JOHN UTZ: So I think if you think about how retailers are approaching health care, there's a couple of things that they're doing that are quite different than how health care companies approach health care. One is they design around the customer first. So who is my customer? What demographic are they in? What do they need? What are they looking for? How do they shop in my store? What are they telling me they want? They really ask and they look at the customer first. 

Whereas a traditional health care system might say what condition do I want to treat? I have a heart center. Well, obviously, I'm only looking for heart patients, and I've designed this experience potentially around heart patients. But, really, what I want is those complex heart patients. So they don't think about the customer first, they think about the condition. Whereas a retailer thinks about the customer and what their needs and wants are. 

So I think that's one particular example of what's definitely different from a retail perspective as they approach health care, along with the fact that they definitely look at the space and the design of the space, and how to fit it into a retail environment, and where the location should be to attract the most consumers. Again, versus a hospital which might add a heart center onto their hospital as a new wing, but maybe it's not the best place for a heart patient to go. 

What I would say is quite different from a health care perspective is that level of regulation. And retailers, though, they will think about the regulations. They do go through the analysis. Their interpretation might be slightly different, but they don't get any leniency on complying with the regulations from any perspective that a hospital would get. So I think they both have the same regulatory challenge. 

I would say that hospitals, traditional providers need to think about retail and that it's becoming a first destination for consumers. So it's level-setting the experience, which is generally pretty good in a retail clinic, if you look at customer satisfaction scores. But it's also now becoming the entry point for a lot of consumers to enter the health care system. And so if a hospital, a traditional health care organization ignores that retail component and the experience around it, you know, they're either going to miss out on certain patients coming to their heart center, or to their hospital. Either that, or they may actually wind up having quite a disjointed experience because they have one in the retail setting, and then they go to a hospital which is an entirely different process. Right? 

So you think about-- retail clinic, they might say, OK, check in online, you have a five minute wait. Here's a pager, walk around the store while you're waiting for your care. You can pick up other items, you can interact with people. Whereas in a hospital, you basically have to come in, fill out reams of paper for the most part. Then you sit there confused, you have no one to talk to. They take a copy of your insurance card and you sit around for half an hour waiting with nothing to do but look at old magazines. Right? So it's quite a different way of approaching things. 

More and more consumers, particularly those buying products or exchanges, or even those getting insurance through their employer are moving to high deductible plans. So, basically, what that means is in some cases it's catastrophic coverage. So you have a heart attack, you're on the hook for the first $10,000, $6,000, $4,000, whatever your deductible is set at, and then they cover the vast majority of the rest. So what that means for the average consumer who doesn't have a heart attack or use health care that often, is that they're paying 100% out of pocket for the majority of their health care experience. And in that case they're seeking out experiences that they enjoy, but also experiences that are cost effective and get them the care that they need. 

And they're starting to think about tradeoffs, right? Do I really need this MRI? Do I really need this lab test? Do I really need this medication? Am I going to take it? You know, who should I go to and get care? If it's $40 to get a visit done at a Walmart and $200 to go to my primary care physician, and I have an ear infection I've had 100 times before. I know what it feels like. I'm probably going to make the choice to go to a retailer who's cheaper. Obviously, they're more affordable, accessible, a better experience. Other things to do in the store; you can get your medication right there. So it's going to start driving, I think, some interesting tradeoffs from a consumer perspective. 

I think you can certainly design a delightful customer experience in a rural hospital, and that's something that rural hospitals can learn from someone else or tackle on their own. Right? And that is not necessarily going to have a direct impact on outcomes. It will have an impact on customer satisfaction. 

So I think there's no reason that a rural hospital can't deliver the same experience or level of experience as a big hospital. I think the care side is a little bit trickier in that rural hospitals often have more generalists than they have specialists. They do less procedures, and have generally less opportunities to learn and be on the cutting edge as a big hospital. So I think what the system as a whole needs to evolve to is a center of excellence model, where if you're talking about oncology, you have a M.D. Anderson or a Sloan Kettering who can actually distribute their evidence-based best practices, how to care for a patient, provide technology to enable that. And also provide a connection for that local provider back to the center of excellence to actually get help treating that patient locally. 

So I think if you can address the experienced part locally, and then gain access to the best care and evidence out there in a distributed fashion. You can likely solve the problem of getting better care in a rural environment. 

Consumers don't want to travel to get health care, right? They want to stay locally, they want to be with their family, they want their support network around. And, you know, for a while there was this notion of medical tourism. We'll just put you on a plane, fly you out somewhere in Asia, potentially get you the service at a fraction of the cost, and you can stay in a Ritz Carlton-like hotel environment for a long time. And that did get some traction, but for the most part people don't want to be away from their families. And part of the recovery process is having your families and your support structure around. So the patient, along with the payer and the system in general, want to avoid having to send people-- I would say, or at least only send them when they really need to go to those types of centers.