[Editor's Note: I remember Ralph Nadir talking about this in great detail during the US Presidential elections in 2008. --LW]
Welcome to Wal-Mart. The nurse will be right with you.
Wal-Mart, the nation’s largest retailer, has spent years trying to turn some of its millions of customers into patients, offering a simple menu of medical services that consumers can buy along with everything from a bag of chips to a lawn mower. Now, the store is in the throes of its most aggressive push yet to become a one-stop shopping destination for medical care.
The company has opened five primary-care locations in South Carolina and Texas. It plans to open a sixth clinic, in Palestine, Texas, on Friday, with six more planned by the end of the year.
The clinics, it says, can offer a broader range of services, such as chronic-disease management, than the 100 or so acute-care clinics leased by hospital operators at Wal-Marts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Wal-Mart is marketing itself as a primary medical provider.
Like its competitors, Wal-Mart is looking to grab a bigger share of the billions of health-care dollars being spent in the United States and benefit from the shifting delivery system that has resulted from the Affordable Care Act.
With its vast rural footprint, Wal-Mart is positioning its primary-care clinics in areas where doctors are scarce, and where medical care, with or without insurance, can be prohibitively expensive. If the in-store clinics succeed, the company said, it is prepared to open more.
“If they’re rolling it out across the rural stores primarily, they’re actually filling an important gap in the health-care ecosystem,” said Skip Snow, a health-care analyst at Forrester Research.
But while experts agree that increased access to health care is a good thing, others say patients with chronic conditions need complex care that retail giants cannot provide. Diseases such as diabetes, for example, can result in complications that are not easy to manage.
“There’s not a role for retail clinics to take care of chronic, ongoing problems like that,” said Dr. Robert L. Wergin, president-elect of the American Academy of Family Physicians. “It can provide a service, maybe an entryway into a system.”
While the company says that about 15 to 20 patients use the existing primary clinics every day, a large percentage of those patients do not have a primary doctor outside Wal-Mart, according to Dr. David Severance, the corporate medical director at QuadMed, which is joining with Wal-Mart to help staff and run the clinics.
While the retailer has been pushing into health care for years, its early attempts stumbled. Dozens of acute-care clinics have closed, largely because of management problems.
The primary-clinic model could offer new advantages over the more-basic clinics, often referred to as “retail clinics.” The limited list of minor illnesses that a retail clinic can treat — the flu, for example — often peaks in the winter months and slows significantly at other times of year, said Tom Charland, the chief executive of Merchant Medicine, a health-care research and consulting firm.
Wal-Mart also says it will be better off working with only one partner, QuadMed, instead of multiple partners that each run a handful of clinics, which was the model used in its acute-care clinics.
Along with medical assistants, nurse practitioners, who generally receive less training than doctors but can prescribe most of the same medications, run the primary clinics.
The Wal-Mart primary-care clinics charge patients $40 a visit; employees at the company and their dependents who are covered under its own insurance pay $4 a visit. (Wal-Mart says that more than half of its 1.1 million employees receive health-care coverage through the company.) While it accepts Medicare, it does not accept third-party insurance, although it is exploring the option, a spokeswoman, Danit Marquardt, said, adding that it is starting to enroll some of its stores in Medicaid.
But the primary-care clinics can help drive traffic to Wal-Mart’s pharmacies, which do accept insurance, and the clinics could stand to benefit from the growing number of people now signing up for coverage under the Affordable Care Act.
“To make it profitable, you need to make it have more than just a clinical encounter,” said Dr. Glenn Hammack, the founding president and chief executive of NuPhysicia, which closed the six clinics it briefly ran in Wal-Mart stores.
“You also need to sell them prescriptions, a bag of chips, maybe a magazine while they’re waiting.”