Tuning Healthcare, Episode 12: The Evolving Healthcare Consumer

Brad Fluegel, Principal, BMF Advisors

This episode of Tuning Healthcare features Bradley Fluegel, Principal at BMF Advisors and an executive healthcare advisor to numerous healthcare organizations. He formerly served senior leadership roles at Walgreens, Anthem, Aetna and has led various consulting roles for healthcare organizations. Brad shares key insights from his payer and healthcare retail experience, and where he expects the industry to move in the future.

“It was just fascinating to me to be in a retail environment. I remember we always had these Monday morning meetings, because it was a lot of… As they say, retail is detail, right? Everything matters. It was early on, and we were talking about Halloween candy at that meeting, in terms of talking about bag sizes and pre-Halloween pricing and post-Halloween pricing, and where to put them in stores. I didn’t have anything obviously to contribute to that conversation, but I found it fascinating, because it’s all the stuff we never really talk about in healthcare. We like to tell people what to do. We like to say, “Take this drug,” or, “Get this test,” or, “Don’t eat that food.” In a retail environment, it’s about influencing people to do things. Get them to buy more stuff or get them to go to your store versus somebody else’s store. It just hit me right away right out of the get-go that this is a different environment and that I’ve made the right choice to learn about that when I made that move.”
– Brad Fluegel, Principal, BMF Advisors and former executive at Walgreens, Anthem, Aetna, Reden & Anders 

In this episode, Brad and Lumeris Senior Vice President Nigel Ohrenstein discuss:

• The role of the payer in healthcare today and during the pandemic
• The evolution of the healthcare retail/consumer model, and how it influences access to care, particularly in underserved communities
• The importance of independent primary care models and how they may evolve in the future
• The need for effective care coordination
• The multi-modality of the physician patient experience and where care is delivered across the continuum

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• Read Transcript Below:

  Nigel Ohrenstein: I’m joined today by Brad Fluegel. Brad currently advises a broad range of healthcare organizations. He was most recently the Senior Vice President and Chief Healthcare Commercial Market Development Officer for Walgreens. Prior to that, he held senior roles at Anthem, Aetna, and was the CEO of Reden & Anders. In this episode of Tuning Healthcare, Brad and I discuss the role of the payer, the evolution of the retail model, and how it helps access to care, particularly in underserved communities, the importance of independent primary care, and how primary care evolves over the next decade, and the multi-modality of the physician patient experience, whether that be retail clinic, home health or in part of the health system. Join Brad and me as we tune healthcare. 

  Nigel Ohrenstein: Brad, thanks for joining me today. Appreciate you taking the time to chat with us. You’ve had a number of large roles in your career from Reden & Anders to Anthem, Aetna, Walgreens. What was the most fun? 

  Brad Fluegel: Wow. Well first off, thanks for having me. It’s a pleasure to be with you here today. I would say that the role that I had that was the most fun was when I was a consultant for about 10 years, most of that time with a firm called Tilling House, which is part of what’s now Willis Towers Watson, which we ultimately sold to a firm called Reden & Anders, which is part of what’s now Optum. I just really enjoyed being a consultant, being out meeting with lots of different people, people trying to solve lots of different problems, doing some intellectual analytical work, and just really enjoyed the freedom and flexibility that that provided and the diversity that that provided. That was probably the most fun, if anything about work is actually fun. 

  Nigel Ohrenstein: Yeah. It should be. It should be fun, right? We spend a lot of time doing it, or at least what we’re trying to achieve should be meaningful. Maybe that’s a better way of putting it. 

  Brad Fluegel: Right. 

  Nigel Ohrenstein: Does that align with the role that you feel like you learned the most of your senior roles? Obviously early in careers you learn a lot from people, what to do, what not to do often, right? I feel like in my early stages of my career, I learned more sometimes, “Oh, I don’t want to be like you,” when I manage people, like more than I sometimes learn how I want to replicate you. But does the one you had the most fun in align to the one where you learned the most? 

  Brad Fluegel: That’s interesting you say that early in your career, I learned a ton when I started outside of college about now defunct firm of Arthur Anderson where I was the accountant CPA. Sort of quickly learned that being a smart 21, 22-year-old doesn’t mean anything. Actually, you really don’t know anything about how the world works and that sort of… Even before that, I worked construction when I was in college. I was a laborer. If there’s anything that teaches you to try to pay attention in school and do well, it’s spending some time out in the hot sun being a day laborer. I learned a lot from that. 

  Brad Fluegel: Probably the job that I learned the most from though later in my career was when I was the head of strategy at Aetna, and I worked very closely with Ron Williams, who became the CEO while I was there. He was the president and then became CEO. Though it was very difficult job and very demanding job, I just learned a ton from him about process and organization and how to get stuff done. So it was probably the hardest job I had, but the one that I learned the most from. 

  Nigel Ohrenstein: No disrespect to any of your former employers, but if you can get things done in a payer, you can probably get things done anywhere in the country. Is that probably fair? Is that unfair? 

  Brad Fluegel: It’s very fair. We talk about getting things done in months as opposed to years like most payers probably, some of the progress. But yeah, no, it is a difficult environment, and I think there’s so many things coming at payers. There’s a lot of innovators that come in and want to get their product and services offered. Just so much fatigue within payers from some of those innovators, because there’s so much opportunity and so many things that they need to worry about, and also the decision making process within payers is such that nobody can say yes, but a lot of people can say no. So it just makes it a lot more difficult sometimes. 

  Nigel Ohrenstein: Yeah. I’ve always joked that payers never miss an opportunity to miss an opportunity, which is sort of from our lens of trying to drive better outcomes, managing populations, sort of the Lumeris angle of how we look at the world. We wish payers would collaborate more, drive more, more partnerships with the provider community to drive outcomes. But while we’re on the topic of payers, given your experience, you’ve held very senior roles at Anthem and at Aetna. What happens to the payer? How do the payers evolve, right? I think it’s a fascinating, just that micro piece of the healthcare landscape is fascinating, because you have United, who obviously years ago invested in Optum, right? They’ve obviously now evolved to becoming the largest private employer of physicians in the country. So almost like insurance, they saw it becoming commoditized, maybe even a decade ago and have moved away. Your previous companies like Aetna has sort of took a shot at the value-based care world. Didn’t turn out so well, and now it’s gone a completely different track all together. 

  Nigel Ohrenstein: Anthem has sort of was maybe slow to the party, but now is sort of doubling down on sort of a digital strategy. So that whole micro element of the overall healthcare landscape of payers is fascinating. How do you see it? 

  Brad Fluegel: Well, I think that people have been talking about the demise of health plans for a long time, but at the end of the day, they provide a function that’s important, which is to try to stitch together some cohesion within a very complicated, disjointed healthcare system that we operate in. So they sit at the center of that, and all the money kind of flows through them, whether they’re providing the insurance themselves or operating on behalf of governments or self-funded employers. So all the money comes in, and then almost all the money goes out to providers and various other kinds of medical device manufacturers, drug companies, and all of that. So they sit sort of at the center of the system. That’s why people are very eager to try to develop business relationships and other things with them, because that’s where the money sits. 

  Brad Fluegel: But that’s a business that at its core is sort of a commodity, particularly among some of the bigger payers. They’re still good, profitable, decent businesses, but I think a number of them have thought about how they extend their footprint into other kinds of services and technologies. So there’s been this big push, as you point out, into various types of vertical integration, as you pointed out at starting at Optum. I was part of what’s now Optum legacy organization that used to be Ingenix when it was much more technology focused. Now it’s, as you said, everything, right? Technology, PBM services, physician groups, ambulatory surgery centers. It’s everything. 

  Brad Fluegel: I think a lot of people in the industry, payers have looked at that and said, “Hey, let’s create…” The number of payers that you talk to that say, whether it’s Anthem’s DBG group, the Diversified Business Group, it doesn’t take long for each of them to say, “Yeah, we’re trying to build a little Optum” to try to expand their footprint. But Optum’s been doing that since at least 20 years, maybe a little bit longer than that, and they bought hundreds of companies, most of which they don’t even talk about. So it’s not an easy thing to replicate for others. But again, to your point, I think they are trying to expand their footprint. 

  Brad Fluegel: I think the one that’s most interesting and that other payers are trying to pursue in different kinds of ways is this integration with the physician community, whether that’s through relationships with companies like VillageMD or One Medical or outright purchasing or physicians. I think that is one that pretty much every payer is thinking about. 

  Nigel Ohrenstein: Right. It’s a fascinating landscape. 

  Brad Fluegel: Which is good for you guys, right? 

  Nigel Ohrenstein: Yeah. Yeah. It is good for us. Obviously the more that payers want to partner with the provider community to drive superior outcomes, that ultimately is obviously good for us, but I think also good for healthcare in America. The closer that healthcare, in my opinion, gets to the point of care, the better. I think that I agree with you. Payers provide some very good functions and support. There’s also some things that I think are better serviced through the provider community than through the payer. There probably isn’t anybody in the country who gets sick and thinks, “Oh, I must call Blue Cross Blue Shield of X,” right? They think, “I must go to Dr. Brad,” right? So I think that evolution, as you say, is good for us, more importantly good for the community. So that’s great. 

  Brad Fluegel: I think that’s right. I think one of the things that… And I think to your point, getting stuff closer to the delivery of care makes a lot of sense. I think if you look at all the different things that traditional health plans, insurance companies do, enrollment, paying claims, providing services, providing, in many instances, the insurance itself. All of those things are traditional insurance functions that whether you’re a life insurance company or a property and casualty insurance company, they all do that. 

  Brad Fluegel: What’s a little bit different about healthcare and health insurance is that they then bleed into the actual delivery of that service, right? It’s like Allstate owning autobody shops or things of that sort. So they better bleed into that, in terms of life insurance companies trying to keep people alive longer or whatever it might be. I think part of the problem that health plans have stepped into is that as good as most doctors and health systems are, they don’t do everything that’s necessary to provide good, quality healthcare to individual patients. 

  Brad Fluegel: So if doctors were better at care coordination and appropriate referral patterns and prescribing the right drugs and all sorts of other things, if they had the tools and technologies and support and the money to do all that stuff, there’d be no need for the payers to step in and do step therapies or all the other kinds of prior auths and other kinds of things that payers do. So I 100% agree with you, to the extent we can find ways to empower frontline caregivers and physicians to provide the right care, to provide the right support. Health plans could probably be perhaps much less intrusive. 

  Nigel Ohrenstein: Yeah. No, I think that’s right. Obviously we’re on a mission to try and do that, and enable providers to manage those populations. I’d love to talk a little bit about Walgreens and your experience there. But what I’d love to start with is the transition, right? So when you went from Anthem to Walgreens, Walgreens, correct me here if I’m wrong, was really just seen as a local pharmacy/convenience store, and not how we see them today, right? Walgreens today is, and CVS and now Walmart are seen as almost like healthcare companies, particularly Walgreens and CVS. So I’m really fascinated by what was the motivation and desire to make that switch? Was it really your vision here that you saw how Walgreens would evolve that you sort of went to execute on? Obviously you’ve really executed on a lot of great shifts at Walgreens over the time you were there. So start with the motivation to move and take us through that journey. 

  Brad Fluegel: Yeah. Happy to. As I said, I’d spent almost my entire life either consulting to or working in health plans. That’s what I did from the time I got out of graduate school until leaving Anthem. I took a little bit of time to decompress. Worked as an EIR at a private equity firm in the Bay Area to get exposed to that community and what’s happening out there, and just seeing the world from a little bit of a different lens. 

  Brad Fluegel: When I started thinking about going back and getting a full-time job again, the thought of going back into health plan I couldn’t stomach. It was just I felt I had done that. I’d done everything I wanted to do in that environment. I just couldn’t imagine doing that again. At that time, this is 2012, so we’ve been at this a long time, right? Everybody’s talking about the healthcare’s going retail, and consumerism is the big deal. Obviously we’re still talking about that. 

  Brad Fluegel: But I thought what better place to learn about that than a retailer? Particularly a retailer like Walgreens that, at that time and still to this day was very interested in changing the pharmacy model from being not just a convenience store to pick up potato chips and cigarettes and things of that sort, and then pick up your scripts, but to be kind of a more complete neighborhood health destination. So that was the vision of the CEO at the time, and that’s a lot of what I came there to lead. 

  Brad Fluegel: It was just fascinating to me to be in a retail environment. I remember we always had these Monday morning meetings, because it was a lot of… As they say, retail is detail, right? Everything matters. It was early on, and we were talking about Halloween candy at that meeting, in terms of talking about bag sizes and pre-Halloween pricing and post-Halloween pricing, and where to put them in stores. I didn’t have anything obviously to contribute to that conversation, but I found it fascinating, because it’s all the stuff we never really talk about in healthcare. We like to tell people what to do. We like to say, “Take this drug,” or, “Get this test,” or, “Don’t eat that food.” In a retail environment, it’s about influencing people to do things. Get them to buy more stuff or get them to go to your store versus somebody else’s store. It just hit me right away right out of the get-go that this is a different environment and that I’ve made the right choice to learn about that when I made that move. So that was great. It was a great six years there. 

  Nigel Ohrenstein: So how do you see the role of the Walgreens, CVS, Walmart now as well evolving? Where do you see them playing over the next if you were there or even from your position now as an advisor to multiple companies, how do you see the retail model evolving over the next decade? 

  Brad Fluegel: I think each of them, whether it’s Walgreens or Walmart or CVS and Rite-Aid, to a lesser extent, they’re all trying to do the same thing, but just in different ways, some through Walmart building out their Walmart health centers with the doctors and lab services and all sorts of other things, CVS with their Health Hubs as well as a broader footprint in other kinds of healthcare businesses, and Walgreens through a variety of partnerships with companies like VillageMD for primary care and the like. So they’re all trying to get in that space. I think the rationale there is that these retail establishments are where people go. Pharmacies in particular, people go to a lot. 

  Brad Fluegel: There’s been a lot of talk about Amazon or other kinds of mail delivery, but people, for whatever set of reasons, even now prefer to go walk in and pick up their drugs, and whether they talk to a pharmacist or a pharm tech or not, they just like the safety and comfort of that environment. So mail order has been stuck at 10% forever. It’s just not something that people use as frequently. Maybe that will change over time and the like, but people still come into their store to pick up their drugs and other things. 

  Brad Fluegel: The rationale is that they have a brand permission, I think, and an opportunity to provide a broader set of services to those customers coming in to pick up drugs and other kinds of convenience items. They’re geographically proximate, so it just makes a ton of sense to try to create these neighborhood health destinations. I think the other rationale is if you look at the core businesses of these entities, they’re under a lot of duress. Maybe less so at Walmart, but certainly at CVS and Walgreens. The convenience store aspects of them with generally a bit higher prices than you could get at other places has put a lot of pressure on the retail business. So they have to deal with that issue, and all the retail space that they have, they have to figure out what to do with. I think to some extent, filling that space with health services makes a ton of sense. 

  Nigel Ohrenstein: So how do you see… So I agree with you, it makes a ton of sense. As you say, they’ve got a footprint like nobody else’s when it comes to retail. So how do you see the model of what I see as the big three call them, right? Walgreens, CVS, and Walmart. I agree the Rite-Aid to a smaller extent, but those three ae really pushing hard into the healthcare space, versus you mentioned One Medical. There’s obviously a massive growth in the urgent cares and the different types of clinics that have evolved. Do you see the big three owning that space, or do you think there’s a place still for different types of urgent care and other types of clinics? If so, how do you see that evolving? 

  Brad Fluegel: Well, I think there’s obviously a huge push, which I think makes a ton of sense, and back to your prior point about organizing, particularly the primary care community. I think there’s also a desire from some people in the industry to make sure that that primary care community is not owned by hospitals, that there is some role and future for independent primary care, whether they’re part of bigger physician groups or not. 

  Brad Fluegel: I think that they are the frontline point of care for a lot of the health improvement opportunities that exist for those with chronic conditions and the like. So I really am very bullish, if you will, on the organization of primary care, because I think that having onesie, twosie docs without the kind of technology and other supports just doesn’t provide. As we were talking before, it doesn’t provide the kind of ecosystem that can take care of patients very well. 

  Brad Fluegel: So I think they’ll continue to organize, and whether it’s Village or VillageMD or One Medical or Iora or ChenMed, or whoever else is out there. I think those will continue to exist, and I think that the retailers, the big three retailers that you mentioned will participate in primary care in some way, but I still think there’ll be opportunities for investments in some of these other freestanding companies to also operate. 

  Brad Fluegel: Walgreens, as you know, announced a pretty big partnership with VillageMD to put VillageMD clinics in their stores or adjacent to their stores and bring the primary care doc and the pharmacy together as a care team. So that makes great sense. CVS is doing that in a different way through advanced practitioners, but not really with primary care. Walmart is doing it with their own primary care folks. So I think there’s different ways of doing it, but they’ll still be, I think, they’re not going to take over the world. There’ll still be plenty of other docs running around. 

  Nigel Ohrenstein: Yeah. At least from my perspective, I’m not worried about them taking over the world. I think in many ways, the evolution is ultimately a good thing, right? Because one of the greatest challenges is access for people, particularly in certain zip codes, right? To get healthcare outside of the emergency room. What’s great about Walgreens and CVS and Walmart is that they’re not just where… Not like a Whole Foods or Nordstrom or they’re in wealthy zip codes. They’re in a massive cross-section of zip codes around the country. 

  Nigel Ohrenstein: So as you think about it, we’ve got a massive problem, right? I think about it just in terms of I live in the Bronx, right? I happen to live in a nice suburb of the Bronx, but the Bronx overall. You’re more likely to die five years earlier than if you live in Manhattan a mile away. That shouldn’t be. So what I think is amazing about the Walgreens, CVS, Walmart getting into delivery of primary care is the access. There’s so many more things you can do with it, but just that piece alone should be a great step forward for how healthcare evolves in this country. 

  Brad Fluegel: Yeah. No, I think that’s exactly right. I don’t remember the exact stats, but CVS and Walgreens always talk about being 90% of people live within three miles or five miles and whatnot. So they’re very proximate, and they’re everywhere. As you said, they’re not just in certain communities. Some underserved communities, a pharmacist is really a primary care provider where people come and talk to the pharmacist about whatever ailments they might have, because they have less access to physicians. So I think you’re right. I think there’s a way to provide broader healthcare in communities that are underserved that will be helpful. Walmart’s taking a slightly different approach, because they’re more focused on rural communities than urban communities like Walgreens and CVS are, but I think that’s another area that’s very underserved and in need of additional support. So I think it’s a good thing. 

  Brad Fluegel: I think the other thing that they could have an opportunity to make progress against is the other issues that impact health within certain communities around decent food and access to community rooms and things of that source to deal with loneliness and other kinds of issues. So I think as the nation continues to work on some of these social determinant issues, I think these retailers that sell food, that have space can hopefully help make some progress against those issues as well. 

  Nigel Ohrenstein: Yeah. I think it’s fascinating. An area that we at Lumeris spend enormous time thinking about is primary care, right? It’s one of the sad parts about US healthcare and anybody who’s ever had a family member in hospital knows is that there really hasn’t been a coordinator of care. [It] really falls on some family member to play that role, which is mind-boggling when you think about the sophistication of some parts of the US healthcare system. 

  Nigel Ohrenstein: So what I think is really interesting as we think about the evolution of primary care is first of all that role, as you said, of some elements of the retail space, but also some elements of what I will, for want of a better word, call self-service primary care, right? This evolution of digital in the primary care. I think a lot of people think about telehealth, and they think of it as the ability to be online and have a face to face consultation with your physician. I think that’s highly rudimentary. That’s really just the mechanism, if you like, by which we could interact the same way we’re interacting now through an online platform, right? That, to me, is just the mechanism. I think how it evolves, particularly as you think about AI, especially in terms of health, you mentioned them before. 

  Nigel Ohrenstein: So what do you think, as you think about primary care, what role do you think there is for self-service for the companies that are investing in some elements of the digital experience? Juxtaposed to what you said before about how people still like to go to the pharmacy and get their prescription, is there a role? Would it evolve? If you’d ask my grandmother would she have gone to self-service checkout in a supermarket, she probably would have said, “Never, I like to chat to the young person checking me out. It’s an opportunity to interact. Never would do that. Why should I do the job that is somebody else’s job?” There would probably be a list of reasons. Then I’m like, “How can I go to self-service?” Right? If I’m even in a supermarket, which is we’re getting most things delivered. 

  Nigel Ohrenstein: So as you come back to primary care, do you think there’s a role for the digitization of some elements of primary care? How do you see that evolving? Slowly? Quickly? What’s your perspective on that? 

  Brad Fluegel: One of the things that I think is interesting about what’s happened over the last seven months is there’s a lot of focus on Teladoc and Amwell and MDLive and the explosion in visits that they’ve conducted, but what I actually find is more transformative than that is the fact that health systems and traditional physician offices jumped in, because they had to. The barriers to that historically have been obviously reimbursement levels, having the right technology to support that, and then thirdly, both patient and physician comfort. We’ve solved, at least for now, the payment issue, which we’ll see how that evolves over time. Hopefully that will not revert to discourage that. We’ve solved, at least now, the patient and physician comfort level, and we’ve also solved, though that’ll probably change back, the technology issue by making everything possible. 

  Brad Fluegel: So what I think is long-term transformative, I think this is what you said is that a video chat is a mode of communicating with your doctor or their practice or their primary care office, right? So the way I… I think you’ll have text. Sometimes you can just text your doctor. Sometimes you can have a phone call. Sometimes a video chat, and sometimes you need to go in and see that person. I think it’s just part of a multi-modality way of dealing with your physician groups. So that’s what I think has been transformative, and I think that’s going to stick as long as physicians still get paid to do that, so there’s not an incentive for that. 

  Brad Fluegel: I also think that there’s a role for technology, whether it’s through remote monitoring, through the use of pharmacists or pharmacies to help monitor people so that there’s other parts of the care team, whether that’s a physical or digital that can help provide some of the services to patients that allow primary care physicians to do what they need to do. 

  Nigel Ohrenstein: Right. So you sit on the board of Fitbit, perhaps the longest-running acquisition, saga of 2020, but I won’t make you comment on anything related to that. But put that aside. What’s fascinating again is you bring another perspective here of healthcare to the table, right? Which is sort of wearables. So how do you see that evolving, sort of the whole category of wearables and the impact that has on people’s health? How do they use it? 

  Brad Fluegel: Yeah. The technology is just going to keep getting better and better and better. I think now Fitbit, you can do your oxygen levels. You can do temperature checks now. Obviously Apple and other Samsung devices do similar things as well, but the ability to have something that you routinely wear that can track a variety of vital signs, EKGs. I think there’s a risk of too many false positives, obviously, but the technology will continue to get better. But to be able to monitor a number of vital signs and to see when things become out of whack, particularly for people, not necessarily for me or for you, but for people that have maybe perhaps some other kinds of health issues. I think it’s enormously powerful, and I think, as I said, as you’re able to track more vital signs, that they’ll be an important part of the overall care plan for everybody. 

  Brad Fluegel: At Fitbit, we sort of call it the check engine light concept, which is like your dashboard in your car. If there’s something wrong, something will pop up that you need oil, or you’re out of gas, or whatever it might be, to the extent that [you] get to that point, I think it’ll be good for everybody. 

  Nigel Ohrenstein: Yeah. So this is another topic that I struggle my brain with all the time, and as I try to think how do we create a future healthcare system that is truly excellent, but also efficient and really and truly consumer friendly, it’s very difficult, as you know only too well, it’s not the same as other industries, right? I can go buy a desk. I can go buy a mattress as a consumer, and I can make that call. It’s harder in healthcare. I need a physician. I can’t make some of the calls on my own. But one of the things that I think about a lot, and I’d love your perspective on this, is we’ve touched on so many different topics today, right? The role of the payer, the role of the clinic, retail versus the specialized clinics, wearables. We’ve hit primary care. We’ve hit the digitalization of it. There are others we haven’t hit, like home health, mental health, right? 

  Nigel Ohrenstein: So how does that coordination happen in the future with all these different pieces? How do we put all that together? 

  Brad Fluegel: Well, I think it’s a great point, and it’s one of the concerns that I have. As you said, among the things that I do, I do some work with some early stage companies. One of the things that payers and employers or other people talk about and health systems talk about is that we don’t want to continue to do things which fragment the care for individuals, right? That you have a primary care doc, perhaps. Maybe a behavioral health provider. You maybe have diabetic care through some app like Livongo or something else, and that it needs to all be coordinated, because people are full people, that they need a coordinated way to do that. 

  Brad Fluegel: I think that that’s going to need to reside in one of two places. I think ideally, as you said before, it resides with the primary provider, whether that’s a primary care doctor or a specialist, depending on the individual. In an ideal world, that person would be able to integrate through technology and other kinds of supports all the different things that that patient is involved with. So I think that would be the ideal place where it would come together. 

  Brad Fluegel: I think that thinking the patient him or herself is going to do that, is probably asking a lot. I think that most people just don’t even… People that have certain conditions don’t focus on that every day and may not have the expertise or the time or the interest or whatever it might be. So I think they need to be helped. Hopefully that could be done through the provider channel. If not, I think the payers will try to do that. Again, I don’t know, to your earlier point, I don’t know if they have the same level of trust, if you will, to be able to sit in that position, but they’re trying to do that. 

  Brad Fluegel: So I think we got to sit in one of those two places. Perhaps, as payers and providers integrate further, we talked about Optum and United and some of the things that other health plans are doing to get closer to physicians, perhaps that will happen, perhaps through technology like yours or Aledade or other kinds of people that are trying to do things like that as well. Hopefully that will be able to put a warm hug around these people and help them navigate that, because it’s incredibly complicated, particularly when you’ve got stuff that goes wrong. 

  Nigel Ohrenstein: Right. So I like to end with what I call the quickfire round. It’s just a couple of quick questions, get your perspective. Best piece of advice you were ever given? 

  Brad Fluegel: I was going to say if it feels good, don’t do it. 

  Nigel Ohrenstein: Fair enough. 

  Brad Fluegel: Meaning that don’t just do things… Think about why you’re doing things before you act. 

  Nigel Ohrenstein: Right. Good advice. What do you do to relax, have fun when you’re not helping healthcare become a better place for all of us? 

  Brad Fluegel: Well, I used to love to travel. I love international travel. That’s the thing I most enjoy doing. But in the absence of that, I’ve been focusing on just taking great care of myself and working out a lot and trying to get back in better shape. 

  Nigel Ohrenstein: Right. If you could change one thing about healthcare, what would that be? 

  Brad Fluegel: That it would be built around the patient and not the doctor. 

  Nigel Ohrenstein: Right. That would be a great thing. Brad, thank you for taking the time to join us today. I really appreciate your perspective just across the board from your experience. It’s fascinating to learn what you think is evolving in healthcare, because as we said, you’ve had this payer experience. You’ve got this retail experience, and then services in between. You really bring the gamut of experiences. So really appreciate you taking the time today. Thank you very much. 

  Brad Fluegel: Absolutely, my pleasure. Have a great day. 

  Nigel Ohrenstein: Thank you for joining us today. Please follow us on your favorite streamer, and don’t forget to rate us, as it helps others find our podcast. I hope you continue to stay safe and healthy. Please join us next time as we tune healthcare. This is Nigel Ohrenstein in New York.