Episode 28: Would you get your eyes checked where you buy your shampoo? Jeremy Kirsch and Steven Wisch of Network Eye bet you will — and they’re bringing eye care to the masses at your local retailer

Justin Steinman:
Definitively Speaking is a Definitive Healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.
Hello and welcome to another episode of Definitively Speaking, the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, Chief Marketing Officer at Definitive Healthcare, and your host for this podcast.
Let's talk about your eyes. If you're of a certain age like me, your eyesight has probably started to deteriorate. You used to be able to read that menu at a restaurant with no problems. Now, well, now your wife's holding the menu up across the table so that you can read it or you're hunched over that menu using the camera flash on your iPhone as a reading light. And for some people, declining eyesight is just the start of the problem. Age-related macular degeneration is the leading cause of blindness among people over the age of 65.
The problem here is that most people don't get tested early enough or they can't get an appointment at their doctor, or they just think the problem's going to go away. Well, the reality is the problem's not going to go away, so you better do something about it.
And that's where the folks at Network Eye think they can help. They're bringing diagnostic eyecare to you. You can get your eyes checked at CVS and then pick up some shampoo and toothpaste while you're there. It's a pretty unique business model because it's bringing specialty care into a mainstream clinic. We're all familiar by now with the concept of basic primary care and vaccinations at our favorite CVS, Walmart, or Walgreens, but diagnostic eyecare is something else.
To dive a little deeper into this topic and their very interesting business model, I've asked two of the founders of Network Eye join me today on Definitively Speaking, Jeremy Kirsch and Steven Wisch. Jeremy brings 20 years of operating senior leadership and entrepreneurship experience to his role as CEO of Network Eye. Jeremy's an expert in starting and scaling software and tech-enabled services businesses, including those that use behavioral science to drive consumer action.
Jeremy, thanks for joining me today.

Jeremy Kirsch:
Hey, Justin, it's great to be here.

Justin Steinman:
Awesome. We're so glad you're here.
Steven serves as the Executive Chairman at Network Eye. He has 35 years of executive management and experience as an investor, C-Suite executive, and advisor to Fortune 500 companies. Steven is the Chairman of Channel Control Merchants, a reverse logistics deep-value retailer, which serves many of the largest retailers in America. Steven, thanks for joining us today.

Steve Wisch:
Thank you, Justin. It's great to be here.

Justin Steinman:
All right, so we're psyched to have you guys here. It's a pretty unique business, and frankly, it's an area of medicine that I thankfully don't know too much about. So, let's just start with the basic for our listeners here. Jeremy, what conditions are you targeting with Network Eye and what services do you provide? And while you're at it, in just plain English, can you explain what age-related macular degeneration is?

Jeremy Kirsch:
Thanks, Justin. I'll do my best. We're we're targeting 100 million Americans who are either living with diabetes or are over the age of 65. These are folks who are at risk for retina disease. The two diseases are called diabetic retinopathy and macular degeneration. We use fully autonomous artificial intelligence to more quickly and simply diagnose, and then our retina specialists will treat these patients right in our retail and mobile clinics.
In plain English, or at least in my New Yorker English, age-related macular degeneration, or AMD, is when the center of your retina, called the macula, wears down due to natural aging. This leads to vision loss. It's one of those unfortunate issues we contend with as we get older.

Justin Steinman:
Got it. That makes sense. So you have diabetics who have this problem and do people get tested regularly for this, or is this like something that their doctor tells them to do? You guys are a new business, but this is an old problem. So, what's the history here?

Jeremy Kirsch:
Yeah, it's a great question. And both folks living with diabetes and the elderly should get tested once a year. The diabetics, for diabetic retinopathy, and the elderly should get a comprehensive eye exam to see if they've got macular degeneration or other issues like cataracts, glaucoma, et cetera.

Justin Steinman:
Right. But people should do it once a year, but they probably don't. Right?

Jeremy Kirsch:
Yeah. What's really tough about this is that a lot of people don't even know they're supposed to get this type of exam every year. And in many cases, you don't see the problem until it's too late. And so not getting the test every year is what causes a huge problem with this as the various diseases progress.

Justin Steinman:
You're probably actually not seeing the is probably more accurate, given what we're talking about here.

Jeremy Kirsch:
Exactly. They do not see the problem.

Justin Steinman:
Exactly. All right, so diabetic retinopathy is when your eyes degenerate and you can't see it. And so you guys have a treatment for this, is that right?

Jeremy Kirsch:
Well, yeah. There are great treatments out there and they've been out there for a long time. What we're doing that's unique is that we're using new artificial intelligence technology to more quickly and less expensively detect the diabetic retinopathy. In fact, this is the first, what they call fully autonomous AI that's being used by clinicians. It means the doctor doesn't need to read the images, they don't need to, in fact, be there. The computer can detect the disease state. And so this is very revolutionary and it's coming to many parts of medicine.

Justin Steinman:
All right, so talk to me about this here. So you actually have got an AI that can read a scan? You got some genius coder back there? Because I know it's not you, buddy.

Jeremy Kirsch:
Definitely not me, but people much smarter than me. So it's actually not our technology. There are several companies that make this, and we're the ones who've sort of brought it into a retail environment, and we've basically shortened the pathway from getting tested to actually getting treatment. So what's really great about this is that the technology can do the read without the physician, and computers are just really good at reading images. In fact, much better than people.

Justin Steinman:
Yeah. And that, I remember. Even back in my days at GE HealthCare, we were working on all this software that could read breast cancer images and lung cancer images and only send the high-end cases or the complicated things to the radiologist to read. You always want your radiologist focusing on the complicated things, not the really basic thing.

Jeremy Kirsch:
Yeah. It's the same in eyecare, Justin. Essentially what we're able to do here is keep the doctors focused on doing the treatment and let AI help with the detection. And that's why doing it in locations such as in a retail location like Network Eye is just such an advantage. It's just simpler, easier, more convenient, and we can get it to more people.

Justin Steinman:
So you have doctors on staff at Network Eye, but not at CVS, right?

Jeremy Kirsch:
Yes and no. We do have doctors on staff, and what we do is we schedule specific days of the week where they are actually in a fully functioning clinic inside the CVS, and they'll do treatment on those days. Now simultaneously, we're able to do the screening using the AI six days a week. So that's what's really incredible about this model.

Justin Steinman:
Right. But I'm not going in and sticking my eye and pushing it. Who's doing the screening at CVS?

Jeremy Kirsch:
Yeah, we've got technicians that are able to do the screening and these are trained ophthalmic technicians, but these sorts of screenings are also being done in primary care offices. So you'll have NPs or RNs or other providers that can do these kinds of screenings. But like you said before, let's keep the specialists at the high end of their degree and let them do the treatment, which by the way, we are doing in CVS. We're doing complex minor surgical procedures for the treatment right there in the CVS clinic, which is amazing. People thought we were crazy for even suggesting that this was something that folks would do, but people have been doing it now for over a year and they really love the experience.

Justin Steinman:
Hold on. I think you're crazy. So you're doing surgery in CVS, next to my shampoo?

Jeremy Kirsch:
Listen, we're doing the workhorse procedures for retina care. And so what does that mean? That means we're doing injection procedures, laser procedures, and these are procedures that, because this is a chronic condition that we need to manage over time, most of these patients that are coming in for either diabetic retinopathy or macular degeneration, they're coming back two to 12 times a year every year to get this kind of care. And what we've done is we've created a very consumer-friendly, convenient experience. And when you come into our clinic, which is inside the CVS, it's a nicer clinic than you'd go to at a specialist private practice office.

Justin Steinman:
So there's probably a MinuteClinic in the CVS, and then you guys are next door?

Jeremy Kirsch:
Yeah. So you've got the MinuteClinic and then the pharmacy, and then we're right there next to it, and we've got our own branding and we've got our own staff that's there to manage the patients when they come in.
But let me tell you, it really is an amazing experience for a lot of patients who either don't have a physician today to help manage these conditions, or we have many patients who are switching to come see us because again, it's just more convenient. They love the fact that they can go pick up medication, come see us, and then like you said, pick up their shampoo as well before they go home.

Justin Steinman:
This blows my... I'm still stuck on the fact you're doing surgery in CVS, but we'll come back to that.
So Steven, you're a guy who's built businesses, you've scaled businesses. How does this thing scale over time?

Steve Wisch:
I have built similar businesses. I built a retail business, a reverse logistics retail business that serves the mass underserved market in America and supplies them with all kinds of merchandise for clothing, health and beauty supplies, furniture at the lowest possible cost. This business is a similar business and excites me because it serves the mass underserved market with retina disease, people who have diabetes and those who are over the age of 65. And we're making it more accessible, more friendly, lower cost, and still of the highest possible quality, which is super, super exciting.
And in essence, what we're doing is providing health equity to Americans and we're trying to change healthcare in a significant way as a result and making it more accessible for all.

Justin Steinman:
Wow. So we've got surgery at CVS compared to a furniture business, a low-cost furniture business, and reverse logistics. We are all over the place today, guys. This is great.
So where do you guys go next with this? Do you go to 10 more CVSs or do you go knock on Walgreens' door and go, "Hey, look what we're doing with CVS. You guys want in?"

Steve Wisch:
So we're in the process of having discussions with CVS about expanding our pilot to other markets and we're deep in discussions about picking the next markets with them. We're also in discussions with all the other major retailers who are very interested in what we're doing. It's likely that the next step will be an expansion with CVS, but it's a possibility that we will test with some other retailers in other markets as well.

Justin Steinman:
Got it. So it's just about diabetic retinopathy or are there other diseases and other things you guys can treat? Do you guys envision yourself replacing optometrists and ophthalmologists completely?

Jeremy Kirsch:
We're certainly not replacing the ophthalmologist or the optometrist. So right now, as we discussed, we're treating all retina diseases, which are both diabetic retinopathy, number one; and macular degeneration, number two. So those are the two disease states. And what we're doing is we're taking advantage of the AI. The AI is going to become available for macular degeneration, for glaucoma, and other eye diseases because as I mentioned, AI is very good at reading images.
Now, where does it go next? Fully autonomous AI, there's a whole pipeline behind this. So you've got things like you mentioned, for cancer screenings, you've got things like when you take retina images, they're doing a lot of studies right now where they can detect biomarkers for Alzheimer's, for Parkinson's disease, for cardiovascular disease.
And so as the testing gets more advanced, what we believe is going to happen is you can then start to manage some of the care, again, in a retail health environment. And so you can bring the specialists into, like you said, next to the MinuteClinic, into the MinuteClinic so that you can keep folks out of more costly centers such as private practice offices, or God forbid, the hospital where it's the most expensive to manage these patients.

Justin Steinman:
I'm glad that you brought up cost. I guess one of these questions I have is guys chose to put this in a retail store and not put it in its own private practice. You could have set up your own shingle and brought your technology there and done that. Why'd you choose to go to a retail store?

Steve Wisch:
So if we set up our own shingle, it would be essentially a doctor's office. There are lots of retina practices around the country. The idea, and when Jeremy and Lindsay, Dr. Smith and Dr. Achenbaum, came to me and talked about bringing healthcare to the mass underserved market in a retail setting, I said, "That's getting to exactly where the puck is going."
This makes it much more friendly and much more accessible. There are many Americans that don't trust their doctor like the three of us do, and they do trust their local CVS or Walmart or Walgreens, and they're constantly going, obviously, to pick up their shampoo as we said, or the deodorant, and it's very easy to then get your eyes tested. And once we work with you and you have pathology and we discuss with you what the next steps are, it's very natural and easy to come back to see our doctors in our clinic again and again.

Justin Steinman:
I think regular listeners to this podcast know that I spent a number of years working at CVS, and while it's been about three and a half years since I left there, I do recall that there was some stat that the company was very proud of, that 70% of Americans live within five miles of a CVS, which is astronomical if you actually stop to think about that statement for a second.
And then when they were building out these whole health hubs, one of the initial concepts was having it be a place where frankly, retired people came and hang out and got their socialization. And in my town, they all go to Dunkin' Donuts and have coffee there. CVS is like, "No, no, no. Come here, get your healthcare, we'll give you some coffee. Maybe you'll get some counseling about what's bothering you." It seems like you guys are trying to play into that whole model.

Jeremy Kirsch:
Yeah. I mean, essentially healthcare services that are well-suited for the retail environment are very good business for someone like a CVS, and obviously for the other big retailers. So on a revenue per square foot, on a profitability per square foot, these are great businesses.
So the fact that we've taken about 600 square feet of retail space, transformed it into a small clinic, and have a place where not only patients, but their caregivers come back, as I mentioned, two to 12 times a year every year for care, that's a tremendous business for a CVS where they want people coming in to pick up stuff at the pharmacy, to use the MinuteClinic for other healthcare services, and as you mentioned Justin, to pick up other stuff at the store.
Now, the one thing I will say that is amazing about retailers and retail health, the data that they have on what people are doing, whether it's what they're picking up in the pharmacy or what they're buying in the front of the store, being able to figure out what healthcare services they might need is something that we're helping connect the dots on with this kind of service. And that's really, when you talk about getting into a much more convenient, lower-cost healthcare system, these are the kinds of things that really move us in that direction.

Justin Steinman:
What kind of dots are you connecting there? Talk to me a little bit more about that. Give an example.

Jeremy Kirsch:
Yeah, so a great example. You've got folks who are picking up their metformin at the pharmacy. Metformin is one of the most common treatments for folks living with diabetes. Well, those folks, as we mentioned before, every year, should be getting their eyes tested. So if their pharmacist asks them, "Have you had your eyes tested this year?" And then says, "By the way, you can just walk over there and the Network Eye team will test your eyes," or if they're in another CVS location, if they let them know, "Hey, by the way, at the CVS down the road, you can get your eyes tested," this is how you start to connect the dots. And in many cases, some of those patients have no idea they're supposed to get their eyes tested once a year for their diabetes.
So this is how you start to connect the dots, and we see this happening every day as we're running this business.

Steve Wisch:
Another example, Justin, is if you have an ExtraCare card and CVS notices that you are buying ARED vitamins, which means that you might be an early person to get macular degeneration. Obviously, it's got to be done in a legally compliant manner, but you can then say, "Justin, we see you're buying AREDS. Did you know that you can go to your CVS and get your eyes examined once a year?"
So it's very easy, very simple, and people do it. It's just much easier. Everyone's busy. You've got family to take care of, you've got work, you've got all kinds of responsibilities, but everyone goes into their local CVS or equivalent, picking up things, and if you could then just go get your eyes examined, why not do it that way?

Justin Steinman:
So do you guys pay CVS rent? Do you guarantee them a certain amount of revenue per square foot? Do they get a cut of your services? How's the financial? What's in it for them?

Jeremy Kirsch:
Essentially, there's a license fee right now for us to use the space that we're in. And you have to be careful in healthcare, as I'm sure some of your listeners know, about doing rev shares. So right now, there's a license fee. Obviously, there's a lot of benefit that CVS gets for this getting done with the foot traffic that's coming in, for people spending more money while they're in the store.
We didn't talk about the benefit to Aetna, which is tremendous because this is one of the quality measures. Getting your eyes checked for diabetic retinopathy is a huge quality measure. And so that accrues to the Aetna side of the business. So there's all sorts of benefits, synergies and benefits that CVS gets.
As we look to expand it, obviously there are legally compliant ways for us to work together with an affiliate or joint venture-type model, and those are the things that we're looking at now.

Steve Wisch:
Yeah. I would say, Jeremy answered the question, but going forward as we expand, hopefully we'll partner more formally with CVS and they'll be an investor and they could benefit from the economics alongside us as well. So they're not just leasing a space to us, but they're actually part of what we are doing and as we grow together.

Justin Steinman:
So Jeremy, you brought up the Aetna piece. That's really interesting to me. Aetna, for those who don't know, is a commercial insurer and they pay for provider healthcare. But does Aetna pay you? Who pays your bills? If I go in and show up, and I don't have Aetna, I have Blue Cross Blue Shield, do you charge Blue Cross Blue Shield? How does this all work?

Jeremy Kirsch:
Getting this sort of testing and treatment is all covered by your medical insurance. So whether it's Aetna or Blue Cross or Cigna or UnitedHealthcare, that's who we're charging on a fee-for-service basis, both commercial but also Medicare and Medicaid patients. So it's covered by all the insurances and that's who we're charging.
And we're looking to do some really interesting things as well around value-based care, which hasn't been done in retina before. So there's quite a few things that are interesting as the market evolves around how patients are best taken care of. But yes, it's all covered. And if you're uninsured, people can also cash-pay for a service like this as well.

Justin Steinman:
And government pays for this with Medicare and Medicaid, I would assume.

Jeremy Kirsch:
Absolutely.

Justin Steinman:
You said interesting stuff with value-based care. You want to give us a little preview there?

Jeremy Kirsch:
Yeah. I mean, I don't want to give away all the secret sauce, but there are ways for us to manage folks who are living with diabetes, at least in terms of their eye health, and the elderly, mind you. So these are some things that we're talking to some of the plans about. We're also talking to some of the primary care providers about, but as you know, it's a big trend right now in the market, and as long as we're able to provide great care for patients, it's something that we'd be open to doing for our patients as well.

Justin Steinman:
Got it. And you said earlier this was one of the measures for Aetna. What does that mean?

Jeremy Kirsch:
So every insurance plan has certain measures, quality measures, that they're trying to achieve, and preventative screenings are a big part of that. The theory obviously is that if everyone gets their preventative screening, you can save cost over time for these members and for these patients.
So a diabetic retinopathy eye exam, like we perform six days a week, is something that all the insurers value very highly because they actually can make more money from the government if they hit these certain quality scores. And it's good because it's good for the patient in the long term to have these things done as well.

Justin Steinman:
Got it. All right. So let's pivot here and talk a little bit more about retail healthcare. We'll call you guys retail healthcare experts, right? You guys seem to have earned that credibility.
So according to some data that we pulled from our platform, over the last five years, the use of retail clinics has grown 200%, which is more than urgent care centers. Those just grew at 70% over the same time period. Meanwhile, use of emergency rooms declined by 1%, and claims filed at primary care offices declined by 13% all over that. So you're looking at explosive growth of retail clinics, fast growth of urgent care, and everything else declining. What's driving the change toward retail medicine?

Steve Wisch:
I would say that medical care in America is too expensive and it's not accessible to most people. And retail health is one of the best solutions to adapting to that and making it, as I said before, more friendly, more accessible, and we think it could be done in a lower-cost way. There are many ways to do that in a retail setting. Obviously we're using artificial intelligence-enabled technology, we are bringing the patient directly to our clinics to get tested and treated, so we're eliminating the need to go see your ophthalmologist directly and going right to our clinic.
So I think the purpose here is there are so many retailers around the country, and with online commerce growing, the retailers need people to come to get more foot traffic. This is a great way to do it, to bring additional foot traffic into a retail setting, and to make it easier for people to get the best healthcare possible.

Justin Steinman:
So following up on that, there's no debate that retail clinics make medicine more affordable. According to some research we've pulled up here, the average charge per claim for a type 2 diabetes [inaudible 00:23:37] without complications last year was $160 bucks at a retail clinic, $239 at an urgent care center, $367 for a physician outpatient visit, and a whopping $505 for a hospital outpatient visit.
Now, I'm not very good at math, but last time I checked, $160 is significantly less expensive than $500. Do you guys think you can drive similar cost savings for eyecare in a retail model?

Jeremy Kirsch:
For sure, Justin. I think again, part of it, Steven mentioned two things that are sort of cost out here, for not only the patient but for the system more broadly.
So one, the use of the newly approved AI is generally a lower cost, at least so far, has been a lower-cost test. So for example, the test we do is about a $45 test. That's what it's reimbursed for by Medicare, versus a more traditional physician, comprehensive eye exam, which cost about $100 to $150. So if we take $100 out of every test and there's 40 million people with diabetes and they're supposed to get this test every year, you can run that math. That's about $4 billion of savings, just on this one test.
And so you can take cost out obviously with the use of AI. And then Steven mentioned something else that's important is that by being able to do the testing and then go right to the specialist who needs to treat you, you can avoid going to the generalist. That also will take out the cost, but the time of that visit, which might be a couple of hundred bucks. So there's a few ways here to take cost out. By our math, this looks like billions of dollars in savings as you start to enable some of this more rapid testing and avoid sort of a longer care pathway.

Steve Wisch:
We're also using behavior change education, so we're educating the patients right there. And rather than dilating your eyes, getting a photograph of the back of your eye, sending it to a laboratory, finding out 24, 48 hours later, we're telling people the result in less than five minutes, and then we're educating them on the spot about their pathology potentially, and how to deal with it. That's a huge change because a lot of people, they hear back from their doctor two days later. By then, they're on to the next thing and they forget about it, they ignore it, and it will result in blindness if not taken care of.
So there's less drop, if you will, to treatment of this pathology as a result of what network Network Eye is doing, which we're very proud of.

Justin Steinman:
Yeah. It really seems like you almost got a realtime component there. You're taking cost out, and that's pretty big numbers you were talking about there, Jeremy, but you're also maybe getting probably better outcomes by getting people engaged.

Jeremy Kirsch:
Yeah. This whole thing about getting folks engaged, the technical term is this loss to follow-up for patients. If we can reduce the loss to follow-up, when someone finds out about something, then we're able to manage the disease better. And Steven's right, this is a huge benefit of being able to do things in real time.

Justin Steinman:
Where do you guys go next? Steven, you mentioned health equity earlier, and health equity has been a big theme of this podcast across so many of our episodes, as guests have come on and talked about how they're increasing access in all sorts of different areas. Do you guys go more urban? Do you go more suburban? Do you go rural where there are massive health equity issues? How do you think about that type of area?

Steve Wisch:
We're starting out in urban areas, that's where the density is, but this problem is everywhere. And we're also starting out in retina, and we've got a lot to do in retina, but there are other subspecialties. Jeremy mentioned dermatology and other areas. That's down the road.
But I would say in addition to urban, there's no doubt, if you look at rural America, it is very hard to find a retina specialist. So we hope to do all, but we have to start and take some small steps. And right now, we're focused on urban centers, but to us, there's a huge white space out there and we're hoping, in the months ahead, to expand a few more pilots with CVS and then expand much more nationally. And I would say at first, in urban centers, but the goal for us, and in my other business, we're very focused on underserved rural communities, that's a big opportunity as well.

Justin Steinman:
It would seem to me that rural would really be a huge value-add for you because in these urban areas, you're probably going to have a more affluent, likely better educated, a majority better educated, and you're going to have better access to doctors who could treat this thing versus if you're living out in the middle of Texas, Kansas, middle of the country, far out from a major city, you're going to have a hard time getting care for this. There might not be anybody near you who could even diagnose this.

Steve Wisch:
I would agree with that, Justin. But I would also say in urban areas, while people there generally might be more educated, there are many people still who don't trust their doctor. And that's a big, big issue. And we're seeing this, and the fact that we go into local communities, we talk with churches and pastors, we go to VA hospitals, we're really getting into the community and talking to people. And by the way, we have a mobile unit which does testing in these local communities. That's a real differentiator. And we're getting to people that otherwise would not be accessed and would not see the possibilities of what we bring to them.

Justin Steinman:
So go to church and get your eyes checked?

Jeremy Kirsch:
We've done it, yeah.

Steve Wisch:
You can ask Pastor Dames in Tampa. Done it at his church on Sunday. Sunday morning church, absolutely.

Justin Steinman:
Great. So guys, this has been awesome, but I got one more big question for you. We're going to go about the future of retail health. Big topic. All right? I mean, I feel like it's really one of the major topics of the year. Retail health and ChatGPT, and maybe the two of them together in something. I don't know, right?
But do you see a world where CVS and Walgreens become the mall of the future, or maybe my mall becomes the healthcare thing? Because we're all buying stuff from Amazon. You don't need to go buy greeting cards or magazines or anything else. It's CVS. My mall around the corners half empty. Do you see where people can go get to a mall for healthcare and there's going to be a blood specialist, a bone specialist, a stomach specialist, an eye specialist, either at your CVS or in the local Natick Mall? Talk to me about that. What do you think?

Steve Wisch:
I think yes, Justin. What I am amazed by is we have patients of all socioeconomic and ethnic backgrounds. They come into our clinic and they say, "Wow, this is the future of healthcare." And when they see our clinic, they say, "Wow, this is not as nice. This is nicer than my doctor's office." So I think this is one of the future ways forward. Obviously, we're not going to lose private practices, but this will enhance the market for healthcare in America for all people.

Jeremy Kirsch:
Yeah. And just to add to that, I think the big retailers have tens of billions of dollars riding on this now, just with all the investments that have been made in primary care. So whether it's Amazon buying One Medical, whether it's Walgreens investing in VillageMD, CVS with Signify, and now with the Oak Street Health deal pending, all the big retailers are investing in primary care because they also see this as very important. And primary care is the gateway. It's the gateway into the care pathway.
And then obviously, the next logical piece is going to be specialty. So are we going to have things lined up, like you mentioned, Justin, in a mall-type fashion? I don't think it'll be exactly like that. My view is that you'll have different areas where you might have one specialty here, one specialty there, and have a little bit of a hub-and-spoke. But certainly, as a lot of the testing becomes more ubiquitous, as we discussed, with AI, you're going to be able to do a lot of this, whether it's what we do, which is ongoing chronic condition management with minor surgical procedures, whether it's just monitoring that's happening, but you're going to be able to do a lot more of this, including across specialties, in the retail environment in the coming years. So, we definitely see it that way as things move forward.

Justin Steinman:
Yeah, I always thought CVS was in the real estate business. They've got all these stores everywhere. I said 70%. And 20 years ago, you did have to get your greeting cards at CVS and your magazines and your soap and your shampoo and all that stuff. I got all this stuff shipped to me now from some warehouse somewhere. I don't even care anymore.
So if I'm running CVS, and to be clear, I'm not running CVS, but if I was running CVS, I'd be like, "What am I going to put in all of this retail that 70% of you are by, and healthcare because you still need to touch people for healthcare?" And so that's where I think the opportunity is really for them to kind of go and put this mall concept in and get people to come in there because healthcare is local, and healthcare, you still got to reach out and touch someone.

Steve Wisch:
And don't forget that when you are seeing us for treatment of diabetic retinopathy or macular degeneration, you're typically spending 45 minutes to 60 minutes with a caregiver, and you and the caregiver are always going to go shopping, pick up your shampoo, as we say, and other things. So this is very important for bricks and mortar. The two come together very, very nicely.

Justin Steinman:
Yeah. Well, guys, I look forward to seeing where you're going to go with Network Eye. This has been a great conversation and we'll have you back in a couple of years to see what's going on.

Steve Wisch:
We look forward to it.

Jeremy Kirsch:
Thanks so much, Justin.

Steve Wisch:
Thanks, Justin.

Justin Steinman:
Thanks, guys.
And for all our listeners out there, thank you for listening to Definitively Speaking, a Definitive Healthcare Podcast. Please join me next time for a conversation with Sean Burke, President of Healthcare at Ascend Learning.
Ascend Learning is an education technology company that includes ATI nursing education which partners with over 60% of the undergraduate nursing programs in the US, and is a major provider and administrator of the leading nursing school entrance exam.
Did you know that according to the American Association of College of Nursing, there will be more than 203,000 vacant nursing positions each year between now and 2031? Sean and the Ascend Learning Team are trying to tackle this problem, and he joins me next time to talk about the state of nursing and nursing education today. I hope you'll join us.
If you like what you've heard today, please remember to rate, review, and subscribe to the show on Apple Podcasts, Google Podcasts, Spotify, or wherever you get your podcast. To learn more about how healthcare commercial intelligence can support your business, please follow us on Twitter @DefinitiveHC, or visit us at definitivehc.com.
Until next time, take care. Please stay healthy, and don't forget to get your eyes checked.