A carrot, a stick and closing the space between
A carrot, a stick and a face-to-face encounter. Those are the tools that will chisel away at healthcare costs, noted Wade Miquelon, Walgreens EVP and CFO. And Walgreens is uniquely positioned to help realize those savings.
To lower costs, you could raise co-pays or premiums to discourage unhealthy behaviors like smoking, poor diet or lack of exercise. That’s the stick. On the other hand, you could waive co-pays or a reduce premiums to help encourage healthy behaviors like regular checkups or disease-state management programs. That’s the carrot.
Or you could put the two together.
And if you add Walgreens’ 8,000-plus stores, retail clinics and employer-based health centers, on-site hospital pharmacies, specialty pharmacies and infusion centers all across the country — and the face-to-face interaction of the tens of thousands of pharmacists, nurse practitioners, physician assistants and physicians in them — then you really have something. Because then you can move the carrot and stick closer together, and shorten the distance to lower costs and expand access.
That’s how Walgreens believes it can help.
“If you do it telephonically and if you don’t have a carrot and stick in place, you can’t change human behavior,” Miquelon said. “We’ve been trying to reduce the 12 cents on the $1 [that represents prescription costs] for years, and we’ll still keep trying to do that. But if we can help people reduce the other 88 cents, that’s the big idea for us,” Miquelon added.
And that’s the big idea that keeps getting bigger in the years to come. Indeed, health reform creates more momentum for Walgreens’ transformation of community pharmacy and the expansion of the model.
“In general, healthcare reform is a net positive for our model because of a few different components,” Miquelon explained. First, will be the 32 million newly insured patients themselves — Walgreens, which already dispenses one out of every five prescriptions filled in the United States, is positioned to gain an even greater share of the new business, Walgreens executives believe, as payers look for ever more creative ways to lower costs and still expand access to care. “It will [facilitate] deeper and deeper relationships [for us] with payers,” Miquelon said.
Another component of health reform that will benefit Walgreens will be the rise of accountable care organizations, as payers demand better outcomes data as a means of measuring cost versus quality of patient care. The combination of its pharmacies, clinics and employer-based health centers — and all of the healthcare providers in them — is “the glue needed to make [the ACO model] stick,” Miquelon said. In a healthcare system where all providers are encouraged to practice at the top of their respective professions, 70% to 80% of all primary care services could potentially be provided in a Walgreens community pharmacy — particularly, one that has a retail clinic.
Critical to community pharmacy’s ability to play an integral role in the ACO model will be the ability to connect providers at every end of the patient care team. “They also need the information to be integrated so they can manage the entire patient’s health profile [at every point in the continuum of care]. Where we’ve gone with our systems and are going, we’ll be able to do that,” Miquelon noted of Walgreens’ recent announcement that it will roll a common electronic health record platform into all 8,000 stores, on-site hospital pharmacies and worksite clinics.
Its Well Experience stores are built to take advantage of it all. The rollout of the new store concept — which it had been testing in several stores — began in earnest last year in Indianapolis, and while it has been tight-lipped on which markets will come next and when, it will continue to open more stores with various levels of the Well Experience model. In true hedgehog fashion, Walgreens plans to go slow, tweak where it needs to and allow the stores to pay for themselves along the way.
Part of the Well Experience format is the ability to co-locate a Take Care Clinic, and while the company also has been reluctant to share its plans to add more clinics, as payers look to get more creative with plan design, it will become more important to have a national footprint for its retail and worksite clinics. “We’d like to become the third place you go for health care,” Miquelon noted. “You go to your doctor, your hospital, but you also go to Walgreens.”
So Walgreens’ future looks bright, Miquelon said, and so does the present. As of Sept. 15, Walgreens is once again part of the Express Scripts pharmacy network.
There is no denying the impact the feud had on Walgreens quarterly comps. In its most recent earnings call with analysts, Miquelon noted that comparable prescription sales were down more than 9%. Still, when you back out the impact of Express Scripts — a negative 0.7% hit, by Walgreens estimates — it works out to an adjusted prescription growth rate of 1.6%, “which compares favorably to the industry, including Walgreens, which decreased 0.3% over the same period, per IMS,” Miquelon explained, during the June 19 call.
And although the temporary loss of ESI customers had some impact on its front-end as well, where comps were down 0.9%, during the company’s recently reported third quarter, the fact that average basket sizes increased by 1.7% despite the fact that traffic in its stores was down 2.6%, was another strong indication that when you peel back the impact of ESI, Walgreens’ underlying business is quite healthy. It is also a strong indication that its transformation is working, and resonating with customers.
And with all of the ESI noise behind, Walgreens executives are quite confident in the company’s ability to get a great number of its patients to come back to Walgreens. “We have been out of networks before,” Miquelon said. “So we have some experience when we’re out of a network [and] what happens when we get back in.”
Walgreens expects a significant surge of pharmacy patients to come back immediately, he said. Others patients will take more coaxing, but the launch of its new loyalty program will help bring many more back over the next six to 12 months. “The No. 1 reason you get them back is because they came to you in the first place,” he said.
Next for Miquelon: Walgreens begins the first step of its two-step strategic partnership with Alliance Boots, looking for synergies and learning from the two businesses. “If you actually look under the hood, their business is very strong and very resilient to tough economies,” Miquelon said. On the wholesale side of the Alliance Boots business, business is brisk. European economies are looking for savings drivers, and in the healthcare space, that means generic conversion. “In the United States, generic penetration is about 80%. In southern Europe it’s only 25% and in northern Europe it’s 60%,” Miquelon said. Clearly, this is an area where the two companies believe they can move the needle.
Why Alliance Boots?
Much has been written already about Walgreens’ epic, two-step acquisition of Alliance Boots that in the end could be valued at $16 billion. As the largest single purchaser of prescription drugs in the world, with a global pharmaceutical wholesale operation to match, in-house manufacturing capabilities in over-the-counter health and wellness and generic drugs, Walgreens-Alliance Boots will have a whole lot more influence on the pharmacy side of its business.
There is no denying these game-changing aspects of the deal. But it’s important to understand just how strategically the two companies fit together. Walgreens set about this course with a definitive plan for how it planned to transform itself — the acquisition just enables it to step up the pace considerably. Walgreens president and CEO Greg Wasson walked DSN through how the deal acts as an accelerant for Walgreens’ five strategic imperatives to achieve its goal of becoming the preferred destination for health and daily living:
To transform the traditional drug store into a health and daily living destination. “[Boots] is probably the leading retailer in the world in beauty,” Wasson explained. “The store design, the experience — everything that helped them capture literally 50% of the beauty business in the U.K.”
But to be clear, that is a transformation that began long before the Boots stores came into the picture. “When we acquired Duane Reade … Joe [Magnacca] had taken his Shoppers Drug experience and his knowledge of what [retailers in Europe] were doing, and he went back and created the LOOK Boutique, and you’ve seen that begin to appear in stores across the chain,” he said. “Now you look at what Boots has, and you put that together, and we think we will be able to move a lot more aggressively into beauty.”
To advance the role community pharmacy plays in health care. “The big thing here is that Alliance Boots will help us become the world’s biggest supply chain and allow us to work in different ways with pharmaceutical manufacturers, front-end suppliers, payers, etc.,” Wasson said, that will lead to new opportunities to grow the business for all parties. “The way I looked at this [Alliance Boots deal] was, as our suppliers become more global, and they are looking for new and unique ways to grow their businesses, what an opportunity to create the first global retail pharmacy supply chain.”
To raise the game on employee engagement and customer service. “The one example I would give there would be the loyalty program,” Wasson said. “When I came into this role more than three-and-a-half years ago, one of the first things I decided was that we needed a loyalty program. … Alliance Boots has the leading program in all of Europe, and it is a big part of why they are able to play such a big role in beauty in the United Kingdom.”
To expand access across new markets and channels. “If you look at the progress we’ve made over the last three years and where we’re headed, Alliance Boots fits squarely into strategy No. 4,” he told DSN. “Channels implied ‘multichannel,’ that’s e-commerce, and Sona [Chawla, president of e-commerce] and her team are doing some great stuff [with] Drugstore.com and Beauty.com, mobile and some of the other things we’re doing there. … Obviously [Alliance Boots] has a leading e-commerce site and mobile channel themselves, and Sona and her team will get in there and see what’s the best of both worlds and accelerate that on both sides [of the company].”
“But markets means outside of the United States,” Wasson noted. “This gives us our first step outside of the United States, into emerging markets.”
To focus on costs. “There’s no doubt that we will be able to find ways to use our scale to help lower costs throughout the whole organization,” Wasson said. “And this is where the suppliers, I think, get excited. Certainly, we are going to take advantage of opportunities to buy and bring efficiencies together. But what’s really exciting is the fact that this is about innovation as well.”
Wasson uses Asia as an example. “I have been talking to Wall Street quite a bit about this,” he explained. “Two years ago, we decided we needed to have an Asian purchasing office. So we started about two years ago, and today we have six people working in an office in Asia, and we’re starting to bring a lot of products in. Boots has 150 to 200 people [in Asia]. They’ve had them there for 10 to 15 years now. And Alliance Boots will tell you that those people out there in Asia are not only there looking for cost opportunities — more importantly, they’re also looking for new innovation and new ideas for bringing products to market. We’re going to be able to leverage that.”
One area in which Walgreens will benefit greatly is in private-brand development— Boots has a research and development group with 400-plus associates in Nottingham, England, that is constantly at work on private-brand innovation. Walgreens has taken steps in this direction in recent years with the creation of such brands as Duane Reade’s Delish and its own Nice! brands, but Boots has long been acknowledged for its private health and beauty brand development, with a long, rich tradition dating all the way back to the launch of its No7 beauty brand in 1935. The deal will help Walgreens emerge with a private-brand presence in color cosmetics that people want to buy.
In addition to No7, it also features the Boots Pharmaceuticals (OTC), Soltan (sun care), Botanics (natural skin care), Boots Laboratories (anti-age partnership with Procter & Gamble) and Almus, which currently makes generic pharmaceuticals in five European countries. Given the market for multisource generic pharmaceuticals and future projections for the patent cliff, having an in-house generic pharmaceutical manufacturing capability is a decided advantage for a drug store operator with 11,000 stores in 12 countries.
Transforming the hedgehog
For years, Wall Street — and customers, too — rewarded Walgreens for being the hedgehog of retail. A homage to the old Aesop fable, unlike the fox, the hedgehog is steady and methodical. And, that’s just how Walgreens operated its business. It didn’t make big acquisitions; it grew organically and built its own stores. It didn’t hire a lot of experts from other fields; it tended to cross-pollinate and promote from within.
For decades, that was the key to its success. And while today the company’s values are very much the same as they have ever been, there is no denying that the hedgehog has grown a bit more nimble. “I wouldn’t say that the hedgehog mentality has been thrown out — I think we are building upon it,” Walgreens president and CEO Greg Wasson told DSN in an exclusive interview. “There are still some things that we do that are very deliberate, where we really pilot [new concepts and ideas] and spend time making sure things work, and then accelerate [from there].”
After all, being the hedgehog is what got Walgreens where it is today — the largest retail pharmacy chain in the United States, with sales of some $72 billion and providing 1-of-every-5 retail prescriptions filled, and on the verge of transforming the business of community pharmacy into a global industry while also transforming the experience of shopping a drug store into something no one has ever imagined — no one but Wasson and his team, that is.
“I think the hedgehog mentality was spot on and quite frankly what made us successful over the last two decades when we were opening drug stores on the best corners in America, to move us from 1,000 stores to the 8,000 we have now. Because of that, we have a tremendous foundation to take this company — and the profession of community pharmacy — forward in an even bigger way.”
What does that mean? For one thing, Walgreens doesn’t even consider itself a drug store anymore. That’s so 20th century. Enter the age of the health and daily living store, embodied in its new Well Experience stores rolling into a number of markets. Right now, there is nothing else like it in retailing. To further elevate the customer experience, this month Walgreens rolled out its new loyalty program, Balance Rewards, which the company has quietly crafted and tested over the last few years. It was one of the very first things Wasson decided Walgreens needed to have to effect the kind of transformation he envisioned for the company.
And it is a good example of how the hedgehog has learned to pick up the pace of innovation when it needs to. “There are times when I don’t think we can stay in hedgehog mode,” Wasson explained. “There are things that we do, where we do have to move things along more quickly. I’d say we’re a little bit of a hybrid.”
Indeed, in the past three years under Wasson’s leadership, Walgreens moved quickly to seize opportunities that helped accelerate its long-term strategic goals. It acquired Duane Reade in 2010 and Drugstore.com in 2011. Most recently, its two-step mega-deal with Alliance Boots (valued at a little more than $16 billion in total), announced in June, redefines its mission. In the United States, Walgreens stores are now destinations for health and daily living located at the corner of “Happy and Healthy.” With Alliance Boots, it becomes a self-described “global pharmacy-led, health and well-being company,” with more than 11,000 locations, each set at the “corner of global reach and local relevance,” as Wasson has explained to analysts.
Indeed, the very nature of the two-step transaction speaks volumes to the “hedgehog hybrid,” Wasson described. It is a classic example of how Walgreens can move fast and still execute in the deliberate manner that has made it successful. The plan is largely for both sides to learn from each other over the next two to three years as the two companies march down the aisle to full completion of the deal, expected some time in 2015. (Details of the transaction provide a six-month window for Walgreens to exercise its option to acquire the remaining 55% of the company beginning two-and-a-half to three years following the initial close of the transaction, which occurred Aug. 2.)
Perhaps nowhere in the company is the “hedgehog hybrid” mentality reflected more than in the makeup of Wasson’s leadership team, which he said reflects “the perfect blend of internal, long-term talent” — like Wasson himself, a 32-year veteran of the company whose career began in the stores — and “external expertise and talent that has helped accelerate the transformation that we’re in the midst of,” he said.
In the three-and-a-half years since Wasson was tabbed for the top job at Walgreens, he has assembled a dream team of sorts, adding top minds from other fields to help inject the company with new thinking, and to look with fresh perspective for new ways to execute its five key growth strategies:
To transform the traditional drug store into a health and daily living destination;
To advance the role community pharmacy plays in health care;
To raise the game on employee engagement and customer service;
To expand access across new markets and channels; and
To focus on costs.
Driving all of this are a couple of undeniable forces that have created an immediate sense of urgency for Walgreens and the community pharmacy industry, in general. Affecting all retailers is the impact of the Internet and e-commerce — convenience and price take a backseat to experience in the brave new world of retail. Certainly, Walgreens’ new Well Experience stores, and the concepts it is testing in its growing number of flagship stores, are redefining content relevance at the local level and producing plenty of retail theater along the way. And its considerable progress in e-commerce has enabled it to cultivate a significant multichannel offering that allows its customers to shop Walgreens in just about any way imaginable.
But Walgreens as a health provider is facing a whole other set of challenges and opportunities. Wasson refers to these as the “push” and “pull” that is driving the transformation of community pharmacy. And, there is no denying that as head of the biggest chain in the industry, and chairman of the National Association of Chain Drug Stores, there is a discernible sense of obligation that Walgreens needs to lead from the front on this one.
“What is evident is that the industry has changed dramatically over the last three to five years,” Wasson explained. “There were both threats and opportunities. One of the threats is just being in health care. [All stakeholders] are going to be forced to reduce costs; continued reimbursement pressure; commoditization, whatever that may look like. … That’s what I call ‘The Push’ — what’s pushing this industry, not only Walgreens, but this entire industry, to step forward and move this profession further along. And being the leader in this industry, as Walgreens, the onus is on us to do that.”
“‘The Pull’ is that, frankly, the nation needs new innovation. And the profession of pharmacy and our presence in 8,000 communities across the country gives us the opportunity to build on that foundation that hedgehog mentality built.”
What does that mean exactly? For years, community pharmacy has talked about advancing the profession, and certainly there has been some important, albeit incremental, change. “We know pharmacists can do much more than they currently are allowed to — we learned that with flu shots and vaccinations/immunizations. Walgreens led the entire community pharmacy industry, and now we’re there — now people think of community pharmacy as the place to go for flu vaccinations.”
Wasson believes that the combination of these early advances and the daunting challenges that lie ahead for the United States — with 32 million newly insured Americans set to be introduced into the health system in 2014 and a nation of hand-wringing payers desperately looking for new answers to old problems — has created a perfect storm in health care. Everything that came before now has led Walgreens and community pharmacy to this one moment to help transform the way patient care is delivered in this country.
“It means expanding the scope of services that community pharmacy can provide — and I want to be clear, I mean community pharmacy — not just community pharmacists,” Wasson explained. “Because community pharmacy encompasses not only the role of pharmacists within the store, but for many of us that are co-locating nurse practitioners and physician assistants, and in some cases, physicians in their stores, it means expanding the scope of services a community pharmacy can provide, and expanding that even further.”
There are signs that the future is already upon us. The state of Massachusetts, which in many ways has been the learning lab for health reform, in August passed a new cost containment law that aims to reduce health spending in the state by some $200 billion over the next 15 years. Among other key measures, the new law expands the services that can be provided in a Massachusetts retail clinic to the full scope of practice for a nurse practitioner, including diagnosis and treatment, management and monitoring of acute and chronic disease, and wellness and preventive services.
“So now all of a sudden in a very convenient location all across the country called community pharmacy, people can get a lot of their healthcare services cost-effectively and with high quality,” Wasson said. “That’s ‘The Pull.’ This nation needs solutions, and we’re ready to step up.”
And now, with the Alliance Boots acquisition, Walgreens has a new opportunity to create new growth opportunities by moving beyond the U.S.-centric view of pharmacy that has defined its business for more than 100 years. The reality is that the problems facing the U.S. healthcare system are very similar to the problems facing western nations throughout the world. By bringing together the two most iconic brands in pharmacy retailing in the world, “you now have the U.S. and the European markets,” Wasson said. “Close to 1 billion people who are aging, the generic wave coming full speed at us, every country in the world trying to control healthcare costs … and what’s the best way to control healthcare costs? To get more people compliant on generic drugs. This sets us up in two of the biggest economies in the world on a global scale, with the opportunity now to expand beyond Europe into Asia and Latin America.”
And that will create new opportunities for Walgreens’ Pharma partners. In many ways, Big Pharma finds itself in a similar chapter in its history. If for years Walgreens’ hedgehog model was premised upon it putting its head down and focusing on delivering new stores to drive topline growth, branded pharmaceutical makers operated on a similar variation on that theme.
“When you think about Pharma, for years their model was pretty consistent,” Wasson said. “They had a pipeline full of blockbusters; they rolled them out, and life was good. Now that pipeline is a little less robust, and they’re looking for new ways to grow their business. One way is to work with new partners in ways that they’ve never worked together before. One example is working with community pharmacy to help people stay more compliant and adherent, to come up with new programs and services.”
Indeed, for branded pharmaceutical companies there can be a lot of money to be had in plugging up the leaky bucket of patient compliance and adherence. Particularly as it relates to specialty pharmacy drugs, a 5% improvement in patient adherence could be worth as much to a drug maker in one year as a brand-new blockbuster drug launch, and without any of the research and development costs.
The growth of specialty and biotech drugs also will create new opportunities to expand the role of the pharmacist. “In a world where pharmacy has proven that pharmacists can inject patients with flu shots, why can’t we begin to do more first-dose injection training?” Wasson posited.
To be sure, its deal with Alliance Boots also will enable it to continue to push the envelope in such areas as store design, beauty and private brand. When you back out the global supply chain implications of the deal, and the massive purchasing synergies that will be created as the combined company becomes the single biggest purchaser of prescriptions in the world, like Duane Reade before it, the Alliance Boots acquisition will be an accelerant to many of Walgreens key strategic goals, particularly, transforming the store and the customer experience.
“Duane Reade had started the new drug store concept, and now you see a lot of that influence coming back to Walgreens and accelerating where we’re headed — the loyalty program, the private brand. … A lot of what we’re doing that acquisition helped to accelerate,” Wasson said.
“When I look at Alliance Boots, I think of it almost the same way — it’s an accelerant. They have innovative store design concepts; they’re a pretty significant player in beauty, where we want to head; they have the leading loyalty program in all of Europe; they have the leading private beauty brand selection in the world,” Wasson said.
And while it’s true that each of these areas is critical to Walgreens’ future growth, creating new reasons for customers to use its stores and ultimately buy more stuff, none is a replacement for its core reason for being. As Walgreens continues to transform the concept of community pharmacy to the health and daily living destination, it is important to remember that none of the heightened focus on front-end business, like beauty and fresh food, come at the exception of pharmacy. “I’ve said this before — our center of gravity is indeed the drug store,” Wasson said. “That’s where we’re focused, and I say that with a whole lot of emphasis and meaning behind it — that is our center of gravity. Everything we do is focused on [bringing] more value to our patients, our partners and our payers.”
By that measure, you can say that the law of gravity still exists — it’s just been transformed somewhat. Just like Walgreens. Walgreens is still the hedgehog of retailing all right, but you better believe it’s a faster, more nimble hedgehog. Like the massive robots from the blockbuster “Transformers” movies that are the theme for this exclusive, special issue of DSN, Walgreens has the ability to transform itself in seemingly endless configurations to create innovative solutions for patients and payers.
In the pages ahead, DSN examines the massive transformation that is occurring at Walgreens throughout just about every aspect of its operation.