Episode 1 afterward: Digging deeper into the future of healthcare innovation

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.

Justin Steinman:
Hello, and welcome to the latest 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. On our last episode, we hosted Michael Greeley, founder and venture partner at Flare Capital Partners. Michael and I covered a whole host of topics around the healthcare industry, so many in fact that invited my friends and colleagues, Brittany Morin-Mezzadri and Todd Bellemare, to join me today and record a special episode of Definitively Speaking that breaks down my conversation with Michael. That's what we're going to do today. Let's jump right into my conversation with Brittany and Todd. Here we go.

Justin Steinman:
Brittany, good to be back here with you again. Tell me, what spoke to you about what Michael said on the podcast?

Brittany Morin-Mezzadri:
My goodness, there was so much great content there and it was hard to pick what I thought would be the most interesting for our listeners. What stuck out to me really were two points that I think speak really well to each other. First, you and Michael had a conversation about M&A activity among healthcare IT companies about how new it companies are entering a very saturated and competitive market where these big and established players are acquiring and just scooping up all of these novel solutions and evolving the boundary of their service offerings. What does that look like and how does that affect patients in the next couple years?

Brittany Morin-Mezzadri:
Then you also had talked about retailers like CVS and Walgreens emerging into the provider space, which I thought was really interesting because you had made a comment about it, in the past it's where you got your birthday cards and your shampoo and now it's where I go to get my flu shot. It's a very interesting and not obvious evolution for CVS entering that space.

Brittany Morin-Mezzadri:
The thing that stuck out to me is whether or not these mergers and acquisitions are ultimately good or bad for lowering the cost and access to care if we are consolidating all of this activity through those major companies, or if patients want that diversity to be able to find the type of providers that will treat their longitudinal care needs, as opposed to episodic care needs.

Justin Steinman:
What jumped out about me, you said that 10 years ago I got my razor blades and shampoo and then five years ago I started getting my flu shot. What CVS and Walgreens and Walmart want to do now is they actually want to be my primary provider. They want to do more than just a flu shot. They want to check my reflexes, check my temperature, check my weight, do the whole full primary care treatment of that. I just don't know if I see myself going to the corner CVS to replace my primary care physician, to get a full physical workup.

Justin Steinman:
I know, Todd, you've been thinking a lot about this type. What do you think of this? Would you go to CVS?

Todd Bellemare:
Yes, for sure, but I think that what really struck me about the conversation really starts first and foremost with something that I obsess over, and it's what the future looks like. When we talk about whether it's M&A or technology companies getting involved in the mix, that really piques my interest for sure, trying to see what does the end of the book look like. I am that guy who tries to read the end of the book first to say, "All right, well, how's it end? Let me just figure that out first, then, okay, let's fill in the blanks as we go," or for movies, "Does the dog die in the end? I'm not watching it if it does." That's the thought process that I go about it.

Todd Bellemare:
When we talk about who is going to be doing this, going there for PCP visits or their primary care stuff in the future, it's the kids, right? It's the Gen Zs and millennials. I'm a Gen X, and like I said, if I'm obsessed with the future like that, then I'm a little bit maybe more on the Gen X side that would say, "Sure, I'll go see a PA at CVS to get my yearly physical," or something like that.

Todd Bellemare:
But it is that sea change that we are on the precipice of right now that I think is just so fascinating to talk about and to hear from people that are at the forefront of it, to really get their perspective and start game planning or gaming out what that system looks like in the next three, five, 10, 20 years from now. I mean, there will be things available to us then that we really don't have a language for almost now, for sure. There's some things we can talk about today that really speak to the early days of those changes too, so very exciting though.

Justin Steinman:
Brittany, you're our designated Gen Z rep here.

Brittany Morin-Mezzadri:
Oh, am I?

Justin Steinman:
Oh, you absolutely are.

Brittany Morin-Mezzadri:
I appreciate that, but I am squarely an elder millennial.

Justin Steinman:
Okay. Well, you're going to have to substitute in for that today, because Todd's saying, as his Gen X, he's like, "Yeah, I think I would go." Would you go? Could you use CVS as your PCP?

Brittany Morin-Mezzadri:
That was a really interesting question, when he was talking about how millennials and Gen Z are more likely to, I think so, but I also think that younger millennials and Gen Z are also calling mom and dad to ask about their healthcare needs. Mom and dad are Gen X and Boomers who have experience in the traditional PCP space. I'm interested to see how fast that will shift and what will truly influence that. I think you had made a comment on your conversation that whoever holds or controls the digital interaction on your device be the arbiter of your healthcare. I think that Gen Z and millennials are faster to adopt that type of technology.

Brittany Morin-Mezzadri:
So, yeah, I don't know. I mean, I go there for my flu shot, but I love my PCP so I'm going to go call her if I need her.

Todd Bellemare:
Well, when you think about that, when you think about those apps, like the quantified life concept, where on your phone or your watch or whatever, you can track literally how your health is progressing. If you can imagine a future in where the Walgreens or the CVSs or other technology companies will start taking that data and say, "Hey, you don't really need to go see a PCP at a hospital or a physician group. We can actually take that data and build you a healthcare outcomes plan." That is the type of thing that you would imagine is in the near future, and who are the people that are so used to quantifying their life right now and putting it on social media and all that stuff? It's millennials and it's Gen Z, and of course, as we go forward, generations to come, because it's the comfort factor.

Todd Bellemare:
You think way back, your barber would throw leaches on you in the Medieval times, and then a next step up, there's a traveling doctor that went town to town, and then from there, okay, now we have a hospital where you can go to, and then there were physician groups, and now there's urgent care clinics. Step by step, by step, we're getting to, oh, now you just go to the robot for your care. It's that generational steps as you go, the more comfort you become with what's available to you and what the system is providing, the next generation is going to say, "Oh yeah, that's more convenient. I'm going to take it."

Brittany Morin-Mezzadri:
Let me ask you this, to both of you, who do you think is going to get there first, the retailers or the major health systems?

Justin Steinman:
I think it's going to be the health systems.

Brittany Morin-Mezzadri:
How come?

Justin Steinman:
Call me old fashioned, but I think there really is a role for the primary care physician, and I still think the IDNs, even the IPAs, most IPAs are being absorbed into IDNs these days, are going to own that. The reason is, I think actually healthcare on the phone is very fragmented. I'm going to have my telemedicine provider on there. I might have my Apple Watch and all my exercise on there. I have a sleep thing. If I'm a diabetic, maybe I'm using a Livongo tool or I'm using Omada. I could have 10, 12, 20 healthcare apps on my phone, each one solving a point problem or a point piece of my care. I'm not a doctor, I don't even play one on TV, I don't know how to interpret all of that signals and what that is. Maybe if you connect the data from app A, B and C, I'm really sick. I don't know that, because I'm not trained and I can't connect that.

Justin Steinman:
I don't think that CVS, Walgreens, any place, episodically is going to catch that. I really think you need the more longitudinal care. Whether you get that from your primary care at an IDN, or you get that from a One Medical, which is kind of the outsource, or even a concierge medicine. But that's just my perspective. What do you think, Todd?

Todd Bellemare:
I mean, it is definitely interesting that you brought up the term longitudinal, like connecting all those dots. To me, that sentence leads directly into something like machine learning. We saw a lot in the late 2000s and 2010s where IBM Watson came around and a bunch of hospitals tried it out for oncology care, and it kind of fell flat on its face a little bit. I think as you think about how technology grows year to year, and even Moore's law where computing process doubles every 18 months, once you get into a certain number of doublings, things can get weird. What I mean by that, you think back on 2008-ish, when the iPhone first came out, and that was like, "Oh my God, a touch screen, that's crazy," and within-

Brittany Morin-Mezzadri:
That was only 2008?

Todd Bellemare:
I know, yes, yes. Within a few years, touch screens were on everything, they're in your car, they're everywhere. That's simply a matter of we got past a certain computing process power where you were able to do more things. That's where machine learning started coming out and doing more and being better at what it was supposed to do. However, there was some stumbling blocks, like there is with any technology.

Todd Bellemare:
I think that as we go forward, and Justin, when you said you've got like five apps that are tracking it, who is going to be able to tie that together with a coherent story about what happens to you or what is happening to you? I do think that as we get past that weird stage of doubling and compute power, at a certain point, that we're going to see some weird stuff like, oh, yeah, this algorithm can tell me if I'm about to have a heart attack or I'm about to be diagnosed with diabetes. Those things will be more interesting as we go.

Todd Bellemare:
What I think that will give us, or at least what it will lead to, is something that I read a lot about earlier in this decade, 2010s or so, about The Rise Of The Robots, which was a book, or The Second Machine Age, two books that are right along the same pathway. A big part of those books was talking about, "in the future", what you're going to see is people going to get their healthcare from PAs and NPs with a little IBM Watson in their laptop next to them. A part of a cost of physicians is taken away if you have more NPs and PAs. When you talk about combining that longitudinal data with the contextual knowledge of a PA or NP and those machine learning techniques and algorithms that are going to be much more powerful by 2025, 2030, I think that is what is going to cause the healthcare system to decentralize from where it is now.

Todd Bellemare:
When I say decentralize, I mean like a CVS is saying, "Okay, yeah, we do the front door," which you guys talked about in the last episode. "From that front door, we just made a connection or we have a sister site with Shields MRI. We're going to send you over there." It's skipping over the big IDNs and the ACOs and that sort of thing. That's where I would, in my mind, that's how see it. Especially when I see it being so fragmented in the things that we have at our fingertips today, there's going to be something, we can pull those together. It's almost like we had cable, we decentralized that and now we have all these streaming services and we're going to have to try to tie them all back and someone is going to say, "Hey, I'll tie all your streaming services together," it's like, "Well, that was cable." It's the same thing with healthcare.

Justin Steinman:
But I don't know Todd, and now I'm getting a little PTSD because I spent about a decade working at GE Healthcare Digital. I lived in the EMR wars, right? The holy grail was interoperability and fire and we're going to be able to send data everywhere. Every year I'd go to [inaudible 00:12:32] and we'd have these big data interoperability showcases. Every night, the night before the show opened, our engineers were pulling an all nighter with the other engineers from the other companies there, trying to be able to pass one tiny piece of healthcare data across that.

Justin Steinman:
Yeah, you paint this wonderful panacea where CVS is going to send data to Shields, it's going to send it to Mass General, and I'm calling BS, man. I don't see how it works.

Todd Bellemare:
Oh, that's fair. I mean, that's fair, looking backwards for sure. I think you have to look ... And not to talk too much about this piece, but think of a technology as a chessboard, and on every square of the chessboard, something doubles. There's an old story about the king wanted to give a prize to this person who came up with a chess board and they said, "Give me a grain of rice doubling on each checkerboard for my reward." By the middle of that checkerboard, there were more grains of rice, obviously in theory, than there had ever been grown in human civilization in history.

Todd Bellemare:
Again, when you get to the halfway point of that chessboard, things get weird and numbers that people don't really understand. We're kind of at that precipice right now with computing power, where 10 years ago, when you were having those sorts of conversations and you can't pass that one piece of information, we're going to get in that funny spot where that technology just blows past where our expectations are. That's why I said we're going to get to the point in 10 years from now where we almost don't have language to describe what that new place looks like.

Justin Steinman:
You've probably been hanging out with Larry Ellison and that's why Oracle's buying in Cerner, right?

Todd Bellemare:
Yeah, yeah, exactly. That was the other thing you guys talked about, which I think is super. The M&A stuff, once you start seeing Apple buying a pear, watch out, that's where we're going to see some really interesting shifts in the market for sure.

Brittany Morin-Mezzadri:
One thing I did want to talk about, Todd had discussed the CVS or the retailer serving as the front door to the health system. You had mentioned in your conversation with Michael about how virtual health, virtual care, is opening up access to folks who didn't previously have good access to healthcare or any health access. Do you think that retailers versus typical IDNs serve as competitive entry points or are they supplemental to each other, and how do you think that change is going to affect underserved communities?

Justin Steinman:
I think the one thing you've got to think about with this is geography plays a massive role. I mean, the three of us are sitting here at the greater Boston area where you can't throw a baseball and not hit a Dunkin' Donuts or a CVS, and you've got all these hospital facilities and doctors up and down the street, but if you're living in Montana, there might be a Walmart 20 miles over and the hospital might be 150 miles away. If you got a sick kid at 2:00 in the morning, are you schlepping to Walmart? Even if there's a nurse practitioner there, you're probably not. I mean, I'm fortunate that my kids' pediatrician lives like a mile away, they're there. I think that's when telemedicine really does become the great equalizer.

Justin Steinman:
I think the tangent to that, or the correlation, would be if you're in Montana and you get a rare form of cancer, you're not going to probably find the doctor who's an expert in that, that doctor might be in New York City. With telemedicine, you can now get a consult and get that world class doctor. That was available five years ago.

Brittany Morin-Mezzadri:
I think that, for better or for worse, the pandemic forcing and accelerating telemedicine and virtual care has benefited multiple communities. We're looking at not only the geographic, I guess, disparate locations, where there isn't access to healthcare close by, but we're looking at single parents who can't take time off work to go bring their kid in, but are now working from home and may be able to call their doctor, or if we're looking at LGBT youth or adults who may not feel comfortable sitting in a waiting room waiting for their doctor for care, or women's health to discuss, I guess, sensitive topics that they may not want to announce in a waiting room to announce why they're there. I think that virtual care and telehealth and easy access to those locations like CVS where you can get immediate care benefits a lot of folk that may not have had access before, but in the long term, can we track those patients to provide ongoing lifetime care?

Todd Bellemare:
Right. I think when you talk about the things that the pandemic has laid bare, certainly accelerating telehealth and that sort of thing, for sure. I think what also it has laid bare is the absolute failure of the United States to serve broadband and usable internet to those geographic places that you were just talking about, Justin. I mean, it's just an abject failure as a country to be able to do that. Especially as we're getting into this, like I said, that shift that we're getting into, where telemedicine now is like thousands of percents increase over what it was in 2019, and still going strong, to be honest, even after people are starting to go back to their doctor's office. Telehealth is still a large percentage of the market right now.

Todd Bellemare:
When you think about the opportunity that is in the market, or maybe the add-on effect of the opportunity to serve those communities that have been underserved in terms of broadband, whether it's Starlink or other types of satellite wifi or Google broadband, those sorts of things, things like that, that knock-on effect of getting that out into the market is the fact that that person in Eastern Montana, where there's not a hospital for 500 miles around, with a rare cancer, they can call someone in the Mayo Clinic or New York or wherever and they can have those things and maybe go a hundred miles in the nearest big city where there's a lab to get the Labcorp or Quest or whatever it is to do their tests, and they could send that electronically, again, to the doctor that they're seeing.

Todd Bellemare:
I think that when we talk about the major themes or things that have been laid bare, among many, many things of course, about basically lots of things within the US, it's the lack of rural broadband, which, again, feeds directly into how virtual health can be a boon for people and how it is not really reaching where it needs to reach right now.

Justin Steinman:
But I think, Brittany, what you said was really interesting, was talking about some of those underserved communities or people talking about very sensitive issues. I think the point you made was spot on, about the importance of telehealth and virtual care there. I think Todd's point about the access is critically important and we've got to fix that, but you go to your Minute Clinic or your Walgreens and you're sitting out there next to the Fritos and you're not going to talk about your most sensitive personal issues, medical issues while somebody else is picking up a can Mountain Dew. Telehealth gives that population the ability to have a confidential conversation in the privacy of their own home, and I think that's really important.

Justin Steinman:
A friend of mine who's a doctor says the most important part of any visit is the last 30 seconds, or what he calls the, "Oh, and one more thing, doc," moment, because nine times out of 10, you go see your doctor and he always says that that one more thing is always the real problem that the patient's actually there for and they spent the entire visit working up to that. You start to wonder if telemedicine, because you're comfortable at your house can actually address that, "Oh, doc, one more thing," and that's what you lead off with.

Brittany Morin-Mezzadri:
Hmm.

Todd Bellemare:
Yeah, I think my assumption be that a lot of those types of conversations, you have to warm your courage up to get to talk about it, that's why it's the last thing. It's like, "Oh, last second, I've just got to get it out." Maybe, like you said, being in that comfortable environment to start with is just the panacea we need to get those conversations in quicker, because that's what you really want to spend the time on, are the things that are the real reason you're there, not just the, "Oh, well, just checking on blood types and checking on this," it's the, "We really want to talk about this and let's spend the time and dedicate it properly."

Brittany Morin-Mezzadri:
Todd, when you are analyzing commercial data, are you able to see patients ... I know that you're able to see the shift to telemedicine, are you able to see shifts towards retailers, so patients who might otherwise be seen in a hospital are now being seen at CVS?

Todd Bellemare:
Sure, yeah. I mean, retail clinics show up in medical claims data for sure. The interesting thing about it is you can actually see the type of visit and the diagnoses that come with them. There are codes for things like first time visit or subsequent visit or consult or follow up or so on and so forth. There is a little bit more of ability to tease out what that looks like over time.

Todd Bellemare:
Yeah, and again, I'm a big fan of the retail clinics. I know that CVS has plans now, they were announcing in December that they're really trying to knock on that door of the PCP entry point and really expand that, not only for the primary care stuff but for the urgent care as well. As we all have seen in the last couple years, urgent care, 10% increases in the number of urgent care clinics popping up year over year, over year, just so many more options.

Todd Bellemare:
We've even seen, when you look at, speaking of looking at where patients are showing up, there's a seasonality to where patients go to the emergency room versus an urgent care clinic. At the the height of the pandemic in December of 2020, when we had the spike in the holidays last year, we actually saw almost a crossover for the percentage of people visiting ERs versus urgent care clinics, where it was typically like 70% ERs, 30% urgent care clinics, with fluctuations due to seasonality when kids are in and out of school, but then when we hit December, we almost had a 51/49 split, it was so close. The expectation is at some point this year, we're going to see that 50/50 split or maybe even see urgent care clinics overtake ERs. Maybe that'll slide back once the pandemic goes away, but as with telehealth, there are definitely new normals coming through with retail clinics, just for convenience sake and urgent care clinics for convenience sake. I think that those are the things we really want to look at.

Brittany Morin-Mezzadri:
The reason that I ask is I'm curious to watch and understand who shifted and also now who is staying, because I think that the people who are staying, that's going to tell us a lot about where are the gaps in our current traditional healthcare system. I think that, should this ever end, we should see who stays within the telehealth space, the retail space, and what does it say about our healthcare system that they're not served in an IDN.

Todd Bellemare:
Geographically as well, right? I mean, when we look at, like Justin, you had said, we can't throw a rock without hitting a CVS or a Dunkin' around here, it's totally true. Is it going to be a type of thing where telehealth stays strong in places where there aren't a lot of places for service, which I would imagine it probably would. Around here, do we see people with the expansion and then going to retail clinics for their primary care, do we see that expand over time, or at least, like you said, Brittany, continue on, and who are the loyalists and who are the reverters almost?

Todd Bellemare:
But when we think about decentralized healthcare here like that, where you walk in the door at CVS, and then maybe a future where you've got some sort of longitudinal component in an app that goes to some sort of connection back to CVS and they send you to Shields or whatever it might be for an MRI, the first gut reaction to that, that people usually have, is that, "Oh, well, decentralized healthcare is going to lead to worse outcomes."

Todd Bellemare:
We were sold on this continuum of care being the better outcomes. When the ACOs came into market back in the early 2010s or so and they're like, "Hey, we keep everybody in this continuum of care within our network, they're going to see better outcomes," and we haven't really seen that. I mean, certainly mortality is lower over time, maybe not this last year or so, but two years or so, but when you look at things like the measured disability adjusted life years, which is a metric that covers the number of years of life lost due premature death or productive life lost due to health or disability, it has been declining like crazy from the '90s of course, but then in 2013-ish or so it started to creep back up, a little bit of a plateau in, you said 2017 or so. But those measures, that's a good correlative factor to how they're managing their disease.

Todd Bellemare:
Like I said, we were sold on this continuum of care being the thing that's going to increase everyone's healthcare outcomes, and if you compare that to decentralizing a little bit, maybe the convenience leads to more people going to get care. So something to have to keep our eyes on.

Justin Steinman:
Yeah. That's a really interesting point, Todd, and I'm actually thinking back to a blog that you recently wrote talking about the rise of at-home care and how that's really started to spike in the pandemic. If you were to start to stitch a theme across what we've been talking about here for the past 25 minutes, it's that I think we're entering in an era where care is going to be everywhere. It used to be, 20 years ago, I guess, you go to a hospital or you go to your doctor's office, and maybe you go to an imaging facility, and even then, standard imaging facilities were just starting to come on.

Justin Steinman:
Now, with the advent of technology, and admittedly there's still areas to go, as you noted, we've got telehealth, you've got at-home care, you've got ambulatory surgery centers, which are spiking, you have got standalone imaging centers. You still have the hospitals, but you now have suburban branches of the hospitals. Are those ASEs or not? That's a good question. You still have the good old PCP office. Then you've got your whole digital therapeutics and your remote patient monitoring and your chronic care condition management tools.

Justin Steinman:
Care is everywhere, and it's been this massive explosion. I don't have the answer, I don't think anybody has the answer, maybe Oracle actually does have the answer, because we're all throwing off all this data. I use Dropbox to manage my personal data and I can access my to-do list anywhere on any device because it's all sitting up in the cloud. Does Oracle start to become the home of, I listed 20 different care locations, can an Oracle or Google or Microsoft or an Amazon collect all of that data and stitch together the real longitudinal record that no matter who's treating you or where they're treating you, they can get that full picture?

Todd Bellemare:
I don't know,

Brittany Morin-Mezzadri:
From an intellectual curiosity perspective, that's a really cool idea. From a desire to not live in a Black Mirror episode, what do you think of that?

Justin Steinman:
It wouldn't bother me. My life's not that interesting.

Brittany Morin-Mezzadri:
Yeah.

Todd Bellemare:
That's fair, and that gets into security and things like that, where HIPAA compliance. All this data that we're talking about, those servers have to be HIPAA compliant, which has a whole host of things and we're all very well versed in there at times. That that is something that I would love to see more cognizance of, when people are loading their data up and maybe some people are not as caring about who sees what in their data, but for sure that is something to think about.

Todd Bellemare:
The one thing that you kind of mentioned, Justin, of all these new places, as opposed to 20 years ago, where you get healthcare, what it reminds me of is the idea that healthcare is not something that happens to you, it's almost like a habit. How do you develop habits? Well, you have to make the thing you want to do become a habit. You need to make it obvious and in front of you all the time. Whether that's exercise, oh, I just have to have a recumbent bike in my bedroom every morning so when I wake up, boom, it's there and I'll do it, okay. When you have that Minute Clinic right around the corner or a telehealth option running on a computer that you're sitting at every day or whatever it might be, I think that when we look at those outcomes in the future, the opportunity for people to get healthcare, as opposed to where they could get it before. I just think that as there are more opportunities to get your healthcare, people will take them because they're more convenient. Convenience equals easier habit forming in my mind.

Todd Bellemare:
That's the type of thing that I have hoped for in the future, that if we keep expanding these, and maybe a little decentralization is okay and that will allow for people who would not give a care before will maybe say, "Ah, it's right there, I'll do it."

Justin Steinman:
That's interesting. I think that's probably a really good breaking point and an opportunity, Todd, to tee us up for the next episode, because our next couple episodes, we've got a series of guests who I think will have a lot to talk about this. We're going to be joined by senior leaders from Pear Therapeutics on one of our upcoming episodes, talking about digital therapeutics and the role that they play. Then we also have a senior executive joining us from Teladoc to talk very much about how telemedicine virtual care, and as you all know, Teladoc bought Livongo and so they got into the chronic condition management space. I think I look forward to hearing on both of those podcasts some of their perspectives on this changing dynamics of healthcare, where and how we're all going to experience it.

Justin Steinman:
With that, I want to thank both of you all today. I really enjoyed talking with you and I can't wait to have more conversations like this with you all over the coming months and years.

Justin Steinman:
Thanks for listening today to Definitively Speaking. Please join me next time when I'm joined by Dan Trencher, senior vice president for strategy at Teladoc. We'll have a wide ranging conversation around telemedicine and virtual care and what's the difference.

Justin Steinman:
If you like what you've heard today, please remember to rate, review and subscribe to the show on iTunes, Google Play, or wherever you get your podcasts. To learn more about how healthcare commercial intelligence can support your business, please follow us on Twitter at @definitiveHC or visit us at definitivehc.com. Until next time, take care and please stay healthy.

Brittany Morin-Mezzadri:
Now, can you imagine if we put a PCP in a Dunkin' Donuts?

Todd Bellemare:
Well, it's like those combination Taco Bell/KFCs.

Brittany Morin-Mezzadri:
Yes.

Todd Bellemare:
It's a home run every time.

Justin Steinman:
Exactly.

Brittany Morin-Mezzadri:
That would be home run in New England. There's a CVS literally across the street from me, which is across from a Dunkin' Donuts.