Unless he has a change of heart, Hal Rosenbluth will likely become a fixture in the U.S. healthcare system.  If history repeats itself, that fixture will be a welcome disruption to those who spend heavily on healthcare.  But for those whose livelihood is linked to the status quo, Mr. Rosenbluth’s arrival may not be so welcome.

The history we speak of is rooted in the travel industry and is manifesting itself today in retail healthcare.  A travel agency and retail clinic are odd bedfellows indeed.  But then, Rosenbluth International was not just a travel agency and Take Care Health Systems is no longer just a retail clinic operator.

Rosenbluth, the co-founder of Take Care Health Systems and now a senior vice president at Walgreens, has lived both worlds.  Oddly enough, the corporate travel world seems to know a lot more about Hal Rosenbluth than the healthcare world. 

“Hal Rosenbluth was a giant in our industry,” says Bill Connors, executive director of the National Business Travel Association.  “Everyone in our industry knows Hal.  He is to corporate travel management what Bill Marriott is to the hospitality industry.”

The 56-year-old Rosenbluth joined his family’s travel business after graduating from the University of Miami in 1974 with a bachelor’s degree in general studies.  The company was largely focused on leisure travel for customers in the mid Atlantic region of the country. 

In 2002 he told the magazine Nations Business that his family’s company had been “a flourishing business held back by politics; powerful individual efforts thwarted by a lack of teamwork.  This was an environment I didn’t relish working in, so it was likely many of my colleagues didn’t like it much either.”

He is best known for changing the business in two ways.  First, he built an IT infrastructure that could help corporations realize the power they had with volume purchasing. In doing so, he essentially created the corporate travel management industry.  Second, he changed his company’s culture so that employees were the top priority and customers, although important, were the second priority.  He even co-authored a New York Times best selling book about it called “The Customer Comes Second: Put Your People First and Watch ‘em Kick Butt,” based on the premise that only when one knows how it feels to be first in the eyes of their employer can they impart that feeling on a customer.

Rosenbluth International, a travel empire with more than $5 billion in sales, was sold to American Express in the summer of 2003 when Rosenbluth was its chairman and CEO.  He describes the turn of events as bittersweet.

“I went to my ranch in North Dakota to hang out, decompress and expunge as much emotion as possible,” he says.   “It was a tough time because I was emotionally tied to the people at Rosenbluth International.  When you are close to people you work with, care about them as individuals and then sell the company, the harsh reality of knowing you can’t be with those people anymore is devastating.  I literally moved bales of hay, fixed fences and other mindless, monotonous chores in order to recover from the sadness of leaving my friends.”

And thought about his neighbors. 

“My neighbors in North Dakota didn’t have great access to care.  People don’t get screened, so they don’t know they are ill.  They go from what seemed like a good state to a very bad state.   I have great access to healthcare in Philadelphia, and thus learned I was pre-diabetic.  But many in this country don’t know they are pre-diabetic in the first place and then can do nothing to keep from becoming a full-fledged diabetic.  So I started to think about the socioeconomic gap, and not just rural America, but throughout the country. A year later it became apparent that whether you had the means or not, access to care is a huge problem and is getting worse.  Right now there simply are not enough providers.”

Then about six months after the sale to American Express, Rosenbluth was approached by Peter Miller, a senior executive at Johnson and Johnson, about doing something in the healthcare industry. 

“I told him he was out of his mind.  Peter had so much success running numerous J&J companies and was its youngest president ever.  I said why would you want to quit all that?”

But the two began looking for the largest problem in America that required a private sector initiative to solve. It soon became apparent that the delivery of affordable, accessible and high-quality primary care services were in high demand and there was nothing in sight that was going to change that.

“I think it’s good news I didn’t know a lot about health care.  We were able to study it for months and then create a model that was not fraught with legacy systems.  It gave us an opportunity to create something from scratch. We were unencumbered by politics and had no fear of disrupting the system as long as we kept the patient at the top of our pyramid. The incentives in healthcare were misaligned and we knew that by putting the patient first, everything else would realign. We recognized the hidden costs of healthcare, the turf issues we were going to face and all the pundits that would tell us it was impossible to accomplish what we set out to do. Our focus remained doing good while doing good business, and that commonsense, the marketplace and consumerism would win the day.”

The rest is well-documented history.  The Rosenbluth-Miller duo created Take Care Health, then won a contract to open several Take Care Health Centers in Walgreens stores.  In the spring of 2007 their
company was acquired by Walgreens.

After having sold a $5 billion travel empire to American Express and a retail healthcare startup to Walgreens, it seems odd that Rosenbluth is one of at least a dozen corporate officers in a large and conservative U.S. company.

“Frankly I’ve done everything to avoid climbing the corporate ladder in my career,” he says.    “I’m not a big fan of corporate America.  I’m a completely transparent individual.  Now I’m part of a public company and can’t be as transparent with the people I work with.”

So is this a temporary assignment? 

“I’ve come to really like working with Walgreens,” he says, as if having trouble believing it himself.  “Originally I thought I might have succumb to Stockholm syndrome [the psychological response in which the hostage shows signs of loyalty to the hostage-taker] but the company has really grown on me. I love its values and have become close friends with my colleagues and fellow officers. The company has a meaningful purpose and we are executing on an elegant strategy.”

But the humor and talk of fellow officers quickly dissipates when the subject turns to the U.S. healthcare system, a system Rosenbluth says needs to be flushed.  

“It doesn’t work,” he says.  “There are not enough providers; there are too many conflicts of interest;   and patients have become victims of the system.  Any time you have that, you have a deteriorating landscape, lack of choice, inefficiency and frustration.  It is the motivator for what I’m doing.”

The connection to the travel business is not irrelevant.   Travel is one of the biggest expenses for companies in the United States.  And Rosenbluth is credited with revolutionizing the way companies manage travel expenses.   Companies spend even more on healthcare.  So now you can go to the web site:
http:/www.takecareemployersolutions.com and quickly see that he is intent on revolutionizing the way companies manage healthcare expenses. 

“We are bringing a holistic approach to healthcare delivery,” he says.  “We’re not a hospital.  We don’t provide specialty care like orthopedics, but we have attracted certain groups of folks to the company that have figured out how to save money for companies while at the same time providing better outcomes for their employees.”

He describes the Walgreens Health and Wellness Division, of which he is president, as the molasses that brings together Walgreens’ healthcare assets, including 7,000 points of care, 66,000 healthcare professionals and more than 250,000 employees. 

Those points of care include 6,659 Walgreens retail stores (of which 334 have a Take Care retail clinic); nearly 400 corporate healthcare sites; and hundreds of infusion centers.  The challenge will be bringing all of this together in such a way that he can show a meaningful reduction in cost.  And his target for that cost reduction is the private sector.

“This is a work in progress,” says Rosenbluth.  “We have made major gains, especially at employer sites where we have engagement at all levels and in all parts of the company, and are now tying them together with the Take Care Clinics.  We’ve been able to test approaches in employer solutions and pharmacy, know what works and what doesn’t work.  You can see the potential when we bring it all together and make it rewarding for patients, providers and employers.  The next challenge will be extending that into an ecosystem beyond Walgreens and taking our value proposition to managed care companies.”

Rosenbluth is convinced his team can reduce cost and reduce conflicts of interest.  And disease management is high on the list of priorities.

“I know of no company that is addressing the chronic disease problem successfully.  Something new has to be developed and designed.  A completely new approach to disease management is part of our charge.  It is an offering that will cross all of Walgreens, and like our employer offering, will become available to Americans regardless of where they work or live.”

As with his success at Rosenbluth International, technology is also high on the priority list.

“We’ve only barely scratched the surface,” he says.  “And there are several pieces to our initiative.  First, providing information for the patient and outcomes for those who pay the bill.  Second, providing the right information for providers so they can deliver the right care at the right time and at the right price.  Third, building the infrastructure that supports all of this.  And fourth, extending that infrastructure to the outside healthcare ecosystem such that the patient benefits and cost reductions are realized by everyone.”

On the subject of a universal electronic medical record standard or system, Rosenbluth believes a solution will come.

There are a lot of different solutions, some partial, some more than partial,” he says.   “Bottom line is those involved in healthcare need to learn to work better together.  Even though many of us compete, we’re still Americans and we’re dealing with human lives.”

Rosenbluth says his instincts tell him that we’re moving to a consumer-centric healthcare record.  People don’t want to be told what to do, he says, so the access and retention will be driven by the consumer along the lines of a Google Health, Microsoft Vault or Dossier model. Individuals will choose the tools that they feel most comfortable with in helping them access their health records.

On the subject of retail clinics, Rosenbluth says that although his Health and Wellness division is much bigger now than just the Take Care Clinics inside Walgreens stores, it is still a critical part of the delivery model.  And it would appear the Take Care brand will be prominent in that model.

“We did a study on the Take Care brand,” says Rosenbluth.  “There is a halo effect, a very positive one.  You’ll see the brand grow in different ways and venues.”

On-site employer clinics will be one of those venues.  But he says, at the same time, employers will have choice in the matter when it comes to how they name their health centers.

“Some like to use their company name,” he says.  “Others want a neutral name.  But still others like to use Take Care.  I think as we continue to roll out our Complete Care and Well Being program, you’ll see more opting for the Take Care brand on site.  Companies are recognizing the value.  We don’t like to impose our name and we won’t, but at the same time, virtually everybody sees the Take Care brand one way or another.”

He says companies have embraced the fact that Take Care Health is part of Walgreens.

“They recognize the benefit that 68 percent of all Americans live within five miles of a Walgreens drugstore and 50 percent live within two miles. As more and more physician practices consolidate they naturally become further from one’s home or work. By being in the neighborhood we are bringing healthcare closer to the patient than ever before. ”

Compared to its humble start in 2004, Take Care Health has become a major force in both retail and on-site healthcare.  Amid all of this growth and expansion there has been a downturn in the economy.  And Walgreens has responded by cutting back on new store growth.

But curtailing new store growth so far has not slowed Take Care’s emergence as a major part of Walgreens’ “more from the core” strategy.  Rosenbluth clearly has the backing of the Walgreens board and its new CEO Greg Wasson.

But as an executive at one of the big HR consulting firms explained, Walgreens’ on-site clinic strategy has its risks.

“The on-site clinic market was really hot about 12 months ago,” he says.  “But with the economic downturn, that market is really slow because it is still difficult to justify the cost versus benefit of these on-site clinics.”
To the slowdown in the on-site clinic movement, Rosenbluth replies:

“It’s true that earlier in the year we saw fewer companies build out health and wellness centers with us,” he says.  “Now that the decision has reached the C-Suite, chief financial officers and CEOs are reaching out to us and asking us how we can bring down their healthcare costs as rapidly as possible. They are pushing their benefit managers and human resource executives to accelerate their efforts, and our holistic approach, national footprint and discounted, transparently priced pharmacy program seem to be the prescription corporate American has been longing for.”

And to the subject of healthcare complexity, he says,  “I’m not a healthcare expert, but I spent my formative years working with very complex six sigma corporate clients.  If you didn’t do six sigma or TQM you didn’t work with them.  Rhetoric should end and everything we do should be measured.  Performance metrics and continuous improvements in healthcare service delivery need greater focus and investment.   We need to get rid of turf issues between different provider groups and learn to work better together.   We can’t be told not to provide primary care at Take Care Clinics because some medical society says so; it should be based on fact and measurement, and when that happens, these unproductive arguments will cease to exist. 

“Don’t tell me it’s ok for nurse practitioners to practice full primary care in rural parts of a state but they become incompetent when they move into a metro area.  Don’t tell me that a nurse practitioner that single handedly performs an emergency tracheotomy on a fallen solider in Fallujah can’t treat pink eye in Peoria without physician oversight. This is America.  We need all the providers we can get. Pharmacists need to be able to increase their scope of practice and nurses of all types need to be able to perform what they are licensed to perform. Medical schools need to make it more attractive to become a primary care physician and tort reform is required to bring down the cost of malpractice insurance so it is more attractive for primary care physicians to continue practicing what they love and not be forced into specialty to make ends meet.   After all, there are 330 million Americans that deserve affordable, accessible and high-quality healthcare, and nobody, nor any organization, can do it alone.”

We are all familiar with the predictions of a booming retail clinic industry. But if you think those predictions have ceased, think again.  Merchant Medicine estimates 2,050 retail clinics by the end of 2014.

Of any company we have followed in the retail healthcare space, Solantic seems to hit all the strategic buttons:  stand-alone urgent care centers in high-traffic shopping centers, clinics in Wal-Mart, joint ventures with area health systems, a clinic in the Orlando airport, franchises for physicians, outstanding consumer marketing and a relentless pursuit of customer satisfaction.

Over the long term, it could be that seasonality is the least of a retail clinic operator’s worries. As we noted last month in an article about the long road to breakeven for retail clinic operators, traditional medical practices are taking a page out of the retail clinic playbook and focusing more than ever on patient convenience and consumer marketing. The result is a trend that we call “ConvUrgentCare™,” the merging of convenient care, urgent care and any type of walk-in medicine that involves non-emergent acute medical care.  Today you can see retail clinic techniques crossing over not only to urgent care and emergency care, but also pediatrics, family medicine and work-site clinics.   And these techniques appear to be working to change the game in walk-in medicine.