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      How Walgreens is Reimagining Localized Healthcare

      Healthcare Rethink - Episode 9

      Did you know 75% of clinical trial participants are Caucasian? Did you also know about 20% of drugs affect people differently based on demographics like race, gender, and age? That's why diversity in clinical trials is so important. On this episode of Healthcare Rethink, host Brian Urban talks to Adam Samson and Falguni Shah of Walgreens about how they’re using their vast retail footprint to foster a more equitable future in clinical trials.

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      Brian Urban: [00:00:22]
      Here it is. This is the Health Care Rethink Podcast. I am your host, Brian Urban. And today we went big league with two big league guests. I'll really say that these are Walgreens celebrities. So today joining our podcast, we have Falguni Shah, director of Walgreens Health Corners and Clinical Services, and the incomparable Adam Sampson, head of clinical delivery operations. And today, we're going to be talking about community health and clinical trial diversity, how Walgreens US health care division is really reimagining localized health care for us all. And I'm so excited to have you both on our little show all going. Adam, welcome.

      Falguni Shah: [00:01:10]
      Thanks, Brian.

      Brian Urban: [00:01:11]
      So with our podcast, we like to get to know our guests through some fun Q&A, through some fun trivia. So I have a few questions lined up for you both here that we can go back and forth. Are you up for the challenge?

      Adam Samson: [00:01:26]
      Let's do it. All right. All right.

      Brian Urban: [00:01:29]
      So in preparation for our conversation, I really looked at what Walgreens has been doing pharmacology and public health and research across our health care ecosystem. So with that said, Adam, I'll give the first question to you. This one's a toughie. So we're going to we're going to test your your brain here. And by the way, Adam is a professor. He's an adjunct faculty, so he's shaping young minds. So you can use this question.

      Adam Samson: [00:01:57]

      Brian Urban: [00:01:57]
      With your students as well. So. All right. Question number one, the UK Medical Research Council, MRC, as they're known, did a trial of petulance for the Common Cold in 1943. It was the first double blind controlled trial. So this trial famously paved the way for the first randomized controlled trial of what, A, scurvy, B, streptomycin in pulmonary tuberculosis or C, chicken pox.

      Adam Samson: [00:02:32]
      Definitely be. The other two are way earlier.

      Brian Urban: [00:02:36]
      You are correct. Look at that. Good, good investigation. There it was streptomycin for pulmonary tuberculosis carried out in 1946 by the NRC. Good stuff. One for one. All right. For Guinea, you're up. Henry Cade served as Walgreens public relations leader back in the day, but more importantly, became the first black American pharmacist to serve as president and chairman of the National Association of Pharmacy. What year did he take that president and chairman role? Was it 1965, 1987 or 2005?

      Falguni Shah: [00:03:15]
      It's not 2005. I want to say. Be is it 1985.

      Brian Urban: [00:03:26]
      1987? You are two for two. Look at this. This is great. So, yes, he helped lead regulations down to the state level, which was which is amazing, sitting at that federal level, integrating industry regulations to protect public health. So maybe this was Walgreens first, deeper step into having integration and influence in public health affairs. So this is just great and you're your pharmacist by background. So of course, I had to hit you with that question for a couple more questions. True or false? Adam, a pharmacist invented Coca-Cola. True. It is true. Three for three. This is actually no, no one has done this well in any of our trivia so far. So it's true. 19 I'm sorry. 1886 Pharmacist John Pemberton created Coca Cola for treatment of common ailments. That is pretty interesting. So question number four, following back to you here, the practice of pharmacy was first separated from medicine way back in the year 1240, and this was largely as a result of a proclamation presented by who? A Frederick, the second of Hoffman's then be King Henry, the third of England, or C Alexander, the second king of Scotland. That's a tough one.

      Falguni Shah: [00:04:49]
      Oh, my God. That's a tough one. I don't know. I'm going to say see?

      Brian Urban: [00:04:56]
      Oh, this was tough. I was going to get that. It was. It was Frederick Hoffman. Yes, It was a use the emperor of Germany and king of Sicily. And it was amazing because after that proclamation, then the practice of medicine and pharmacology were separate and professional regulations globally, then spread across. So that's pretty pretty wild. So that kind of concludes the fun little trivia. Thanks for playing that game with me.

      Adam Samson: [00:05:26]
      I'm glad you got the last one.

      Brian Urban: [00:05:28]
      I've got a pretty good three, four, four. But more importantly, the separation of of pharmacy and primary care. Those lines are blurring. They're coming together. And I think Walgreens, it's so exciting, the work that you both do in the health corners, clinical services, quality and atom. With clinical trial diversity, you're bringing worlds together. You're unifying the health care ecosystem because all the needs that we have as humans spread across the entire ecosystem. So VillageMD what you're doing health corners, just open your 100th store location in California. It's just amazing work. Just expressing my, my, my fandom for Walgreens, but it kind of gets into our first topics here, but I want our audience to get to know you both a little bit better. So if you wouldn't mind spending a couple of moments here for again, just telling us a little bit about yourself and how you've got into your role leading the rollout of health corners across the US and a little bit about what health corners are. And then, Adam, the same for yourself, who you are in the work that you're leading, but following. Can we start with you?

      Falguni Shah: [00:06:42]
      Yeah, sure. So as you mentioned, Bryan, I am a pharmacist by training. I started my career with Walgreens eons ago, is what I say. So I am experienced behind the counter. Understand Retail pharmacy. I took a few years away from Walgreens to sort of carve out a niche career path in health care technology and hospital operations, but came back to Walgreens to lead a really large team focused on 340 B payer strategy. And then over time, as Walgreens evolved and we introduced this new division, Walgreens Health, which is the innovation arm of Walgreens. It took an interest I took an interest in this new division. It was an opportunity for me to bridge parts of my career together, being a pharmacist. So the clinician side of me, the the health care technology experience that I that I bring to the table, and then also pulling in the operations and the payer strategy work that I've done. And so on this side of the House, the innovation side, as we call it, we are branching into health care services, retail, health care services. You'll see CVS, Rite Aid, Walmart, all using parts of their footprint, their store to actually deliver localized health care.

      Falguni Shah: [00:08:21]
      It's creating new access points for the community, for members of health plans. And so it supports population health and improving overall health care. And so the Walgreens Health Corners are essentially that they're inside of our Walgreens stores then. And what we do is we contract with health plans. And we're also looking at working closely with hospitals to be able to deliver services to their members inside of our stores. So where we want to close gaps in care is ensuring that we support health risk assessments, BMI, blood pressure monitoring. Just being there as a consultative health care consultative arm to the member as well. Easy access, supporting their health care journey in an easily accessible way. You don't have to make an appointment. You can walk in, you can talk to our health advisor. So the Walgreens Health Corners are actually staffed by health advisors that are pharmacists or nurses. So that is in a nutshell what health corners are. They're an access point within the community. It's part of our vision that our CEO is set to set out, which is reimagining localized health care.

      Brian Urban: [00:09:47]
      That is amazing to hear. And actually the word that you use a moment ago, I want to hone in on for a moment health journeys. So I think so often in our our payer provider world, we talk about outcomes. How are we measuring these things? And it is about the human experience, the journey that we have from one outcome to another, one experience to another. And I love that the model is so approachable. You can go in, you don't have to have an appointment, you can talk to a health advisor 1 to 1. So I do want to dive into health corners and understand your experience and and the great impacts you've seen thus far. Opening your now 100th location in California that we mentioned a moment ago. But I'm going to pause there for a moment and let's get to know Adam's world a little bit and then we'll get right back into health corners. So Adam, fill us in a little bit more. How did you get to your amazing role? Not not only inside Walgreens, but also in academia as well as your strong influence there. But fill us then tell us who you are a little bit more and some of the great work that you're leading in clinical trial diversity.

      Adam Samson: [00:10:58]
      Yeah. Yeah, I'd be glad to. Thanks, Brian. So I started my career as a clinician out of undergrad and very quickly kind of found my way into clinical trials as a kind of a career path, which oftentimes people fall into right through some other allied health care profession. So I work directly with patients in the conduct of clinical trials for a few years. And then about ten years ago, I moved into more of the business side supporting what's called the contract research organizations, which basically help pharmaceutical companies and other type of medical therapeutic development companies bring their new therapies to market by doing clinical trials. So I worked in a few different capacities. Some have been traveling across the country to visit different clinical trial sites for compliance reasons. Some were more centralized and project management. And then I, about five or so seven or so years ago moved my network for Duke University for a few years, worked on a master's in clinical research while I was there, and focused primarily on pediatric clinical trials that were government funded. After a few years at Duke, I took a position with a pharmaceutical company, a large pharma company, that and ran for them large late phase global trials. So this is big studies that we would do in multiple regions across the globe and was there when we when the pandemic hit. And like so many others in the health care space in clinical trials, we were really confronted with this reality that we weren't prepared from from an infrastructure or technology standpoint to keep our clinical trials going. So I took an opportunity with a very small startup that was working to bring trials into patients homes through technology, and I spent almost the bulk of the pandemic about two years helping to build out a services team.

      Adam Samson: [00:13:01]
      here really great work. I had no intention of leaving. But then I learned about this new clinical trials business that Walgreens was aiming to build. And when I talked to my current boss for me to Tanden, I just I was sold, I was in. It's really exciting. After trying to do trials in a traditional way where patients have to go to a large academic medical center every time. And it's very burdensome doing trials in this newer way with technology and patients homes. Neither is perfect, right? Optionality is something that and flexibility is something that we really need in clinical trials. And what's more flexible than having 78% of the US population within five miles of a clinical trial site? Right. Which I'm stating a figure for Walgreens there we have 9000 stores as well as some owned assets such as Falcone was talking about and some partner's assets that really position us well to make an impact in the clinical trial space. So our business was launched just about five months ago. I joined a bit after that and I've been here building out the team as head of clinical delivery operations. My role is to really look at our existing footprint and try and find ways to start bringing these clinical trials into communities and offer them offer them to patients oftentimes that wouldn't have access to these type of trials. And I was fortunate enough when I joined to learn about the great work that Falguni and her team with the health counters are doing. And it's just a great partnership for us to. Be able to utilize that health space for both the work, the payer support supported work they're doing as well as clinical trials.

      Brian Urban: [00:14:56]
      Thank you, Adam, for sharing your journey through your different experiences in the research space and what you're doing now and the partnership that you've struck on the health side and the shop that Falcone is leading. So this is wonderful to hear. And you mentioned, Ramita, amazing leader, great charisma. Very similar, I think, in a lot of ways to Alethea Jackson leading DNI work and then also Roz Brewer, too, at the very top. It seems like you have just these very intelligent, very charismatic, relatable leaders. So that's got to have an amazing influence, I think, across your body of work as well. So you made a really good point there in terms of the partnership that you have with Health Corners. So following I got to the back to you here. So tell me a little bit about how your partnership internally is impacting what you're doing in health, commerce or maybe some early successes you're seeing in health corners? We'd love to learn a little bit more there.

      Falguni Shah: [00:16:00]
      Yes, of course. So this is a very timely conversation. We're actually launching our first clinical trials in our health corners at the end of January. And thanks to Adam and his team for supporting some new services and innovation in our health corner. So we're going to start introducing phlebotomy services in our health corners. And that is the business case was actually brought to us by Adam. And so it's a start to be able to support the clinical trials with phlebotomy, but the intention is to support phlebotomy for our payer partners as as well as our provider partners. And in the future, we want to be able to open up phlebotomy services to our customers that are not part of a contracted service. So you can come in to Walgreens, use that as a as a a channel to get your lab services done. Again, making it easy, making it convenient, no appointment necessary. But through Adam and his team, we continue to evolve the health corner, making it new services available, making it innovative. And we have a few other things that we're hammering out between Adam and I to help support not only the clinical trials business, it's innovation on the health corner side.

      Brian Urban: [00:17:34]
      That is so exciting. And thank you for sharing that on our little show because I had no insight into that so early. Congratulations to you both on this partnership and the amazing work that will come from it as well. So really, if all going to you made me think of something to throw. Throw back to Adam here on the clinical trial and the research side of things. So, as you know, being a historian, academia and research research prowess that you have clinical trials, human subjects, it's it's been it's been a bad road, at least in the US from the 1900s onward. Thankfully, establishments of institutional review boards have been put in place for safety of subjects. And just all this better work has finally come out of it. But we've come to this kind of arc really, that we need to expand the populations that are coming into these clinical trials to ensure that we're including diverse ethnic race and gender. So with that, just starting at the very top, Adam, what is Walgreens approach to clinical trials and how do you ensure diversity? Can you walk me through that a little bit?

      Adam Samson: [00:18:51]
      Absolutely, yeah. So at a high level, our approach to clinical trials, we're offering three services out of the gate. One of them is to obviously Walgreens has covers about 160 million lives. We really know our consumers well. We want to be very thoughtful with how we engage with them and how we present them potential clinical trial opportunities, being being mindful of the fact that Walgreens for the past 100 years plus has been building this trust. And we want to we want to carry that forward 100%. So we have ways to look at records and determine if people might qualify for a particular study and then reach out to them as Walgreens representatives, either through our pharmacists or other means to to help share with them the potential for participating in a particular clinical trial. We can also do really cool things or data science that go far over my head that help us to really look at those type of data even in a de-identified way, and start to better understand target patient populations for new drugs that are coming out. And help us analyze the results of clinical trials. The kind of third service line, which is where I sit, is really we're calling it trials to patients, right? So how do we how do we know where the rubber hits the road, like interacting with patients in store at home through this omnichannel approach? And in doing that, we are setting for ourselves some very.

      Adam Samson: [00:20:26]
      Ambitious metrics around what we want to meet for diversity targets, as you mentioned. Right. So historically, even though the practice and even the view of clinical trials, I think overall has improved over time and there's been some help, some aid by the pandemic to to show that clinical trial participants are medical heroes. Right. And also that clinical trials can be they can be a care option sometimes for for patients who don't have other options for treatment or who really could use that type of in-depth follow up that you get as part of a clinical trial. So the ability to take that and partner with the Health Corners team and find those locations where these these patient populations would otherwise not likely have access to these trials. So the average clinical trial or the average person lives about 2 hours from the closest clinical trial site historically. So if we can take and we can hone in on that right. And let's say a pharmaceutical company comes to us and they say we're going to run this this clinical trial to determine if this this drug is safe and efficacious. And we know that overall for this therapeutic area, X number X percentage of these participants are white, African American, Asian, other. We should be meeting those metrics when we're studying, Right. We want to collect data that's representative of the population when that drug hits the market. And right now we're not doing that as an industry.

      Adam Samson: [00:22:09]
      So data released by the FDA shows that about 75% of research participants are white. And we know that about 20% of drugs actually have a significant difference when you start looking at different aspects of demographics, right, be it race, age, gender, other things. So we need to be much more thoughtful. And FDA is really started to increase their vigilance. There's new guidance and even some policy that's looking to be implemented that says, you know, pharma company, you need a diversity plan. And I think that's where Walgreens is really uniquely positioned, given our vast footprint, to be able to say, okay, we need this proportion of the population. This is where those patients are and let's go ahead and implement this clinical trial within those regions where we know there's a high population of these different groups. And we can also do things more grassroots, right? So. Patients coming in, seeing their pharmacist. You guys know they see their pharmacist far more than they see their PCP. They have that trusted relationship. So it's another opportunity not to convince people to participate in a clinical trial. That's not our aim, but our aim is to educate about clinical trials in general. That way, when an opportunity presents itself. Hopefully folks in these communities would be interested in participating and help us to to really get to where we need to be in terms of diversity and trials.

      Brian Urban: [00:23:46]
      Those are really insightful walk through. Thank you, Adam, because you highlighted the really the process in which you educate, build trust, and then you build opportunities for more diverse populations to go through clinical trials and medical heroes. Indeed, because they're helping provide evidence that can be carried forward into precision medicine, into ensuring that there's broader access to certain medications by race, ethnicity. So that's an extremely powerful and rich work. And you're just getting started being able to leverage all your assets across Walgreens and externally as well. And you mentioned something out of that. The pandemic was highlighting certain things for you all and even spurred your operations here in Walgreens. So with the social and health really economic tragedies that we saw being highlighted from the COVID 19 pandemic that we're still not out of, but we're coming through, there is definitely a shift for a lot of health care organizations, small or large, in how they saw their patients needs. And you mentioned pharmacists have a far more, I say, high touch with patients than maybe a primary care or other specialists as well in most cases. So it seems like the focus on the patient has been now going outside the doctor's office, recognizing that health truly happens at home. So with that, said Falcone, this this one's probably for you, but really for both of you, how is Walgreens Health really starting to approach strategic partnerships where there's community based data platforms, grassroot initiatives? What's that approach like? And maybe what what successes are you starting to see there in terms of your your strategic partnerships?

      Falguni Shah: [00:25:50]
      Maybe I can start, Adam, and then you can jump in. I think the first thing I want to say. My husband is a primary care physician. There is so much value in having a primary care physician, and we're not here to replace primary care. We are here to support the primary care and be a partner with the primary care physician. So with that said, what Adam really said, that the pharmacist are probably more accessible than your primary care physician. I think it's because of the footprint that we have. Right. And pharmacists are in your community. We saw during COVID that pharmacists were first line of defense in terms of the vaccinations, in terms of testing easy and accessible mechanisms for patients and customers to come to our stores to get the services that they need. And what we've learned from the pandemic and the work that we've done with COVID 19 is that pharmacists should be practicing at the top of their license to continue to help keep the population healthy, to continue to help support our primary care physicians. And so some of the things that Walgreens Health and Walgreens is expanding into are some of those additional services around test and treat, for example, where patients and customers could come into our stores and get tested for flu, get tested for strep, and then allowing our pharmacists to either collaborate with the primary care physician or allow them to practice at the top of their license in certain states and prescribe based on certain protocols that helps reduce emergency room visits, urgent care visits. It reduces the cost of health care actually helping to keep patients healthy. What we're doing within the health corners is supporting a lot of the work that Walgreens also is doing around test and treat vaccinations. And as I mentioned, we're partnering with our payers and our providers to close certain gaps in care where we're monitoring blood pressure. We're helping to monitor their their blood glucose and providing that additional support that the members need and the patients need outside of their primary care visits.

      Adam Samson: [00:28:29]
      Yeah, I mean, just building off what Falguni is saying there, right? I mean, I think that I mean, I know clinical research, but I don't know pharmacy. This is a new space for me, so I learn a ton from working with Falguni and others here on our retail and pharmacy ops teams coming in to Walgreens. I mean, I was blown away at, you know, what is it now? We're up to like 60 million COVID vaccines that we've administered. And the fact that this infrastructure was just stood up basically overnight and we were learning these things in real time. I'm in awe of the capabilities. And so as we look at. Freeing up, as you mentioned. Right. Some of the pharmacist time so that they can practice at the top of their license. Now, this is another area where we're looking to partner strategic partnerships both within Walgreens and perhaps outside of Walgreens. When it comes to, as you mentioned, Brian, you know, there's work that we can do at the community level, whether that's with faith based organizations or others, to spread the kind of understanding of better health and clinical trials within these communities and be a hub for some of those things as part of Walgreens and as some of these initiatives take place, like Walgreens has the micro fulfillment centers that will help to take some of that workload off the pharmacies. That will be potentially another way that we can use those interactions that pharmacists and pharmacy techs and others in our Walgreens ecosystem are already having these interactions with them and be able to include in that just general information about health, but also about clinical trials to help to bridge some of those gaps as well.

      Brian Urban: [00:30:20]
      I love how you both captured what I was hoping to hear from that question right there. So really, you touched on a couple of interesting things there. One thing I did want to highlight in your mention of the 60 million vaccines. So for our listeners, the vaccine equity campaign that started early pandemic and all the way through that has delivered tens of millions, 60 million. The number I saw a year and a half ago was 30 million. So it's amazing how you you grew over that. I think Dr. Van was was leading a lot of the efforts there. And of course, across all the different stores in your footprint. So that's amazing. If you haven't heard about that, I suggest you look up a few great articles that are out there in relation to the work that's been done. And truly, it seems like the culmination of both of your work areas is coming into fruition at physical stores. But also, Adam, you mentioned earlier how you're engaging with patients that can't get to stores. So in home you mentioned a little bit about in-home services and how you're helping patients that might have barriers with transportation. And you mentioned you're working with health plans to provide resources to members that that might need transportation and support there. So I want to touch on this a little bit and then and start to take us into the into the future as we're coming up on time here. So, Adam, can you help me understand a little bit more about how members are engaged that maybe can't get to stores, whether it's at home or if it's through community based partners? How is that approach starting to take place or or maybe how are you starting to think about that design if it hasn't already been in place yet?

      Adam Samson: [00:32:06]
      Yeah, yeah. So we definitely have some in place and some that we're building, but lots of potential to leverage existing assets to really make that happen as far as have a really good omnichannel approach and be able to have folks not just in-store but at home and elsewhere from both clinical care and also from a clinical trials perspective. So we have our Mywalgreens app, which is one way that we can engage with our consumers from their home. There are a number of clinical trial activities that now through technology we used to have to have clinical trial participants come all the way into the academic medical center to fill out a simple questionnaire and get a blood draw. Now what we can do is we can have that questionnaire be on their their smartphone or provision them with a with a device so that they can complete those in real time and we can have access to that. And we can also do things through mobile, phlebotomy and other services, which I think over time we will partner with Health corners and others as well as we we've Walgreens has accelerated, I believe, our full acquisition of Care Centrix, which is post-acute and home health care provider with just a phenomenal track record of great patient care and patient satisfaction. So over time, being able to leverage those type of assets that we'll have here at Walgreens for bringing clinical trials into patients homes is something we're very interested in.

      Brian Urban: [00:33:37]
      That's a great point. Through the various strategic acquisitions partnerships, you're having even more of a deep omni channel approach. And you mentioned your husband being primary care. Awesome shout out. We'll have to follow up eventually on the VillageMD side of the strategy with Walgreens as well, because that that culmination and partnership of pharmacists and primary care is so crucial to providing the needs of all the patients and lives you serve. So we'll we'll definitely get into that in the future. But I want to take a. And here maybe look into the crystal ball kind of a couple of years out here as Adam, you're building up your clinical trial diversity operations focusing. You have maybe now two or 300 Health Corps locations. So kind of a hook shot question for you both. And we can start with you. What do you hope or what do you think will be the biggest impact that health corners and partnership with atoms clinical Trial Diversity Services will have in the communities you serve? What what what can I pull out here of your heart and your vision with this?

      Falguni Shah: [00:34:52]
      I think I'd have to take it back to our tagline of reimagining localized health care. You know, we learn through the pandemic that there is this health inequity, and I hope that through the health corners and an omnichannel approach, that we can really increase access to health care for all, especially in the very rural areas, for populations that are both socially and economically challenged. So my hope is that our health corners are going to support population health, help support access to health care, and not only through a physical location, but we are an omni it's an omni channel approach to improving health care.

      Brian Urban: [00:35:46]
      Awesome. I'm excited for the vision. Adam, same question for you. What do you think? What's the hope shot? What's the vision, the good impact you can feel coming from this a few years down the road?

      Adam Samson: [00:35:59]
      Absolutely. And I think the exciting times ahead, right? We're only four or five months into our clinical trial business, but already are able to see quite a clear vision of what that might look like. I'd love to see us within the next few years really execute now. Right now. Now we have all the assets that we need. We have all the talent that we need now. We just have to pull that together, execute, and really show that we can deliver these trials in a way that is of high quality and a great patient experience and start providing clinical research as a care option kind of across the country and have multiple case studies that we can bring to you in a few years and say, Look, this is how we were able to deliver on our mission. So yeah, look forward to circling back.

      Brian Urban: [00:36:49]
      Awesome. I love to hear that. I feel the the energy and the passion and both of your voices can see it in your eyes for sure. I'm going to follow this as you get into the execution phase. I'm a big fan of the work that you're both doing. Thank you both so much. Organi shah for joining the conversation. Adam Sampson for joining the conversation. It's been a pleasure chatting with you both. And for more excerpts and insights from our show, please visit finthrive.com.

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