Nashville Health Care Council Sessions: Kevin Ban, MD, Walgreens Boots Alliance

David Shifrin: Dr. Kevin Ban thanks so much for your time. This is a lot of fun getting to just hang out and talk to people here at Nashville Healthcare Council Sessions.

Kevin Ban: I think this is probably a pretty good job, huh?

David Shifrin: This is a great job. It’s great. Yeah. And so we just had the opportunity to hear you and a number of other folks including Dr. Marc Watkins, who just wrapped a conversation with talk about the role of retail in healthcare and where we’re going. And we have spent so much time over the last decade at least talking about consumerism and patients as consumers.

And if Amazon can figure us out, why can’t my hospital? And it seems like we are at a point where that is happening and so much of that I think is thanks to the role of retail sort of writ large. So, I would love to hear you start off by talking about what you said on stage about how you, as somebody who’s leading in this space who has a medical background and is also a dad who is acting as a consumer, what is your perspective now over the last couple of years coming out of the pandemic of the patient as a consumer, as families as consumers and how that’s influenced your work?

Kevin Ban: Yeah, I think what I said on stage was it’s been like waiting for Godot. And we just keep waiting for this consumerism to show up and yet it never quite gets here. I think that things may be changing as a result of the pandemic but even more importantly, I’ve seen real change happen in healthcare when there’s some financial incentive. And in some ways that bothers the inner doctor in me that’s what it would need to be in order to make things change, but it’s what I saw.

David Shifrin: Yeah, you’re mission-driven, it shouldn’t be about money.

Kevin Ban: I guess I’m naive. I hate to… I’m really serious, I think I’m just naive. And when you go to med school and when you’re a physician in the early days, and I mean in your residency, there’s this concept of do the right thing. It’s, what’s the right thing?

You know what the right thing is, right? So if I said, David, do the right thing, say what is that? What would you do for your mother, your father, your grandparents, your siblings, your kids? That’s the right thing, okay. And that’s the way I would say 99 percent of providers are wired. We’re just wired to do the right thing.

The problem, the rub, is when you don’t have financial incentives that help you achieve the right thing. So, what do I see? That might be some interesting backdrop. I’m seeing financial changes that are hitting now the consumers. We pushed risk initially onto providers that happened through the pioneer ACO. It was all of these risk sharing programs have come out for provider systems, healthcare systems that really aren’t capitalized to take on any of this. And now we’re seeing it happen. And we’re pushing it onto patients.

How? Through high deductible insurances. And then if you have enough money, you have an HSA to pay for it, but that’s not always the case. And high deductible insurance sounds all cool and the gang until you have to stroke a check for four grand. And then it’s a problem. And that’s what happened to me last summer with my daughter. And, all’s good, but I stopped being in that moment a healthcare professional.

And when her pediatrician, someone who trained me parenthetically said, hey, go across the street to the community hospital to get testing. And it was complex testing to a certain extent, but some of it was simple testing. The bill was huge. And I think that could have happened at equal quality and for much less money making the value high.

Okay, when something like that happens to you, you get fooled once but you don’t get fooled twice. And so, I have, much to the chagrin of my wife, who’s Italian, and I don’t mean kind of Italian, I mean born and raised in Florence, Italy, where she’s like there can be no negotiation when it pertains to our children’s health. I now am pushing back and saying why are we doing that? Why are we doing that there? What is that going to cost?

And I think eventually that’s what will happen. And that’s when consumerism really settles in. And it’s not because of do the right thing. It’s because financially it’ll make sense for people to do that.

David Shifrin: So how do you take that into your work and thinking about, I mean, you said you were in a fortunate position where you could write that check that first time. Many people can’t as you talked about, and I can’t remember what the exact number is, but something like more than 50 percent of Americans don’t have is it $400 to cover an emergency expense?

Kevin Ban: Yeah. I think it’s just shy of 50 percent.

David Shifrin: Just shy of 50 percent.

Kevin Ban: If asked to write a check for $400 or more would have to borrow money in order to do it. I think that’s where it comes down to. So, you’re exactly right. And mine was a multiple of about ten of that.

David Shifrin: And so, between the financial strain and just the fact that we aren’t educated in how to navigate this insanely complex medical system, we have neighbors who are struggling to pursue care, asking the right questions, paying for it when they’re able to. So, how do you…

Kevin Ban: You’re put into indebtedness at an alarming rate because of health care bills, right?

David Shifrin: Yeah, at a shocking rate. When that person is looking for care, how do you show up for them and say, “We’re here, we’ve got pharmacy, we’ve got urgent care, we’re ready for you and we’re gonna help.” I don’t know if you would use the terminology of the front door, but what is your role and how do you think about that and helping to navigate and take some of that pressure and burden off of people.

Kevin Ban: Alright. First of all, as you’re saying this, I’m with you. I a hundred percent get this and it makes me think, and forgive me if this is just random brain thinking, but remember the first time like you opened your iPhone and there weren’t even instructions. I don’t know if you remember that.

David Shifrin: Yeah.

Kevin Ban: ‘Cause you didn’t need them. It was so intuitive, it made so much sense that once you turned the darn thing on, it was like smooth sailing. Here’s the deeper criticism I’m going to make, like, why do we even need anyone to help us navigate through our healthcare system? That’s craziness.

And I’ll tell you, early on in my career, I led a project in Tuscany on behalf of Harvard Medical International. And I learned so much from that experience by working in socialized medicine, which we have demonized. But the truth is that people in Italy, and we will oftentimes talk about how there’s a problem with access to care, which I never saw quite honestly. They knew how to use the system like they didn’t need navigators, right? But we do which says something about our health care system and it says something about how we have to somehow simplify something that’s become nearly impossible to navigate.

Now, can we help people do that? That’s the vision but let’s never forget that this is a workaround, okay? I just want to call that out. That having a navigator is a workaround. But unfortunately, that is the state of our healthcare system. And we should and I think could do better. Yes, we can be that front door to access care. Let’s talk about access to care for a second.

Kaiser Family Foundation came out with some really interesting stats at the end of ‘22 where they said that there were over 8,000 medically underserved areas. And in those medically underserved areas, where there’s primary care shortage, we failed to deliver, even 50 percent of the care that was necessary. That impacted nearly 100 million Americans, so about 30 percent of our population. And in order to rightsize that, we would need somewhere over 16-17,000 new providers. We have no line of sight for that.

So where I am is we must rethink the resources that we have in our system. And we must rethink how we access and deliver care. In some way, and again, I’m going to come back to the piece that I mentioned earlier. I’m going to put my money, excuse sort of the pun here, on a financial model that incents providers, healthcare systems to want to work with retailers, which we don’t have right now, okay.

But if there was some sort of way that we could work together synergistically and create a we-do you-do type of mentality. Hey, we’ll do this. We’ll do this exceptionally well. We’ll be sure that we’re not siloed in the care that we’re providing and that we’re communicating. By the way, that was a reference to technology, which is not a technical problem, but a political one. And that will allow you to focus on other more complex actions for people who need to figure out how to gain better health.

So that’s the vision and that’s where we’re headed. But I have to say, it’s wonky, right? Like it’s not easy and new care paradigms require not only that people consider that they might do that, but it also considers that the establishment, which fights very hard to resist change, will accept that.

David Shifrin: I’m very interested in change management, how you communicate, how you bring people along for… not bring them along for the ride, right? Because they’re not riding, you don’t want them riding along. You want them active participants in the change.

And as you’re creating this new model and you’re pushing forward with your peers and your competitors and the folks within on your team, how do you talk about the work so that you’re getting everybody to understand their role and to drive that change? You just mentioned the traditional system which holds true anywhere, right?

There’s just, we get, we become sclerotic. It’s hard to change. It’s hard to turn the big ship, whatever. How do you talk about it?

Kevin Ban: Why, do people want to work with me and try to solve this problem? Is that the… might that be assumed?

David Shifrin: Sure. I mean, yeah, how do you get people excited to do this hard stuff?

Kevin Ban: Okay, now I love this question. And I’ll tell you that I’m going to start at a high level and kind of work my way down. I build horizontal relationships exclusively, okay. I do not build vertical relationships. In fact, my advice would be that you one ought never build vertical relationships. The moment you have hierarchy in your relationships where one person is more important than the other, it’s broken. I build horizontal relationships with people. I’ve done that throughout the entirety of my career.

Oftentimes, people are like, whoa, pause. What do you mean? The CEO of the company? You’re talking about something different. Now, my responsibilities are different than the responsibilities of the CEO but they are no less important.

I’m going to connect some dots here for you. When I was the CMO of a hospital I got together with a janitorial staff. We were getting into value-based care contracts and I wanted everyone to feel like they were a part of the success of the hospital. And I started to share infection rates with them. Now I could never prove that a cleaner room and bathroom correlated with better infection outcomes. Okay, I’m putting my hands – the Italians had this saying “I’m putting my hands out in front of me.” – But, what I did say to them is, I know that when you do a really good job, that you contribute to the well-being of our patients. And I think that put a little bit of pep in their step, quite honestly. Horizontal relationship. Yes, I’m the CMO of the hospital. Yes, you’re on the janitorial staff. But we need to work together. These problems are worth solving. And when I’m recruiting people I try to approach it from that perspective, which is, we are fellow journeymen here.

We are co-conspirators in trying to disrupt this system that isn’t delivering in the way that any of us want. And so, when you join me, we join together to work on something that’s worthy.

David Shifrin: That’s great. Last question, and it is an admittedly cliché question, but we’re here, we’re at Sessions, there’s so much energy, there’s a lot of great people here.

What are you excited about right now? What’s got you fired up?

Kevin Ban: I was about to say, I like change. It feels like change is imminent. We just can’t go down this path… we can’t, like this can’t go on. We’re already spending stupid amounts of money and somehow this blows up.

And so, it feels from crisis comes opportunity and there just might be tons of opportunity. Now that means change. My wife constantly reminds me that I actually don’t care for change that much or at least I like the change that I can control. But I do feel strongly like from crisis comes opportunity. So bring it.

David Shifrin: Kevin Ban. Thanks for your time. It was absolute pleasure. Really appreciate your insight on stage and now backstage.

Kevin Ban: Thank you.