are not [inaudible 00:13:58] with the ir medication regime. We also
notice a direct t ie in, in terms of no n - adherence and increased
medical cost, patients who, for whatever reasons, whether it would
be cost, lack of understanding of the medications they ' re on, are not
taking them appropriately. Th at leads to complications, admissions to
ho spitals, emergency room visits, and medical complications of
diabetes , the [inaudible 00:14:26 ] the neuropathy, the neuro
problems, the kidney disease.

Anytime we can impact adherence , sometimes simply as much as
explaining about the medication they ' re on, what the side effects are
to increase adherence , and then get that information back to primary
care physicians , w e see that as really value add. Another feature when
we talk about bringing in digital, we have a program , called Pharmacy
Chat, where over 12 ,000 chats are conducted per week. There's a
pharmacist available 24/7 for customers who have questions about
medications and side effects. They can go online and have that kind of
virtual pharmacy chat with the pharmacist, really helping folks with
some o f these conditions.

Dr. Patrick Carroll

Margaret Flinter: Dr. Carroll , one of the marketing campaigns or slogans that I always
personally liked about Walgreens was the one that says , We're at the
Corner of Happy and Healthy . As you so well know, all is neither
happy nor healt hy in a lot of neighborhoods. We really had to
embrace addressing these social determinants of health, the housing
and stability, food scarcity. I would bet based on your training and
experience that you ' ve had to give some thought to this as you
develop t his health care model within Walgreen s . Where does
Walgreens get involved in helping address those social determinants
of health or partnering with others in the community to do that?

Dr. Patrick Carroll: You ' re right. If you actually look at where we are in this country in our
physical locations , we ' re in every type of neighborhood , h igh income
to the lowest of income . Our customers come from a real full
continuum of economic backgrounds . We are the community
pharmacy in every community we serve , working w ith customers who
are struggling with co - pays. We work with them around co - pay
assistance programs. We ha ve community specialty pharmacies
spread across the country. The cost of specialty meds are really high
with their chronic medical conditions, the HIV patients who needs
medications , or a person with a chronic inflammatory disease. We
work with them around co - pay assistance adherence programs in
every type of community around the country. We feel like we bring
value to our customers because of our locati ons across the country.

M ark Masselli: Dr. Carroll , I want to talk a little bit about genetics and genomics.
About tw o years ago , Dr. Collins at NIH launch ed the All of Us
initiative . We were fortunate to be one of the 10 health systems
chosen to start the laying out of the IRB. The hope here is to get a
million lives and follow them longitudinally , a much more expanded
Framingham Study , if you will, but really looking at the genetic
information and gathering information on electronic health records
and soc ial determinants as well. I understand that Walgreens is going
to play an important role going forward in this initiative. I ' m
wondering if you could talk to our listeners a little bit about the work
that you ' re going to be doing in this.

Dr. Patrick Carro ll: Today, we actually are part of the All of Us initiative and that Precisi on
Medicine Institute initiative . We do that through participation at
selected clinic markets where we still run the clinic s, such as in
Houston. We have this up and running in sev eral other markets . We
are involve d with that initiative. It ' s really exciting work . That's what
we do today.

We see the future is going to be very focused on pharmacogenomics,
making sure we ' re matching up the right medications , particularly
these very c ostly specialty medications to the appropriate patients. As
we talk about the lab services we ' re bringing into our stores, we think

Dr. Patrick Carroll

that ' s a nice synergy also where this lab testing that can be used in
the area of pharmacogenomics and clinical research is going to be
available at our stores , at least today. We see that that ' s really
growing area, an exciting area where health care is going.

Margaret Flinter: We ' ve been speaking today with Dr. Patrick Carroll, division vice
president and chief medical office r for Walgreens Healthcare , a
division of Walgreens Boots Alliance , where he oversees the retail
clinic business as well as clinical programs , and health system
alliances. You can learn more about Dr. Carroll ' s work by going to
walgreensbootsalliance .com o r follow them on Twitter @ W algreens.

Pat, thank you so much for your work and for joining us on
Conversations on Health Care today.

Dr. Patrick Carroll: Great. It ' s great to reconnect with folks from Connecticut.

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M ark Masselli: At Conversations on Health Care , we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning journalist and managing
editor of FactCheck.org , a nonpartisan, nonprofit consumer advocate
for vo ters that aim to reduce the level of deception in U . S . politics.

Lori , what have you got for us this week?

Lori Robertson: Presi dent Donald Trump recently said " We've got the cleanest country
in the planet right now. " He was talking about clean air and cl ean
water. Rankings complied by researchers at Yale and Columbia
Universit ies say otherwise. Out of 180 countries studied , the U . S .
comes in at number 27 on the 2018 Environmental Performance
Index . On air quality , the U . S . ranked 10 th. On water and sanita tion , it
placed 29 th .

Trump made his comments in a campaign style rally in West Virginia ,
saying, " There's nobody cleaner than us. " Trump provided no
evidence . The White House didn ' t provide us with anyone we asked.
There are several countries that are cl eaner than the U . S. The report
which is released b y annually and even numbered years was produced
jointly by Yale and Columbia in collaboration with the World
Economic Forum.

This year , the U . S . ranked 10 th in air quality . While it was tied with 11
other countries for 1st in household air pollution , it was 88 th in
exposure to particulate matter. The U . S . ranked 29 th overall in water
and sanitation. Contrary to what the President said, there are
countries that are cleaner than the U . S.

That ' s my fact check for this week . I ' m Lori Robertson, managing

Dr. Patrick Carroll

editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country ' s
major political players and is a project of the Annenberg Public Policy
Center at the University of Pe nnsylvania. If you have a fact that you ' d
like check ed, email us at chcradio.com . We'll have FactCheck.org ' s
Lori Robertson check it out for you here on Conversations on Health
Care.

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M ark Masselli: Each week , Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. The global rise
of diabetes and obesity are threatening to cripple health care systems
in coming decades. Both diseases are largely driven by behaviors. One
of the most challenging behaviors for clinicians and patients to
monitor is accurate measurement of food intake as well as its
nutritional value.

Dr. Janet Cade : We do know that people who track their food intake , that does
influence what th ey eat. That ' s been proven over many years with
sort of Weight Watchers and some of that. We also note from
research that if people are telling us what they eat, they tend to
underestimate that intake as well.

M ark Masselli: Dr. Janet Cade directs the Nutr itional Epidemiological Group in the
School of Food Science and Nutrition at the University of Leeds,
England. They created their own online tool , myfood 24 , which has
extensive nutritional and caloric information on tens of thousands of
commonly consume d f oods.

Dr. Janet Cade : Well, o ur database has about 45,000 foods in it. We ' ve taken the
backpack label information and we ' ve mapped it to insert, if you like,
the missing nutrients that aren ' t on the backpack in order to have a
complete database of nutrient s and foods. There ' s over 100 different
nutrients , including various amino acids and fatty acids [inaudible
00:22:53] which we can report on.

M ark Masselli: Dr. Cade thought there should be an eas y - to - navigate online tool that
provides a seamless interface for researchers and study participants
to use.

Dr. Janet Cade: We still have to get people to type in the actual type of the food it
was . We've got quite sophisticated ways of helping people to do that.
Then you just tall y that up to the day really . Basic ally you just type in
everything you ' ve eaten . Then it will tell you nutrients that you ' ve
consumed.

M ark Masselli: Researchers are lauding the additional granular nutrition information.
Dr. Cade says , while it ' s be ing used primarily by researchers now,

Dr. Patrick Carroll

sh e ' s hoping to advance this tool into clinical settings , providing
clinicians and patients struggling with diabetes or weight
management , a more accurate assessment tool for record ing their
nutritional intake.

Dr. Janet Cade: I am a little frustrated that s o much research resource ' s gone into
developing new technologies for measuring DNA , genomics , that sort
of thing, and so little have gone into measuring behaviors , like dietary
intake, physical activity , where we could learn so much more about
observationa l epidemiology. This project is a step in the right
direction.

M ark Masselli: myfood 24 , a comprehensive online dietary recall tool , providing
researchers and their study participants an easy and more accurate
way to track nutritional intake data , l eaving t o a better understanding
of nutrition ' s role in disease and weight management, now that ' s a
bright idea.

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Mark Masselli: You ' ve been listening to Conversations on Health Care . I ' m Mark
Masselli.

Margaret Flinter: I ' m Margaret Flinter.

Mark Masselli: Peace and health.

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
University , s treaming live at chcradio.com , iTunes , or where ver you
listen to podcast s . If you have comments , please email us at
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