The Health Management Academy

Episode 13

Innovating with Speed at Scale

Featuring Cheryl Pegus, M.D.

Episode Description

In this episode, Cheryl Pegus, M.D., the EVP of Health and Wellness at Walmart, joins Renee at The Table. Dr. Pegus takes us through Walmart’s healthcare progress and future vision. Later, they discuss how scale and speed can go hand-in-hand, data as the key to move from talk to action, and how to support the next generation of leaders.

About Our Guest

Cheryl Pegus, M.D., EVP of Health & Wellness, Walmart

Dr. Cheryl Pegus is Walmart’s executive vice president of Health & Wellness. In this role, Cheryl will develop Walmart’s bold healthcare vision, leading Health & Wellness across the Walmart enterprise. Additionally, Cheryl is co-founder of A New Beat, an organization dedicated to improving the cardiovascular health and careers of women and underrepresented minorities. She sits on the board of the American Heart Association and is the immediate past board chair for the Association of Black Cardiologists.

Read more here.


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Renee DeSilva 0:07

Welcome back to The Academy Table. I’m Rene DeSilva, CEO of the academy and your host, we are back from our break, and excited to share a new slate of conversations as we round out the year. And that starts today, I had the pleasure of welcoming a colleague and friend, Dr. Cheryl Pegus. Walmart’s Executive Vice President of health and wellness.

In recent years, Walmart has expanded its healthcare offerings, there will be 48 standalone Walmart health centers open by the end of next year, and currently 5,000 Walmart stores, many with pharmacies and vision centers. To give you a sense of Walmart’s reach, let me highlight one stat that Cheryl shared 90% of Americans have set foot in a Walmart over the last year, and 70% in the last month. And so, as I reflect on our conversation, a few takeaways come to mind.

First, I want to underscore again, the scale at play here for Walmart, all the numbers are impressive on their own, I was most struck by Cheryl ability to balance that scale with the desire to move quickly and decisively, as members of the academy community and any leader of large organizations now, scale and speed don’t often go hand in hand.

Next, Cheryl is a strong believer in the data and continually measuring your impact, she’s very clear on that. You’ll hear that passion come through in the many numbers that she shares. Walmart is able to change strategy based upon zip code level feedback, and by listening to their more than 1.6 million associates. And Dr. Pegus cites those metrics as a key way to move from talk to action.

And finally, from a leadership lens, I appreciated her reflections on equity, belonging in the role of social networks, both informal and formal. Listen to how she describes the power of focusing on those who talk to you instead of about you. And the ways that we all can remove obstacles as we look to help support the success of others. So with that, let’s head to the table.

Good afternoon, Cheryl. I’m so excited to have you at the table with me today.

Cheryl Pegus 2:33Thank you, Renee, for having me. We’ve planned this for a little while. And I’m thrilled that we finally get to do it.

Renee DeSilva 2:39Yes, me as well. You were one of my most hopeful guests. And so I’m glad that it’s coming to fruition a lot to unpack with you. So let me jump right in. So when I think about an organization that is uniquely positioned to move healthcare forward, it’s hard to not just reflect for a moment on Walmart’s scale. And so at a very high level, 5,000 stores serving 2 million people at one clinics 4000 pharmacies just an incredibly strong platform. So then reflect for me if you would on with all that as sort of table stakes. How do you encapsulate Walmart’s vision for its healthcare work?

Cheryl Pegus 3:21I want to just emphasize a couple of years statistics because I think they’re important. 90% of Americans came through a Walmart in the last 12 months. It’s unbelievable. 70% in the last month, if you look at where Walmart’s are located, we have 5100 stores 4000 of them are in HERSA-designated medically underserved areas. This is where Sam Walton built Walmart’s understanding the access points needed for everyday things like milk and eggs and clothing for your children. This is where he builds them in America. So they’re in rural America. They’re an underserved communities. And so when I think of what I do, following a mission that has been really strong and how do you give people an ability to have everyday low cost at everyday low price, and to live better, I’m building upon that with what we’re doing in healthcare, and ensuring that our access that we provide follow the overall Walmart principles of cost and access, but add into that from a healthcare perspective, quality and improved outcomes. Our strategy is to be an integrated omni-channel healthcare organization that utilizes data and technology to improve three things that we can measure engagement, health equity and outcomes.

Renee DeSilva 4:56That’s so cogent and clear and I like how strongly the mission comes through applying the original mission and extending it to healthcare. So let’s unpack that further. When you think about or when we reflect that so much of health care exists outside of the doctor’s office, take us through the component parts, you have some conviction around needing to have in order to fulfill that mission of cost, access, quality and improved access.

Cheryl Pegus 5:28Yeah, so here’s what I would say for most people today, visiting a physician when they’re not sick. We all talk about this. So I’ll just say it, you may spend 15 minutes with your doctor. And you may do that twice a year, many of us once a year. That’s your health care, if you believe that the interaction with your doctor is all you have to do for health care. But what do we really know? And what is science taught us? Health care is how do you feel in the community that you live in? Do you have access to fresh food? Are you able to have physical activity, be it walking, or access to a place where you can get exercise, and by the way, I just want to give a plug for walking still the best free exercise that we all can do. But you also need if you have been diagnosed with high blood pressure or with diabetes, to take your medicines and to take your medicines, you actually have to be able to afford your medicines. And if it’s complicated, like diabetes, which is a challenging condition to manage, you have to understand how to do your finger sticks. When should you adjust your insulin? Is there something you should do about your diet? What if you get sick, it is extremely complicated. These are not things, however, that we need a doctor to help manage doctors on needed to care for people where they’re diagnosing an illness, and where they’re helping someone to find the right referrals that they need in health care, and managing people with complex illnesses, cancer, a heart attack, what we need others to be part of the team and helping people achieve their best health. And so who can help you need fresh food? Well, you need a place where you can get it. And you need a place where it’s affordable. I did not know this before coming to Walmart. But Walmart is the largest provider of fresh organic food in the country, including where I’ve said we are at the lowest price, we need to ensure that we are bringing that to health care because we already have it. Health care, you’ll want 100% of Being Well is made up of 20% Visiting doctors only 20% 40% of your health is based on Social Determinants what I was just talking about fresh food, access to a place where you can exercise access to a place where you can afford to have fresh air where you can afford to be able to open your windows, be able to get the things that you need, and be in a place that allows you to lower the stress levels. Mental health when we think about it today, it is a social determinant. Yes, you may require to see a psychiatrist or psychologist, but the stresses of daily life of whether you can afford food, afford your medicines, whether you live in a safe environment, having an incredible impact negatively on people’s health. So we’ve got to address social determinants. personal behaviors make up that other 30% If you have high blood pressure, if you’ve been told you should do your blood pressure check at home. Do you even know what an ambulatory blood pressure cuff is? Has someone taught you how to use it? You don’t need doctors for these. What we hope in what we’re doing at Walmart is what supplementing what doctors do with the things that you need to do on your own, that we’re empowering you to do that. So we use community health workers to help you gain your health insurance. Have you applied for Medicaid? Do you have trouble finding your drugs? Do you know how to apply for a pharmaceutical company aid program for your medicines? We’re helping people do that, while helping them figure out the right foods that they should be eating while helping them with how do you access test strips for diabetes. We last year launched our own brand of insulin called rely on which is 70% cheaper than what’s in market. Again building on the Walton family in the Walmart tradition. chin. So we’re here to supplement what doctors do. We’re not trying to take it over. But there are huge gaps to fill. And we want to be a partner in doing that.

Renee DeSilva 10:11I love that. So let’s just go back to one of those early metrics that you mentioned, 90% of Americans have visited a Walmart across the last year 70%. In that last month, you’ve got such a rich set of data to inform understanding of what’s working. And so I know that you are a strong believer in metrics and ensuring that you can measure the impact. How do you apply that at that level of scale?

Cheryl Pegus 10:37It’s a really great question. And I would tell you, the data really matters because I do think many people rush in with solutions without asking first the people who live in those communities. What do you need? And then secondly, asking the healthcare professionals who are providing care in those communities how can we support you, and you’ve got to do both. And so here are the things we hear from the people who come to our stores. They say their top barrier for medical care, almost 40% of them is the cost, that it’s not convenient. Over 50% of people say it’s not convenient for them to get health care when healthcare professionals want to give it. That’s a really important point, I’ll come back to that 58% of Walmart, customers don’t think their healthcare needs are being met. Two and Three Walmart customers say they don’t meet the requirements for daily fruit or vegetable consumption. And they’re aware, six out of 10, that they indulge too much in bad habits, but they don’t know how to change. Only one and five, say they’ve been told or taught how to change their health behaviors. Just listen to those statistics. These are right, if it’s 90% of people, they’re educated, they’re aware that their health is important to them, they don’t have a trusted place to turn that’s accessible and affordable. And so the ways that we are looking at that is we first collect that data. And then we continually collect data. So I’ll pick one, when we asked people if they can afford their insulin, only 60% of people who come through a Walmart and with health insurance said they couldn’t afford their insulin. That’s a key metric. We then look at data across the country front collected by other organizations, and we knew the high cost of insulin is a really big deal. Now you can address that by thinking, Okay, how do I work with an insurance company for coinsurance, but what you’re really seeing is that the overall cost kept increasing, you could say you should manufacture your own insulin, you could do that starting de novo. And that would take about five to eight years to come to fruition. Or you could partner to bring a product to market within two years, setting the cost standard for what you would like it to do. And partnering with someone who’s already has a product that’s been FDA approved, which is what we did, we partnered with Novo Nordisk we now have a rely on insulin, it is our own branded insulin that you can get at Walmart physicians prescribe it. And in the last nine months, we’ve saved people who were paying for their insulin over 15 million just by having that product available. And we haven’t even market at it. That’s unbelievable for us, the ways we’re doing it is first word, identifying the gap, looking at what a cost-effective solution will be looking at the utilization, and then launching it at scale, which is what we’re doing now. And so for us, that’s how we’re using the data. The other thing that we do is we measure not just in these health care areas, but we will look at hearing, we will look at what times are best for you to see a clinician, we take that data and we’re building our models out. And then we ask people every week, how are we doing? Do you feel like you’re getting the care you need? We do it independently in each of our lines of business. Pharmacy gets screened our clinics, our optical sites, and we’re thrilled to say that we’ve really leaned in on this. And our NPS scores are up 10-15 points across all of our businesses and our Walmart clinics. It’s at 81 and our pharmacies, it’s at 78. In our optical sites. It’s at 71 What For doing to get those things I believe is the most important thing you can do in healthcare right now, which is what taking care of our own associates, which is what we call our Walmart employees. We’re asking them, what do they need so that they can go out and care for the community and be it in, hey, we need to adjust the staffing, our lunch hour should be different, our training should be different. Here are areas where we’d like more education, we’ve really leaned in, in that Quadruple Aim component of care for your associates first, and then they will provide the best care for the communities, again, using data to help drive us forward in what we’re doing. So we know where we need to lean in more. And we know where we’re getting, frankly, not great feedback. That’s really important for us as well.

Renee DeSilva 15:54Yeah, as you’re running through that, what I’m noticing is just the power of an organization, with roots in retail, applying that zip code-level insight to the healthcare challenge. And I think that when we this lot of conversations around the role of consumerism and driving health, I think this is a really good example of how that comes to life through the core DNA really applied towards solving some of these big access and care gaps. I think that’s an incredibly powerful example.

Cheryl Pegus 16:26It’s interesting, I say this to many people, so I’ll say it here. It is an incredibly humbling coming into Walmart, and looking at how they see the communities they serve, zip code by zip code, we 80% of the immunizations for COVID. We did were in underserved communities. And the reason we were able to do that was because of the infrastructure Walmart already had of understanding these individual communities, as you said, Renee, zip code by zip code, and a key factor in that I think everyone’s aware of Walmart has 1.6 million associates in the US. It’s because our associates live in those communities. And so we’re not just asking the communities, we’re asking the people who work at Walmart, what do you need for your health? What do you need for your family’s health, and being humble and partnered enough to make sure that we’re meeting their needs, and if we’re doing it, they are proud to go out and help us meet the needs of the communities. I can recall having horrible weather in Texas when we started doing COVID vaccines. And we had people who would sleep in their cars to keep the vaccines at the right temperature, or a pharmacy having a fire in Mississippi, and people driving to the parking lot so they could continue to serve their neighbors. That feeling of ownership and accountability. And knowing your community is definitely in the DNA of Walmart. And it has been a privilege, frankly, coming from healthcare to a place who not only understands their consumers and their community, but a willing to have everyone feel as if they can influence where they live, that it’s just a unique approach to how you manage a business and 1.6 million people within that business.

Renee DeSilva 18:34Yeah, so say more about that have there been other and I’m gonna get to your personal background in a minute. But you came with such deep healthcare roots and background as a physician and then as a leader as well, what other what else other than that deeply locked into the associates and how they view the world and obviously, the sort of zip code analysis. Were there any other big surprises or humbling moments as you settled into your role there?

Cheryl Pegus 19:00That Walmart’s probably the largest organization in the country. I’ve worked, again, in many healthcare organizations. I enjoy working in organizations where you can do something at a large scale, but I also like working in innovative organizations that can move with speed. My biggest surprise and learning at Walmart was how speedy this organization as I would put them up against any speedy organization. We were the first to do the digital vaccine record. We just built it partnered and got it done. We were the first to introduce the ability to schedule online. We just did it and got it done. When I came into WalMart, it was during COVID. And we knew that many people in the communities that I’ve mentioned, are medically underserved areas, but to get access to health care. You need telehealth, probably one of the fastest acquisitions out there, we went ahead and acquired a telehealth company. Epic will tell you this, the fastest implementation of epic at scale at clinics has been done at Walmart within seven to nine months. And so I think the thing that has surprised me is the speed and decision-making of the organization, even at this scale.

Renee DeSilva 20:28Yes, speed and scale often don’t reside in the same center. So that’s impressive. I guess one other thing on that, then I want to move on to partnerships. But advice, then this is something that we talked about, with our health system members, it’s just where I spend a lot of my time on, how do we, as healthcare providers, in particular, continue to move at a faster clip coming out of the pandemic than we experienced on the front end of that, you talk through speed of decision making in a large organization? That probably is very matrix in some ways? Is there anything that you would offer as an insight there around? How do you move with greater speed and intention in decision-making?

Cheryl Pegus 21:09So it’s a little bit of what you mentioned before, you have to have very clear metrics of success, which means you have to have very clear objectives within your strategy, that clarity, and the time spent on that upfront, is critical to being able to move quickly. If you know your priorities, and you’re doing it within a marketplace that you understand that you’re not reacting to every new sound bite, you have a lot of clarity of what you’re trying to do, because the data supports it. And I think that has really helped us. And so I mentioned, everything from our focus on consumers? Well, it’s pretty clear to everyone, our goal was to have a 15-point increase in NPS scores across all of our lines of business, what to do to get there, and you’re getting it measured, you’re getting feedback every week, same thing for associates, we do surveys, town halls, all the normal things, but we’re getting that feedback pretty instantaneously. And then you understand that in the market, where you now have pharmacists who’ve taken on really doing additional responsibilities. And they are, what are the metrics for clinical care by pharmacists that you should have in the optical world, we’re seeing growth and tell optometry and E-commerce, you’re pretty focused on what you can do there. And then a clinic business, you understand the importance of the integration of face-to-face with telehealth and in home. And that value-based contracting is pretty important. If your stretch strategic framework is pretty clear. Your lines of business can be very focused with clear metrics in what they’re doing. And we have found that to be really helpful for us.

Renee DeSilva 23:01I love that. I’m taking notes as you’re talking. There’s a lot to unpack there. All right, well, let me move us on to partnerships, I am sure that there are no shortage of partnership options that cross your desk, given all that we talked about on the front end of this conversation. So maybe comment if you would on the lens by which you assess where it makes sense to partner. And maybe if there are any that come to life in the moment, that would be great to talk through as well.

Cheryl Pegus 23:28Sure. And so I mentioned our strategy, integrated omni-channel organization, pretty simple, but hard to achieve, use data and technology, and then have metrics engagement, health equity outcomes. So we have lots of assets, as you’ve mentioned. 4,100 pharmacies, 3,400 optical sites, 4,000 in medically underserved areas. When I started, we were at I think 18 clinics were at 27. Now, the first thing we needed to do is we needed to connect all of our assets. So if a customer is getting their eyes examined, and they say they have diabetes, they could be asked, gee, are you filling your prescriptions? Can you afford it? We can then say by the way, we have rely on insulin and our pharmacies, you can speak to your clinician, or we can help with that. Or if you’re at the pharmacy, you find out that someone has high blood pressure, but they don’t know that the guidelines say you should measure your blood pressure at home. Can we allow them to be able to access that product within our stores. That connection of that data of that individual to make it easier for them to take care of themselves, required us to be on a platform where we connected all of our health care assets on nestle in a HIPAA environment. This is something that you could have lots of conversations about, well, you could take what Walmart’s already doing, build upon it and have this platform connect to the rest of Walmart. But I mentioned speed. What we also want to be able to do besides do things at speed is connect people who come to our stores for their health care, we’re in our clinics, we provide primary care, then told behavioral health, optical diagnostics. But what if you need to see a cardiologist or rheumatologist, if you need to be hospitalized, we want to be able to connect you from Us stores, to health systems. And so when we look strategically, we partnered with epic to be able to do that, not just across our clinics, but our telehealth asset will be on it. Our clinical services and pharmacy, what we’re looking at doing an optical giving our team one platform to be able to see the needs of our customers and patients, and then giving them the ability to take their data with them when they visit a specialty or tertiary healthcare institution. That type of partnership, being able to do it at scale is really important for us. We are entering Medicare Advantage, fully capitated value based here, we have our clinics. And yes, you could go in and do this, where you’re building out all of the individual assets. But again, speed and scale, we partnered with optim, to be able to provide us some of the AI tools and data analytics that we require, so that we could launch in January of 23. And so our partnerships are based on our strategy, what do we want to achieve? Who are the partners who have the same mission, and there’s a lot of mission alignment when we look at Partners, and can do it at scale and speed with us. And that’s how we’re approaching a lot of our work today.

Renee DeSilva 27:08That is super interesting. And what will be interesting to note would be as you sort of zoom out and think through, we’re anchoring a lot of our conversations around horizon 2030. What is the if you were to take a broad aperture and look at what is the future of health look like with that lens? What’s the bold prediction that we all see. And I like where you’re going in terms of only doing a few things well, and then figuring out where you partner to sort of supplement around those borders. So I think that’s an interesting framework that you mentioned.

Cheryl Pegus 27:40Yeah. And Renee, I also say what we’ve seen, I’ve mentioned managing social determinants of health and which makes up 40% of your health, as you know, if we focused there, and we focused more on being able to really have self-management, and understand the preventive things you should do, from immunizations to knowing your glucose, blood pressure kidney for all the things that we would say you can do, the more we can do that in a way that is easy for someone to do, the better we will have in impacting the overall health care cost and our healthcare ecosystem. We see many people who want us to come into their homes and our community health workers do a lot of that where Walmart already is delivering fresh food to homes, we now have someone who can assess fall risk, we have someone who can help you if it’s difficult for you to travel, we’re making sure that we are putting your health data on your smartphone, you can make an appointment for your eye exam, your clinical exam, your renewal for your prescription right there. And you can tell us Do you want to deliver it? Do you want to pick it up? Do you want to be in store. And so giving people one place where they’re already going to do a lot of things that they’re doing in their communities at Walmart, integrating that to let them know that we’re hearing them, they want one place they want to trust it, they want it open on weekends and on evenings. They want to be able to schedule it. They want to text with us listening to that and responding and making sure that we’re not asking doctors to do those things. Because doctors way overqualified to help with fresh food, way overqualified to be able to help someone fill out the forms to get the right insurance and so we have building out community health workers to do that. I’m a firm believer and CHWs I believe, our healthcare team-based system Under powers, their abilities. Part of that is our payment models. It’s why we are focused on value-based care. It allows us to include community health workers, and we at Walmart are allowing anyone who wants to be a certified CHW. To obtain the education for free throw you learn in university where you can obtain many degrees for free at Walmart, we this past year added in becoming a CHW. And was seeing a lot of growth for people as they’re doing other jobs at Walmart becoming CHWs. And we’re really excited about that.

Renee DeSilva 30:38That’s powerful. All right, I want to transition and talk a little bit about leadership and identity and how you thought about your own career path. And so I’m struck whenever I talk to you about by a couple of things, one of which is just your clarity, for your own role, and just sort of how you see the world. And so let’s talk a little bit about your background. You immigrated from Trinidad, cardiologist by training, many firsts that would probably fall in your category, but one of the first black female cardiology fellows at Cornell, just encapsulate that how does the collective background, your personal experience show up for you and your leadership approach?

Cheryl Pegus 31:21Yeah, so I’ll first start by saying it’s a little bit of what we’ve been talking about, data is really important to me. And it’s really important for me to understand the environments that I’m in. And I say that because if the environment is not conducive, to help me achieve the things that I’d like to do, or in helping me feel the joy in this work. It’s owning that and making choices and making changes. I knew pretty early on that I wanted to go into medicine. I also knew I wanted to be in an environment that allowed me to pursue some of these social determinants. I grew up relatively poor. I had family members who were ill we could not afford health care. There were some interactions that, well, you guys can’t be treated here. I mean, I watched and witnessed all of that, for members of my family, inside a pretty clear understanding of how the healthcare system can treat people who they don’t see as being like them as being other is probably a good way to think about that. And then choosing how I would look at my medical education. I looked at schools that were interested in underrepresented groups, schools that talked about the importance of women’s health, back then, before we even talked about other underserved populations. And I would ask questions, I would ask, look, I came from a high school that did not have AP programs. I went to a college when my freshman year was really hard. I mean, I had kids who had taken AP and had read Homer’s Iliad, I mean, things that I’d never gotten the chance to do. And Brandeis University really supported me. They’re like, Nope, you did really great on your SATs, you will be successful here, and showed me how to easily gain access to tools that allowed me to not feel others to make me feel like I could belong, and allowed me to achieve this career without my undergraduate education. I would not be here today, my medical school, I knew needed to allow me to do that my interest or in social determinants, they’re in public health. They’re in ensuring that everyone has access to care. It’s in making sure that clinical trials and studies include all groups because women, African Americans, Latinos, have different biologies and treatments need to include them in the studies to allow them to achieve their best health. I looked at schools that would let that happen. And choanal really rose to the top, not just in allowing us to be able to explore programs in the communities, but helping us in making decisions. I actually got my master’s in public health before doing my cardiology fellowship, because they knew and I knew that’s where my career was going to go. And so I think it’s really important for you to spend some time on you and know when your income Double, and try to figure out what’s making you uncomfortable. And do you want to lean into getting to comfort because that requires you finding people who want to mentor and support you to get there. It also requires you saying no to people who do not want to see that happen. And that is okay. You don’t need everyone on your team, you do need to lean into the people who want to support you. And so I say to people, there are people who talk to you, there are people who talk about you focus on the people who talk to you, those people will help you achieve the things you want to do. But they’ll also be honest enough to tell you, when it does something you’re doing that you should change the people who are talking about you, they may at some point turn towards you. But by then I hope you’ve built enough confidence in the people who care about you and who care about the mission of your work to know that you can make room just for them.

Renee DeSilva 36:05I love that. I was listening to a podcast this morning—Plain English. Derek Thompson is the host of that—and it was around what’s the secret success is how they framed it in America. And one of the things that relates did with man you just underscored that was the power of social networks to really propel us. And so I think your Brandeis example was, was both that college experience and the people who you were surrounded by that, really what we’re able to sort of it sounds like put you on that trajectory that you’re sitting in today. And so I think I think a lot about that, too. How do we then use the platforms that we now all occupy to do the same for others?

Cheryl Pegus 36:44Yeah, I would just say, and you have to be thankful and grateful for that, and recognize that you may have had luck. But how do you change this from luck to something that’s reproducible. In my medical school a number of years ago, I went back and started a scholarship for underrepresented minorities, because not only was medical school challenging academically, but I also every year had to think about how am I going to pay for it? And where am I going to get grants, you can max out on loans, and you hear everything about medical students and loans. And I would have to go ask great donors to help me pay every year, and I had a lot of support in my financial aid office to do that. But it was work, it took away from being able to study or do other activities. And so I’ve been sponsoring a medical student every year, for the last 20 years. And to your point, it’s how do you take things off the table so that they can realize that there are lots of people like them, and there’s a lot that they can achieve, and you have to help others do that, because exactly what it feels like. And so you can be that voice. I’m not, frankly that far removed from what that looks and feels like, I get it in the places we’re in at Walmart, I understand those communities who don’t trust— We went into Southside Chicago, in a housing complex to give vaccines, why they don’t really trust going other places. If you know that these things exist. Part of your role as a leader is to take not just what the business aspects are, but what some of the softer social skills are, and combine them to meet people where they want to receive health care, because they all want health care. They just don’t know how to trust it. And they don’t know if it fits into their lives, we can help with that we should be the ones breaking through those walls, to get those communities to see us because they were kids watching that, even as they’re looking at what their adults are doing. I was one of those kids.

Renee DeSilva 39:08Yeah, so to that point, maybe our last question before my final wrap up this notion that sometimes things are accidental, but we have now the ability and really the privilege to try to hardwire some of these things. So talk a little bit in that context of Walmart Research Institute, which I think was an idea you had when you first joined and there’s been a recent communication around that. So just bring that mission to life for us if you would.

Cheryl Pegus 39:32I talked about our strategy. I joined Walmart almost two years ago, and I had a couple of things, just that we are going to do. One of them was expanding immunizations, and I say this all the time, if we got HPV vaccines to all teenagers, particularly in these 4,000, stores of ours that are in rural America. Arca 170 million people, we can eliminate cervical cancer. I mean, just think of that. Right? What are the things you should kind of look at that you can do? So one is how do we increase immunizations? How do we improve care? How do we utilize community health workers, but I think I shared as well, for clinical studies, a lot of clinical studies are done and results done and treatments are promoted and developed based on the people who are studied in those clinical trials. And in many clinical trials, women, African Americans, Latinos, people in rural America, are not included in those studies because they don’t have access to the sites where these studies are being done. You have to then rethink clinical studies, you have to say, yep, you may not shut up, set up a big research shop in rural Arkansas. But how do we get people there to participate in clinical trials. And so there’s been a lot of talk about real-world evidence, real-world studies. And what we’ve done is we’ve built out a platform to allow people with different medical conditions, who come through us stores, where they’re located, to participate in clinical trials, for different treatments, they’re able to identify that they’re interested in clinical studies, we’re able to make sure that they get health literate information that explains to them what the studies have for, and while linking with all of the pharmaceutical and diagnostic companies to ensure that they are included, we want to see clinical studies represented communities of America. And so we’re really excited. We actually announced it today that we’ve launched a Walmart Health Research Institute. And I’m thrilled by the team we’ve recruited to lead that. And they are really building out I think something that I hope will be a model for how you develop treatments for Americans, utilizing all Americans.

Renee DeSilva 42:11Incredibly powerful. I look forward to tracking the progress their final wrap-up question, it’s one that I asked all my guests, which is, for me, a big part of what gives me energy is when you’re around a table with people that you enjoy, and time passes, and you have really rich conversation. It’s where I personally get a lot of my own joy. And so I wondered if you could invite any two people for a conversation at a table that you curated? Who would you pick, and why?

Cheryl Pegus 42:39So one, I’d pick Michelle Obama. And I pick Michelle because people forget that Michelle actually worked in a hospital.

Renee DeSilva 42:51Yes, she did.

Cheryl Pegus 42:52So she knows really, really well of what happens in that environment, but also knows how to focus on a few things to get them done well, and I am always in a learning mode from the best and been none. She’s figured out how to do that, I think at the top Heap of everything that needs to get done so would really be thrilled and honored to have dinner with her. The second person who I think has really influenced a lot of what we think of prevention is Tony Gato, the former dean of Cornell Weill and Tony Gado did studies back in the 70s, that said that we can prevent heart disease and did a study that showed that cholesterol-lowering agents didn’t just need to be given to people when they were ill with heart disease, but you could prevent them from doing it. And what I like about that is taking something where everybody else says, oh, no, no, no, this is only for sick people, and saying to yourself, how do we prevent people from getting sick? What do we do to do that, and I will go out, and I will work. And I will devote my entire research, academic career to letting people know that where we should focus is prevention. And back then when he did that incredibly powerful, not even something we all thought about. We all thought about right? Okay, we’ll get vaccines, we now have antibiotics. And so I really liked the innovative thinking that says I will go out and do what I know is right. And Madison and I will bring people along and he spent his entire career doing that.

Renee DeSilva 44:54That’s right. Well show you’re a force if there’s anyone that can get Michelle Obama to at dinner table. It’s you and I. And if you make that happen, Please invite me I want to crash.

Cheryl Pegus 45:05Definitely. Well, thank you so much for having me really enjoyed the conversation and thrilled at what you’re doing at The Academy and what your team is accomplishing. Congratulations to you.

Renee DeSilva 45:16Thank you. I appreciate it. Hope to see you soon.

Thanks again for joining me at the table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website,, or by subscribing on the podcast platform of your choice, and if you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at I look forward to talking with you soon.