White Paper: Healthcare and Well-being

We are convinced that the answer is not about forcefully shifting from physical to virtual and maximizing the use of new technological capabilities. Instead it is about deliberately utilizing both physical and virtual elements to craft better overall customer experiences. In sports and well-being there are many great examples of how physical and virtual aspects can be combined to create a unique experience. In healthcare the shift from physical to virtual dramatically accelerated when the global pandemic limited access to traditional brick-and-mortar healthcare providers. There are many indicators that the ongoing shift from physical to virtual to experience is not just a temporary trend. We believe that in the future, hybrid customer journeys consisting of a smart combination of physical as well as virtual elements will be the major factor of differentiation to create a lasting competitive advantage.

In parallel, lines between the sectors of well-being and healthcare are blurring and more and more overlaps become apparent. A new ecosystem combining well-being and healthcare is on the rise. Together with the rise of more centralized platforms, we expect a major shift from a hardware-centered, output-­based care model to more solution-focused business models that introduce a value-based healthcare logic at scale. At the same time, we are convinced that such platforms are only intermediary steps towards a truly customer-centered ecosystem that integrates well-being and healthcare.

For most companies direct access to the customer will be a key success factor in the future. Putting the customers at the center of their corporate strategy requires more than PowerPoint slides, however. One of the most impactful methodologies for improv­ing customer-centricity in complex industries such as healthcare, is service design. Service design is commonly defined as a human-centered, proactive approach to designing holistic experiences of services and systems using collaborative, analytical, and creative methods. We plead that service design should not be restricted to the early stages but leveraged as a practical approach for the entire innovation life cycle.

The pandemic has forcefully shifted significant parts of our life from the physical to the virtual world. This is also true of areas that have long been deemed to stay analogue. Across the globe, people are confronted with restrictions in their lifestyle habits. They are, for example, reluctant to go see a doctor based on the perceived risk of a COVID-19 infection. In countries with lockdown, people are not allowed to go to their gym anymore. Surely the latter is a little less dramatic, but due to the duration of restrictions also harmful for individual well-being and health. Luckily a lot of people have found alternatives—mostly virtual ones.

Start-ups and several incumbent players have swiftly adapted their offering of products and services and introduced virtual or hybrid alternatives. This shift to virtual touchpoints happened for us as end customers—healthy or sick alike—across all industries. In the healthcare sector it happened along the entire continuum of care.

For the B2C world it seems certain that business activity will stay virtual, since even before the COVID-19 pandemic, consumer experiences had shifted to virtual to a large degree. Meanwhile, the answer is not so clear for B2B2C industries like the healthcare sector, where virtual touchpoints are strongly rising—although still in their infancy compared to B2C.

Porsche Consulting is convinced that the answer is not about forcefully shifting from physical to virtual and maximizing the use of new technological capabilities. Instead it is about deliber­ately utilizing both physical and virtual elements to craft better overall customer experiences. Hence, the real shift is from physical to virtual to experience.

There are many indicators that the ongoing shift from physical to virtual to experience is not just a temporary trend. We believe that in the future, hybrid customer journeys consisting of a smart combination of physical as well as virtual elements will be the major factor of differentiation to create a lasting competitive advantage.

And with the shift away from physical, it is not only start-ups that reacted quickly to capture the trend. Several incumbent players in the fitness and lifestyle sectors positioned themselves as front-runners—in the truest meaning of the word.

Indeed, these kinds of business models are quite attractive for founders and investors because they ensure recurring revenues and allow one to scale very fast globally. One important part of such offerings is the physical product—like the connected bike or the smart mirror. The physical product increases stickiness and helps build sustainably competitive business models that are much harder for copycats to emulate.

Similar developments can be observed in healthcare. The shift from physical to virtual dramatically accelerated when the global pandemic limited access to traditional brick-and-mortar healthcare providers.¹⁰ In 2020, global venture capital funding for the digital health¹¹ sector totaled USD 14.8 bn in 637 deals—a 66 percent increase—compared to USD 8.9 bn in 615 deals in 2019. The top-funded categories in 2020 included telemedicine, data analytics, and mobile health apps.¹²

But what is the strategy of incumbent players? Their—so far successful—business models have been designed for physical space and a world of face-to-face interactions. Many medical technology and pharma companies are struggling with the transformation from a manufacturer of physical products to a provider of both products and services, digital and physical, along the customer journey of a patient, HCP, or other stakeholders. Only a few incumbents are on the way to transform into players that vertically provide holistic solutions along the care pathways of an indication, or even build horizontal platforms that reach beyond indication areas. The challenge for many incumbent players is how to integrate virtual services with a traditional brick-and-mortar business.

The business of pharma players is affected similarly. The emerging pharma industry trends depicted in Figure 4 ²⁷ are a mixture of physical, virtual and hybrid solutions.

These examples underline the shift from physical to virtual. Some of these examples also make clear how to win with a bold digital strategy. However, virtual-only strategies won’t be the right approach for every well-being or healthcare experience. Most journeys will continue to rely on in-person experiences with some virtual elements on top, where those provide value add for the end customer.²⁸

As shown in Figure 5, key players of the sportswear, medtech, and pharma industries that are on their way to mastering the creation of a customer-centric experience have shown superior shareholder returns over the past decade. Merging non-virtual and virtual touchpoints to create an end-to-end seamless experience for their end customers enabled these champions to outperform their peer group.

To determine where and how to integrate virtual touchpoints, companies need to have a clear picture of a jobs-to-be-done framework as well as a deep understanding of their customer segments. Furthermore, companies have to match these insights with their tech-savviness and willingness to adopt new solutions. The COVID-19 pandemic has been an accelerator to infuse virtual into our predominately physical well-being and healthcare systems. We see it as an initial spark for the adoption of new hybrid or virtual solutions at a scale that has substantially lowered adoption hurdles. A lasting effect that—as in any change process—has just marked the beginning. Virtual and hybrid health is here to stay and grow!

We think that the discussed shift from physical to virtual and hybrid will in parallel increasingly lead to blurring lines and more and more overlaps between the formerly separated sectors of well-being and healthcare. A new ecosystem combining well-being and healthcare is on the rise. 

Particularly as end customers do not draw the line themselves. From an end-customer perspective, health goes beyond the absence of disease and includes many other factors typically attributed to well-being, such as mental well-being, getting enough sleep, and fitness and endurance, as shown in Figure 6.³⁰

Driven by the human urge of the quantified self, the spreading socialization of an active lifestyle, and enabled by new technologies like smart sensors, the two sectors are increasingly merging. Personal health can be significantly impacted by one’s environment and lifestyle.³¹ This evidence is putting a spotlight on how well-being-related services can effectively decrease risk for chronic diseases including conditions such as heart failure, stroke, cancer, diabetes, respiratory conditions, and arthritis.³² In general, there is a growing health awareness in our society. People focus on prevention activities, resilience, and conscious nutrition to stay healthy. They also like to know if their prevention activities work and if and how they need to adapt their behavior and daily routines. That’s why an increasing number of people track their health, e.g. with devices like smart watches or health apps. If signs of abnormality show, medical consultations are triggered earlier on. This shows how the well-being and health sectors are beginning to merge at the edges. 

This merge creates new opportunities for innovative business models that provide seamless experiences between health and well-being from the customer’s perspective. Customers themselves are the most transformative forces here. That’s a huge advantage for the big tech companies. With their direct access to customers through their platform services and famous B2C products, tech giants such as Apple and Google approach the healthcare market more from the B2C well-­being perspective.

Apple’s watch OS 7 delivers enhanced customization tools and new health and fitness features—in addition to the existing ones like the ECG feature: sleep tracking, automatic handwashing detection, additional workout types, and a hearing health feature give greater insight into overall well-being. “We’re energized by the positive impact Apple Watch is having on our customers and are excited to deliver meaningful new tools that support their health, fitness, and wellness,” said Jeff Williams, Apple’s chief operating officer.³³ Furthermore, Apple provides a personal health record (PHR) feature within the health app. PHRs create a link between medical institutions and a patient’s iPhone. Thus, iPhone users can see a central view of their allergies, conditions, immunizations, lab results, medications, procedures, and vitals across multiple institutions, and are notified when their data is updated. In the US, over 500 institutions currently support health records on iPhone, listing more than 11,000 care locations.³⁴    The integration of electronic health records (EHRs) with PHRs with user-­friendly and seamless access and authentication via a smartphone will likely be a game changer in how health data is available and used.³⁵

Google is trying to seize this opportunity as well. At the beginning of 2021, Google completed its acquisition of Fitbit. For more than a decade, Fitbit has helped people around the world live a healthier life and Fitbit has built a vibrant community of more than 29 million active users. Fitbit's latest health and fitness smartwatch, Fitbit Sense, features stress management tools and an ECG app to assess heart rhythm for signs of atrial fibrillation (AFib).³⁶

Google Health has recently announced a feature coming to its Google Fit mobile app that uses machine learning to give users heart rate and respiratory rate readings without the need for any hardware other than their smartphone's camera.^{37, 38} At the same time, Verily LifeSciences (formerly Google Life Sciences) is building integrated solutions to improve human health. The research solutions include products and initiatives to increase participation in clinical research and support evidence generation to accelerate new medicines, devices, digital tools, and care delivery.³⁹ At the same time, their Google CareStudio advances show how an experience for doctors can look when—in typical SAP style—EHRs meet Google’s core competencies in search technology, context indexing, and software engineering.⁴⁰ In a nutshell, all of the examples above show that Google is massively pushing its health strategy.

So far, big tech companies have leveraged their core strategic capabilities to enter the well-being and healthcare market: Amazon is the leading global logistics player, so they started with the pharmacy business; Google has a competitive advantage in data science and AI innovation, so they have applied this to EHRs; and Apple is a device company, so what is more obvious than thinking about smart watches as medical devices? ²⁸ Now let’s also add Walmart to the picture. In the US they launched Walmart health centers, which feature an array of primary medical services, dental care, and behavioral health services.⁴¹ Beyond their brick-and-mortar healthcare advances, they are also building a virtual footprint such as by acquiring CareZone to provide a mobile app that helps individuals and families manage medicine and chronic illness for each member of the household.⁴²

The big tech companies are just at the spearhead of companies that are approaching the healthcare market via the well-being movement: Sports companies, nutrition providers, gyms, and numerous start-ups are on the way. While in the past, incumbent medtech and pharma players have not followed this approach, digitalization has opened up new possibilities. Previously, incumbent medtech and pharma players didn’t have direct access to patients but only to healthcare providers like hospitals, doctor's practices, or pharmacies. Now, they’re starting to seize the potential of virtual care and direct contact with patients. A good example: the remote patient monitoring activities from Medtronic with their MyCare­Link patient-facing apps for heart failure or Abbott, which has extended the diabetes-focused LibreSense remote glucose monitoring platform to non-diabetic patients. With the Libre Sense offering, Abbott now targets athletes who want to optimize their training and recovery with a real-time view of glucose levels. Indeed, the remote monitoring market that tries to improve customer experience is the focus of numerous start-ups like FibriCheck, Myia, and Casana—as well as players like Omodo Health, Ada Health, or Babylon Health, which are by far no longer start-ups but are also fighting for access to the end customer.

One thing is certain: for incumbent players, navigating these converging sectors of well-being and healthcare is not easy. Sports and lifestyle players by origin do not have the capabilities to enter the regulated healthcare market with complex stakeholder networks of policy makers, insurances, healthcare professionals, patient associations, et cetera. While start-ups in this space have historically targeted more the B2C side, they are increasingly tapping into B2B(2C) business models—like, for example, providing preventive health initiatives to companies and their employees.

On the other hand, healthcare players, for example, are not familiar with the fast-moving consumer goods market and do not have the end-customer understanding, agile processes, and corporate structures to play an authentic role in the B2C market. That’s why companies should carefully consider how to approach new opportunities beyond their home turf and evaluate collaborations with other players. However, there can be no doubt that the relevance of direct access to customers will rise. For incumbent players, preserving the status quo around product-centric business models is not an option, even if margins and growth rates in the core markets are currently still positive. In the future, we anticipate the rise of a patient-centered well-being and healthcare ecosystem. If incumbent players do not gain access to customers, patients, and their data themselves, they will have to pay the price for this access to other players—as many do today when looking at rising prices for ads on Google.

As of now, the end customer is merely a part of the system, and certainly does not take the center stage. Other stakeholders, such as payers, hospitals, resident medical professionals or other healthcare providers are only loosely tied together and working with siloed systems and data. We believe that in the years to come, more and more interoperable healthcare platforms will arise. As a combination of vertical, indication-centered, and horizontal platforms, which center around a certain value creation step in the delivery of healthcare, these platforms will increasingly interconnect stakeholders. They will help drive down transaction costs in healthcare and push interoperability. Together with the rise of more centralized platforms, we expect a major—and more disruptive—shift from a hardware-centered, output-based care model to more solution-focused business models that introduce a value-based healthcare logic at scale. At the same time, we are convinced that such platforms are only intermediary steps towards a truly customer-centered ecosystem that integrates well-being and healthcare.⁴³ Even now, Tencent’s WeChat in China with its wide-range of health-related mini-apps provides a glimpse how customers in the future will be able to navigate their entire continuum of care—everything conveniently at their fingertips. Similar ecosystems will arise at the regional or national level. In Europe, these will likely—and hopefully—have a markedly higher emphasis on giving customers control and visibility over their own data.

One of the most impactful methodologies for improving customer-centricity in complex industries, is service design. In a context with fast-changing customer and employee requirements, new adaptation strategies are necessary for developing effective business models. Service design is a strategy that places people in the middle and enables a shift from a focus on products to a service-oriented mindset. It is the role of service designers to guide the organization in their shift to this new way of working, providing a safe space for all to play a role in becoming truly customer-centric. This evolution requires a fundamental shift in mindsets, measurements, and daily practices across the organization.

Service design is commonly defined as a human-­centered, proactive approach to designing holistic experiences of services and systems using collaborative, analytical, and creative methods.

Human-centered
means the subject or object in focus (e.g., a system, product, service, or entire business ecosystem) is viewed from the perspective of the target group—mostly human beings with their everyday troubles, goals, values, and jobs to be done. 

Proactive
means that cross-functional teams strive to “fail fast” and learn early on in the process, with little investment. The goal is to achieve a validated value proposition to avoid costlier changes later in the development and commercializing phases.

Holistic
means that solutions are designed to deal with challenges to key stakeholders who are part of a system and therefore create maximum value for all parties.

Collaborative
means that learning happens together with key stakeholders who are knowledge experts or decision makers for the project. Value is created by multidisciplinary teamwork instead of working in silos.

Analytical and creative
methods enhance and accelerate the learning process. Analytical methods can be, for example, the quantitative simulation of scenarios to derive performance indicators. Creative methods encompass everything from ethnographic user research to ideation methods and experience prototyping.

The benefits to organizations of using design to become more customer-centric are evident. Without the right approach to operationalization, however, it is at risk of becoming just another buzzword. Regrettably, the gap between the statements of executives and the actions of their companies is significant: while the majority of corporations describe themselves as customer-centric, only 11 percent of their customers agree on this “fact”—as a representative Harvard Business Review study revealed.⁴⁵

The direct impacts specific to service design are not broadly quantified in the way most other mature practices have come to expect. However, on a case-by-case basis the results are very clear—for example, service design has reduced hospital admissions, emergency room costs, and the total cost of care savings for organizations like United Healthcare.^{46, 47}

Traditionally, design has focused solely on the needs of the patient or customer experience, leading to change not being fully adopted across the ecosystem due to lack of incentives for all stakeholders in the ecosystem. In order to deliver on the full value of service design, practitioners need to improve their ability to quantify projects through business or value cases that articulate the value for all stakeholders involved in this new service model.

Even so, service design is demonstrating that technology is not the sole answer to business or organizational challenges, especially in the shift from physical to virtual, but an enabler for empowering the customer regardless of how much or how little of that experience is in-person. Design does this by making the time and space for engaging people in the ecosystem, giving them a voice in the plan for desired changes. Moreover, service design is widening the perspective of healthcare to focus on prevention rather than just treatment. This illuminates new opportunities for healthcare companies to engage with new partners or start internal innovation projects that create upstream and downstream opportunities to help their customers– with the target to build ecosystems or platforms offering a seamless customer experience along the entire continuum of care.

(1) Nike, Inc; “FY 2021 Q2 Earnings Release Conference Call Transcript December 18”;Nike, Inc; December 18, 2020;
https://s1.q4cdn.com/806093406/files/doc_financials/2021/q2/NIKE-Inc.-Q2FY21-OFFICIAL-Transcript-with-QA.pdf

(2) Reinaldo Fioravanti; “Nike: Just do it. Differently!”; Harvard Business School; April 30, 2020;
https://digital.hbs.edu/platform-digit/submission/nike-just-do-it-differently/

(3) Baburajan Kizhakedath; “How digital transformation is powering Nike business growth”; Infotechlead; December 27, 2020; https://infotechlead.com/cio/how-digital-transformation-is-powering-nike-business-growth-64623

(4) Maggie Tillman; “What is Peloton, how much does it cost, and are there alternatives?”; TOPi; January 25, 2021;
https://new.topi.io/what-is-peloton-how-much-does-it-cost-and-are-there-alternatives/

(5) Peloton; About Us; “The Peloton Story”; https://www.onepeloton.com/company

(6) John Ballard; “2 overlooked catalysts for Peloton stock in 2021”; The Motley Fool; January 17, 2021; 
https://www.fool.com/investing/2021/01/17/2-overlooked-catalysts-for-peloton-stock-in-2021/

(7) Adidas AG; “New partnership with Peloton”; 
https://news.adidas.com/training/new-partnership-with-peloton/s/aa650037-ffd7-4c70-b482-2b8eb8fe6984

(8) Edelhelfer “VAHA receives investment from Porsche”; November 30, 2020; 
https://www.edelhelfer.com/en/insights/details/2020/11/30/vaha-receives-investment-from-porsche

(9) Lululemon Athletica Inc.; ”Lululemon Unveils ‘Power Of Three’ Strategic Plan To Accelerate Growth”; Lululemon Athletica Inc.; April 24, 2019; 
https://investor.lululemon.com/news-releases/news-release-details/lululemon-unveils-power-three-strategic-plan-accelerate-growth

(10) Teladoc Health; “Perspectives 2021: The path forward for virtual care”; 
https://perspectives.teladochealth.com/

(11) Includes: Social health, mobile health, telehealth, personal health, rating and shopping, health information management, revenue cycle management, service providers, security

(12) Mercom Capital Group; “Digital Health Funding and M&A - 2020 Fourth Quarter and Annual Report”; page 4;
https://mercomcapital.com/wp-content/uploads/2021/01/MercomDigitalHealthFundingMAQ42020ExecSumm.pdf

(13) Teladoc Health; “What we do”;
https://www.teladochealth.com/what-we-do/

(14) Heather Landi; “JPM21: Teladoc projects 2020 revenue to reach $1.1B as it expands virtual primary care”; FIERCE Healthcare; January 11, 2021; https://www.fiercehealthcare.com/tech/jpm2021-teladoc-projects-2020-revenue-to-reach-1-1b-as-it-expands-virtual-primary-care

(15) Zur Rose Group; “About Us”; https://www.zurrosegroup.com/websites/zurrosegroup/English/1000/about-us.html

(16) Zur Rose Group; “Press Release: Zur Rose Group acquires TeleClinic, Germany's leading telemedicine provider”; July 16, 2020; https://www.zurrosegroup.com/websites/zurrosegroup/English/201010/press-releases.html?newsID=2046807&date=2020-07-16%2017:40:02

(17) Deutsche Apotheker Zeitung; “GEMATIK entscheidet und schweigt: Zur Rose liefert Infrastruktur für das e-Rezept“; November 16, 2020; https://www.deutsche-apotheker-zeitung.de/news/artikel/2020/11/16/zur-rose-liefert-infrastruktur-fuer-das-e-rezept

(18) Zur Rose Group; “Press Release: Collaboration between Zur Rose Group and Novo Nordisk”; January 11, 2020; 
https://www.zurrosegroup.com/websites/zurrosegroup/English/201010/press-releases.html?newsID=2056016&date=2021-01-11%2007%3A00%3A17

(19) Philips; “About Us”; https://www.philips.com/a-w/about.html

(20) Philips; “Capital markets day 2020”; November 6, 2020; pages 4, 7; https://www.philips.com/c-dam/corporate/about-philips/investors/calendar/cmd-2020/Royal%20Philips%20Capital%20Markets%20Day%202020%206th%20November%202020.pdf

(21) Royal Philips; ” Philips to become a global leader in patient care management solutions for the hospital and the home through the acquisition of BioTelemetry, Inc.”; Royal Philips; December 18,2020; 
https://www.philips.com/a-w/about/news/archive/standard/news/press/2020/20201218-philips-to-become-a-global-leader-in-patient-care-management-solutions-for-the-hospital-and-the-home-through-the-acquisition-of-biotelemetry-inc.html

(22) Philips; “News center”; https://www.philips.com/a-w/about/news/home

(23) Boston Scientific; “Boston Scientific Announces Agreement To Acquire Preventice Solutions, Inc.”; January 21, 2021;
https://news.bostonscientific.com/2021-01-21-Boston-Scientific-Announces-Agreement-To-Acquire-Preventice-Solutions-Inc; 

(24) Hillrom; “Hillrom Announces Planned Acquisition Of Bardy Diagnostics, Inc.”; January 19, 2021;
https://ir.hill-rom.com/press-releases/press-release-details/2021/Hillrom-Announces-Planned-Acquisition-Of-Bardy-Diagnostics-Inc/default.aspx

(25) Philips; “Capital markets day 2020”; November 6, 2020; page 10; https://www.philips.com/c-dam/corporate/about-philips/investors/calendar/cmd-2020/Royal%20Philips%20Capital%20Markets%20Day%202020%206th%20November%202020.pdf

(26) Further reading: Artur Olesch; “23 steps Amazon, Apple and Google have taken in healthcare in 2020”; ICT & health; January 26, 2021; https://ictandhealth.com/news/23-steps-amazon-apple-and-google-have-taken-in-healthcare-in-2020/

(27) Global Data; "Telemedicine expected to be a leading industry trend in 2021, with some telemedicine apps having reported whopping 8,270% increase in downloads in 2020, says GlobalData"; January 28, 2021; https://www.globaldata.com/telemedicine-expected-leading-industry-trend-2021-telemedicine-apps-reported-whopping-8270-increase-downloads-2020-says-globaldata/

(28) MobiHealthNews; “HIMSSCast: Is virtual care the next frontier in telehealth?”; February 5, 2021; 
https://www.mobihealthnews.com/news/himsscast-virtual-care-next-frontier-telehealth-sean-duffy-and-chris-hogg

(29) S&P Capital IQ; Porsche Consulting analysis; February 15, 2021

(30) Amrutha Shridhar; ”Health and Nutrition Trends: Seeking a Healthy Life”; Euromonitor International; October 21, 2020;
https://blog.euromonitor.com/health-and-nutrition-trends-seeking-a-healthy-life/

(31) Dariush Farhud; “Impact of lifestyle on health”; Vol. 44, No. 11; Iran J Public Health; 2015; pp.1442-1444

(32) Harald Schmidt; “Chronic disease prevention and health promotion”, in Public Health Ethics: Cases Spanning the Globe; Springer; 2016; pp. 137-176

(33) Apple; “Newsroom”; Press release: “WatchOS 7 adds significant personalization, health, and fitness features to Apple Watch”; June 22, 2020; https://www.apple.com/gr/newsroom/2020/06/watchos-7-adds-significant-personalization-health-and-fitness-features-to-apple-watch/

(34) Apple; “Newsroom”; Press release: “Health records on iPhone available today in the UK and Canada”; October 7, 2020; https://www.apple.com/newsroom/2020/10/health-records-on-iphone-available-today-in-the-uk-and-canada/

(35) Dave Muoio; ”DrChrono's open FHIR API lets patients add their EHR to Apple Health Records”; February 19, 2021;
https://www.mobihealthnews.com/news/drchronos-open-fhir-api-lets-patients-add-their-ehr-apple-health-records

(36) Rick Osterloh; “Google completes Fitbit acquisition”; Google; January 14, 2021; 
https://blog.google/products/devices-services/fitbit-acquisition

(37) Dave Muoio; “Google Fit will soon use smartphone cameras to log heart rate and respiratory rate”; mobihealthnews; February 4, 2021; https://www.mobihealthnews.com/news/google-fit-will-soon-use-smartphone-cameras-log-heart-rate-and-respiratory-rate

(38) Darrell Etherington; “Google to offer heart and respiratory rate measurements”; Techcrunch; February 4, 2021; 
https://techcrunch.com/2021/02/04/google-to-enable-heart-and-respiratory-rate-measurements-using-just-your-smartphones-camera/

(39) Verily; “Solutions”; https://verily.com/solutions/

(40) Google; “CareStudio”; https://health.google/for-clinicians/care-studio/

(41) Bruce Japsen; “Walmart opening more healthcare ‘super centers’”; Forbes; June 17, 2020; 
https://www.forbes.com/sites/brucejapsen/2020/06/17/walmart-rolling-out-more-healthcare-services-super-centers/?sh=3641d188202f

(42) Walmart; “Further enhancing our digital health & wellness capabilities”; June 15, 2020;
https://corporate.walmart.com/newsroom/2020/06/15/further-enhancing-our-digital-health-wellness-capabilities

(43) University of Kentucky, UK HealthCare; “The Foundation of the Strategy: Patient-Centered Care”; 
https://ukhealthcare.uky.edu/sites/default/files/2015-2020-strategic-plan.pdf

(44) Jonny Schneider; ”Understanding how Design Thinking, Lean and Agile Work Together”; Mind the Product; September 20, 2017; https://www.mindtheproduct.com/understanding-design-thinking-lean-agile-work-together

(45) Denise Lee Yohn; “6 Ways to Build a Customer-Centric Culture”; Harvard Business Review; October 2, 2018; 
https://hbr.org/2018/10/6-ways-to-build-a-customer-centric-culture?_hsenc=p2ANqtz-9EhICm6Ri-HwCr-rGGTPevPSQi1EiXzRsx2MsFJhh5n6lrQrMbE0QE1x5uVtznQ1FSDku94v5Aq5RdY2Al75rSHPa41w

(46) Healthcare IT News; “UnitedHealth Group relies on user-centered design approach to improve customer service”; June 29, 2019; https://www.healthcareitnews.com/news/unitedhealth-group-relies-user-centered-design-approach-improve-customer-service

(47) Design Museum Magazine – The Healthcare Issue - Issue 017; “UnitedHealth Group and Optum Emphasize the Care in Healthcare”; https://designmuseumfoundation.org/unitedhealth-group-and-optum-emphasize-the-care-in-healthcare/