November 19, 2021
Gary Bisbee, Jr. 0:16
Well, good morning, Marcus. and welcome.
Marcus Osborne 0:19
Gary Bisbee, Jr. 0:19
We’re pleased to have you at the microphone this morning, bright and early. The purpose today, Marcus, is to get to know you a bit better in your role as host sitting on the advisory committee of Day Zero. And we’re delighted that you are on the advisory committee. Why don’t we pick up your life a bit, maybe at the point that you decided to go to Harvard Business School? Why did you decide to go to business school, Marcus?
Marcus Osborne 0:47
In undergrad, I was a political science major and a history minor. I had intended to go to law school. With the political science, I went to a small liberal arts school. And I think there were 11 of us that graduated with a political science degree. 10 of us went to law school and I was the one who ended up not. So I eventually had a unique opportunity to get into management consulting. And so it was consulting businesses and industries for a number of years, and knew while I was doing it, I wasn’t kind of steeped in business. I had come from the White House . I knew politics, knew political systems, but was not kind of well versed on business. But there was actually a specific moment of time. I was actually working for the Clinton Foundation. And we were doing work to help people in countries that were ravaged by HIV to help them put in place treatment programs and get access to low price meds, and we had been very successful and were fortunate to have a number of donors that were going to help fund initiatives to do that. And there was a moment of time where I was sitting in a room with a number of bankers, and we were discussing the fact that we were going to be buying raw materials in China and then sending them to India and buying other things in India, and that we were shipping them to South Africa, and Rwanda, and Haiti, and others, and that I had a staff in the US, but we had donors from Japan, and Ireland, and Switzerland, and Sweden. And so we were having dollars coming from those donors going to China, dollars going to India, dollars going to South Africa, dollars coming from the US. And what we were worried about was, we needed those dollars to go as far as they could go. And so we were worried about currency fluctuations. One of the bankers looked at me and said, “I’m going to tell you, this is one of the most complex currency hedges I ever had been involved with in my life.” And they spent the better part of two or three hours drawing these things on the board. And it was like, he might as well have been speaking Mandarin. I didn’t actually even know what he was talking about. And I said, you know what, I need to go to business school. I’m the one guy that, if I’m going to continue to advise and engage from business perspective, I better at least have some basics. And so that was the real moment that I said, this is gonna happen. And so that’s why I went.
Gary Bisbee, Jr. 3:04
So how did you dodge going to Wall Street or consulting out of Harvard Business School…
Marcus Osborne 3:10
Gary Bisbee, Jr. 3:10
…because you went to Walmart?
Marcus Osborne 3:12
Yes, great question. Well, for me, I have this kind of tendency that I don’t like to go where everybody else goes. Maybe I’m afraid of crowds or have some sort of strange phobia or fear. But when I was in business school, you know, I was there from 2005 until 2007, and I was a late entrant. By the time I graduated, I had two sons, two young sons. So I was a little bit strange in terms of being a little older, and being a little more long in my life than a lot of others. But, I looked around and I saw something very strange going on at that time. In fact, I think, in my section, if out of about 90 people, and I think this numbers roughly right, somewhere around 60, you know, upper 50s to low 60s, of individuals were going into management consulting, or hedge funds, or private equity, or venture capital investment banking, or the financial services industry. And given that I was a consultant myself, I don’t mean this to be a knock on those industries, but they do not produce or provide anything. Their whole purpose in life is they serve either as a strategist to or as kind of financial and capital advisors, and investors in industry. And HBS was actually a school for general management. It was the original school that was supposed to be the grooming school for the next generation of CEOs. Yet, you know, almost, or maybe two thirds of the people that I was in the section with weren’t doing anything that was related to general management and industry. And so for me, I said, I want to go somewhere very different. I want to go away from, you know, I don’t want to go to New York, or the Bay Area, or London, or Hong Kong. I don’t want to go into financial services or consulting. So where is as far from that as I can get? If you stop and think about it, Walmart and Bentonville, Arkansas are exactly that, right?
Gary Bisbee, Jr. 5:05
Marcus Osborne 5:05
As far as you can get from investment banking and hedge funds, and as far as you can get from, you know, London and Hong Kong,
Gary Bisbee, Jr. 5:14
How many of those two thirds of the class were incredulous?
Marcus Osborne 5:18
Well, you know, in hindsight, we all now know what happened, right? We now know what happened a year later, the fall of the financial markets and, you know, some of them work for firms that no longer exist. And I do think it created a recalibration in people’s thinking, I think many of them did end up going into industry after, you know, short stints, particularly given the downfall. And I do remember a number of them, who I consider to be some of the, I was, I was blessed. I mean, there were, some of the people that I got to learn with are some of the smartest people, absolutely brightest people I have ever engaged with in my life. And I can remember, a couple of them that I have maybe the highest respect for around came and said, I think you made a much better decision than the rest of us. And so that was at least a validating moment for sure.
Gary Bisbee, Jr. 6:07
Kind of almost like a founder blazing a new path, Marcus, fits right in here with Day Zero. What about healthcare at Walmart? How did you move into healthcare there?
Marcus Osborne 6:18
I tell people, I’m not a health care person by nature. What I am is two things. I love opportunity. I want to go in those areas that there’s either a turnaround need, or there’s an opportunity, there’s a growth need. I like areas that still have growth in them, that still have opportunities in them, that there’s still stuff going on, that things haven’t been kind of fully figured out. I’m not a very good keep the train on the tracks guy. So that’s kind of one. I think the other thing is and, you know, it’s where I grew up, I was born in Ashland, Kentucky, which is right at the border, literally right on the border of West Virginia. And so it’s Appalachian area. I grew up in central Kentucky. My parents were both educators. My dad was a school principal. And, you know, I know the challenges that people are facing, particularly here in the US, when you live in places like Catlettsburg and Whitley City, and Paintsville and others that most probably people listening, don’t know where that is. But those are kind of rural communities, and they’re great communities, but often, you know, they’re facing kind of challenges. And for me, I think, purpose, you know, that was why I went to the Clinton Foundation, why I’ve done other things, that it can’t just be enough to say, hey, this is a great growth opportunity where I can make great money. I’ve got to feel that, am I doing something that’s actually creating value for people, particularly the people that I grew up with? I want to know, when I go home and they see me, I want them to be proud of what I’m doing and not be confused by what I’m doing. And so I think that that intersection between opportunity and the ability to drive real positive impact on people’s lives, particularly those people that are important to me, when given the opportunity. That was the path I took.
Gary Bisbee, Jr. 8:00
Well, I know Walmart was in the vision business fairly early, but healthcare delivery is relatively new. And now of course, Walmart Health has been set up to do that. So what was the impetus for Walmart to move into the delivery side of healthcare?
Marcus Osborne 8:18
The move into care delivery. If you were to say that is there a moment of time where it really started was with the launch of the $4 generic program in 2006. And you say, what did the launch of a $4 generic program have to do anything with care delivery? What it did and what was really interesting about that program is it was unbelievably successful. It was successful from a business perspective, certainly, that Walmart saw very significant gains in share, market share, and pharmacy, and it really sort of drove the pharmacy business and drove great pharmacy growth for a number of years. It was also, more importantly, hugely impactful. It helped people save money, it helped the system, it helped kind of drive conversion to lower price generics, it made them, I think, more respectable, in some ways. And you saw kind of faster conversion to generics in the industry and you know there’s number of studies I’ve seen where it saved the system $10 billion or more a year because of the singular launch of that program and the competitive responses.
Gary Bisbee, Jr. 9:23
Marcus Osborne 9:23
But what we learned was this: in many ways, the gains that Walmart saw were not from other pharmacy chains, not from Walgreens or CVS. It was from people who had prescriptions in their pocketbooks or the dashes of their car, but that weren’t getting them filled because they couldn’t afford them or from people who were pill splitting, seniors who were pill splitting, because they couldn’t afford two prescriptions. They could only afford one. And I think it opened our eyes to this vast reality, I guess, that the issue in the US is that there is not vast overconsumption, but there is vast underconsumption, that people couldn’t get the basic meds they need, that they aren’t getting, in the moment, are deferring or delaying, or not getting the basic care they need, because of a lack of affordability, a lack of accessibility, because of the complexity of the system. And so I think that started us on our journey, you know, and you say, with Walmart, though, you know, health services, that’s a tricky business. I mean, you’re caring for people. I think there was, internally, many who would say, I’m not certain that this is a business we have a right to play in. And so it was things that we had to test and kind of learn and understand consumer reaction. But it has very much driven what we’re doing today to say, we’re in care delivery because we know people need access to care. That’s what they tell us, it’s often the kind of top concern. And so we are doing what we’re doing, because we’re trying to address consumer need. And that’s the business we’re in, we believe we exist to serve people. And if people are saying, this is what I need, then we need to figure out how to get it for them.
Gary Bisbee, Jr. 11:00
You’ve spoken about your frustrations with healthcare, and I suspect it leads in part to your interest in innovation and founders and so on. But you’ve been now in healthcare, not really, as a healthcare person, as you say, but just joined the healthcare ranks. Just give us a little bit of your kind of top frustrations with health care, what do you see, looking perhaps more objectively than a lot of us that have been in health care our whole lives?
Marcus Osborne 11:29
There’s probably a number of things that frustrated me, but the two that always kind of come top of mind is, one, how often I see that the solutions that are available to people out there were not designed for them, but they were designed, you know, more for the interest of payers or for the underlying providers. There’s health systems that are delivering the care or some other entity, but not people. And the result is, I think the frustration that I often see is, you know, people not getting the care they need, and that the blame is often put on the foot of the individual or the feet of people. And that they often said, you know, if people only, you know, weren’t so lazy and weren’t so kind of uninformed, and those kinds of things, a system would act better. And so I think that’s the biggest point of frustration that how often what I see is this failure point that care delivery in the US is not oriented to the needs of the people, to the consumer or the individual. And it isn’t designed around their needs. It absolutely is not affordable. And health insurance doesn’t help that, meaning health insurance actually often complicates that. You think, well, health insurance is there to help people pay for stuff. It’s not how it works. And then obviously, with the rise of the high deductible plan and other things, the basic stuff that people need, the basic care people need, is often out of reach from an affordability perspective and the accessibility perspective. And so I think that’s probably one point frustration is that the entire basic care delivery system, we haven’t designed it in a way around the needs of people. And I think a good example of that is you look at the regulatory realities, and often protectionist policies around certain provider groups. Kind of pre-COVID, the limitations on practice, on what a nurse practitioner is allowed to do. But what we know is, what they were trained to do, what they’re clinically capable of doing is up here. But often regulation only allows them to operate here. And so this idea of, if we were really sort of doing things in the interest of the consumer, we would attempt to have regulation that enabled people to have better, more affordable access to care, and that it wasn’t harder to do that. I think that’s kind of one. I think the other one, the other kind of point of frustration is the systemic allowance of massive variation in care and the harm that is causing, that we are allowing or enabling providers to deliver highly variant care where you’re seeing, you know, huge differences and practice patterns, even though the evidence indicates there should be a standard. You’re seeing people, providers not practicing to that standard. And so that’s why you have, you know, high rates of inappropriate and unnecessary care occurring, why you have poor quality occurring a lot of times, why total cost of care is often way higher than it should be. You know, I’m sort of mindful of the reality, when we go back to this appropriateness point that, you know, coming out of the Centers of Excellence work that we’ve been involved with for almost a quarter century now, we’ve seen things like, you know, the rates of when people are having hip and knee replacement and lumbar fusion, surgeries recommended, that more than half of those are actually inappropriate or unnecessary. There was a better path of care that would have delivered a better outcome, help the associate, or the individual be healthier, that would have been much lower cost than a procedure. And so I think for me, the point of frustration is that, is that we haven’t done more and I actually don’t put the blame on that at the feet of providers. I think we haven’t, if you don’t actually hold somebody accountable and if you don’t give them the data and the analytics and the insights that show them, how an individual, how they’re performing, and I don’t care the industry, it could be in financial services, it could be in my job, it could be, if we don’t understand how we’re performing, if we don’t have data that assesses how we’re performing, if we can’t see what good looks like, if we can’t see how our peers are performing, and understand how our performance is different than others, and the things that we could do to up our game, then you can’t get better. I’m sort of mindful of, you know, you look at how much insight is delivered to professional sports athletes to enable them to improve their swing, improve their shot, improve their, you know, whatever it might be. Given we have even more data in healthcare, why can’t we give that same level performance data to our providers to help them reduce variation in care? I think that’s probably the other big area of frustration for me.
Gary Bisbee, Jr. 15:56
Well, I think you’ve just laid out the foundation for Day Zero and founders in general. Why did you join the Day Zero advisory council, Marcus?
Marcus Osborne 16:06
I often hear people talk about the healthcare industry, or they talk about other challenges. There’s a very pessimistic, often negative tone. And I’m hopeful, I’m hopeful. And I fundamentally believe transformation is coming in the system, and that we can make these changes and that ultimately, people can be healthier, and we can make the system more financially sustainable at the same time, while Americans are actually healthier and can live better. But obviously, you can’t just hope. There’s got to be things that drive that transformation. And for me, much of that hope has come and does come from the people, the individuals, the teams that are standing up and that are saying, I want to do something different. I want to innovate in the system, I want to create something new. And so I believe in entrepreneurs, I believe in their ability to create innovation that changes the system that makes it better for people, that helps us lower the cost of care and improve, obviously, improve the health of Americans. Even with the tragedy that is climate change, I believe it’s innovators, and entrepreneurs that are going to help us solve for these big meaty challenges. But back to health care, I’m a big believer. And so for me, I’m involved because I love the innovators. I love what they’re doing. I believe in what they’re doing. The hope I have for transformation of the system comes from the work that they’re doing. And frankly, I’m a bit in awe of them as well. I look at it and see people taking risks that people will have to call me kind of, they say oh, you go rogue all the time and you know, you’re unfiltered. But, I see people taking risks that I often have to challenge myself and say, I’m not certain if you’ve got the guts to take the risk that these individuals are taking, these leaders are taking, these founders are taking. And so for me, it’s maybe my sort of small opportunity to say thanks and show gratitude for the risks these innovators are taking and the pain they’re enduring to transform the industry.
Gary Bisbee, Jr. 18:09
That’s very cool. We’re delighted to have you on the council. You’re clearly a key member. Super interview, Marcus. One last question, if I could. So what advice would you have for this pool of innovators and entrepreneurs that you run up against I’m sure a lot in your position at Walmart Health. But, what advice would you have for them?
Marcus Osborne 18:31
Of the people that I’ve chosen to interview, one of the things that is consistent across all of them is this idea that, yes, you need to believe in what you’re doing and bring deep passion and stay committed. And you know, don’t be afraid and keep charging ahead. Except that, maybe there’s a little bit of a paradox here, you’ve got to be pragmatic, you got to understand that innovation is a learning exercise. And as you learn, you’ve got to be willing to pivot and change because what will happen is, over time, you will understand the challenge that you’re trying to address in different ways. And so therefore, the way you started thinking about solving for that challenge may not make sense anymore. This kind of myth of, you know, two people in the Starbucks writing a business plan on the back of a napkin and then just being dogged against that business plan, not allowing anybody to say no to you, but just keep charging ahead. I would instead say that that is a myth. That’s kind of foolish that the right approach is to be pragmatic, to be open to changing, to be open to evolving what you’re doing, that your your goal is to create solutions at work. Your goal is not to be right. That’s probably my challenge is, don’t be afraid of changing. Don’t view that as failure. View that as success. View that as, when you change, when you have to pragmatically adjust, that’s a sign that you’ve learned and learning is good.
Gary Bisbee, Jr. 19:52
Marcus, well said. Thank you very much for your time this morning. Great having you on the advisory council.
Marcus Osborne 19:59
Thank you so much.