“Why is Wal-Mart speaking at a health care summit?” the company’s vice president for health and wellness, Marcus Osborne, rhetorically offered up at a conference back in January.

“Wal-Mart’s in retail, we’re not in health care.”

But as analysts, researchers, and other experts who spoke with me. took care to point out, Wal-Mart is in health care, and getting further entrenched by the year. In the past six months alone, Wal-Mart launched a major contracting initiative with half-a-dozen major hospitals, and dropped hints — since retracted — that the company is exploring new services like a health insurance exchange.

Notably, Osborne teased a broader health care strategy for Wal-Mart that would include “full primary care services over the next five to seven years,” in a Q&A at that January conference captured by the Orlando Business Journal.

Wal-Mart has since denied Osborne’s comments — the second time in about 18 months that the company has had to walk back stories about its planned primary care services — and Osborne subsequently stopped talking to the press. (Wal-Mart declined to comment, and Osborne did not respond to an interview request for this story.)
But Osborne’s remarks from that January conference, and his other archived speeches, are still readily accessible. And they paint a vivid picture of a company that’s not just a potential market-mover and disruptive innovator, but an organization that could do a lot to positively reform health care.

Background: Wal-Mart’s Growing Role in U.S. Health Care System

In many ways, this isn’t a new story. Back in 2007, Princeton University’s Uwe Reinhardt suggested to NPR that Wal-Mart could be “taking aim at the entire health care system” by expanding its new discount drug program.

“I think it’s a really fascinating way to come out of the corner and really slug the system,” Reinhardt said at the time. “At the moment, the body blows don’t hurt. But they add up. I’m watching this with great fascination, and expect more from them.”

And in subsequent years, Wal-Mart did grow its health care footprint, from launching retail clinics based within its stores to advocating for national health reform. Considering its history — as recently as 2005, Wal-Mart had little involvement in the health care market and was being pilloried for skimping on its own employees’ benefits — it’s been a significant turnaround for the firm, and has positioned Wal-Mart as one of the leading disruptive innovators in health care.

Case Study: Wal-Mart as Powerhouse

But when it comes to potentially reshaping care access and delivery, Wal-Mart is still just scratching the tip of the surface. To understand the company’s scale and ability to disrupt traditional market dynamics, look no further than last year’s Center of Excellence program.

The company decided to directly contract with Mayo Clinic, Cleveland Clinic, and four other leading hospitals. As a result of the COE program, more than 1.1 million Wal-Mart employees and dependents can now travel, at no cost, to those leading hospitals for certain cardiac and orthopedic procedures.

(For perspective, consider that CMS’s much-discussed accountable care organization effort last July, which involved 88 hospitals, affected about 1.2 million Americans.)

“Love them or hate them, Wal-Mart has a huge ripple effect,” Dave Chase wrote at Forbes. “Overnight, every facility in America that does cardiac, spinal, or transplant procedures is now competing with Mayo, Cleveland Clinic and other top providers.”

Opportunity: Wal-Mart as Destination

One reason that Wal-Mart partnered with those hospitals: lowering its health care costs.

“We literally spend billions of dollars” on employees’ health care insurance alone, Osborne noted.

Still, there’s a distinction between contracting with providers to tamp down your own health care costs and competing with those providers by offering services like retail clinics or even primary care.

So why would Wal-Mart get into broader health care services? It starts with “the obvious financial opportunity,” as Osborne alluded to in one talk

U.S. spending on health care is poised to surpass spending on retail — the only developed economy where that’s the case — and Wal-Mart has natural advantages like foot traffic and scale. About 150 million Americans visit a Wal-Mart every week, spending about 50 minutes on average.

Could Wal-Mart Positively Reform Care?

That ease of access could be transformative if Wal-Mart elected to expand its primary care services, experts note, given that many patients struggle to simply get in the doors of a doctor.

And many of Wal-Mart’s customers are especially affected by the burdens of health care. As Osborne noted, roughly one in ten Wal-Mart customers identifies as a caregiver. And the average Wal-Mart customer is losing about $6,000 in income because of that caregiving, he added.

Meanwhile, the company’s $4 generic drug program has appeared to boost adherence to certain medications and reduce costs for some low-income Americans.

One unique element that Wal-Mart could bring to health care access, Dave Chase told California Healthline, is the company’s presence in rural markets. That’s where there’s “the biggest shortage of primary care doctors, and it’s not getting any better,” Chase noted.

That ease of access could be transformative if Wal-Mart elected to expand its primary care services, experts note, given that many patients struggle to simply get in the doors of a doctor.

And that plays into one unique element that Wal-Mart could bring to its health care strategy, Dave Chase told me: the company’s presence in rural markets. That’s where there’s “the biggest shortage of primary care doctors, and it’s not getting any better,” Chase noted.

Meanwhile, many of Wal-Mart’s customers are especially affected by the burdens of health care. As Osborne noted in one speech, roughly one in ten WalMart customers identifies as a caregiver. And the average Wal-Mart customer is losing about $6,000 in income because of that caregiving, he added.

And there’s some evidence that Wal-Mart’s emerging presence in health care has already been a boon. For example, the company’s $4 generic drug program has appeared to boost adherenceto certain medications and reduce costs for some low-income Americans.

A Sleeping Giant

But great things have been predicted of Wal-Mart’s role in health care before — even by Wal-Mart itself.

In 2007, the company’s then-CEO Lee Scott predicted that Wal-Mart would have 2,000 retail clinics in place by 2012.
Today? Wal-Mart has closer to 130, and is “closing locations faster than it’s opening them,” Renee Dudley noted at Bloomberg BusinessWeek.

One of the challenges facing the company: For all of Wal-Mart’s advantages, officials are still feeling their way in the health care space.

“Wal-Mart has developed a great deal of expertise at how to buy and sell products at a discount price,” Ateev Mehrotra, a physician at the University of Pittsburgh Medical Center and a researcher at the RAND Corporation, tells California Healthline. “Providing health care is different” and much more complex, ranging from developing the needed expertise for a broader strategy to hiring practitioners to deliver care, he speculated.

And the speed bumps of launching the retail clinic program may have slowed down Wal-Mart’s plan to launch broader health care services.
“I think Wal-Mart is still going to” move into the health care market, Chase said, although “they’re not on the fast track.”

“But they could be formidable.”

Dan Diamond (@ddiamond) is Managing Editor of the Daily Briefing, a CaliforniaHealthline columnist, and a Forbes contributor. An earlier version of this post appeared in California Healthline.

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8 Responses for “Wal-Mart Could Transform Care–But Does It Want To?”

  1. platon20 says:

    The job of Walmart is to maximize return to shareholders. There is 2 ways that this will happen with healthcare:

    1. Change their health insurance program such that care at the Walmart clinics is greatly incentivized over going elsewhere. Example — copay is $10 at Walmart clinics, $200 at outside clinics. You know what that means? $$$$, both from saving on health insurance costs AND by driving employees to use their in-store clinics instead.

    2. Aggressively market their 24/7 in-store clinics to patients outside of Walmart who happen to have private insurance.

    Please explain to me how those 2 things will “enhance” healthcare.

  2. Dr. Rick Lippin says:

    We will have hit bottom in healthcare if WALMART becomes the provider of choice

    Dr. Rick Lippin

  3. Paul Rausch says:

    Firstly, Wal-Mart’s shifting of healthcare costs onto State and Federally programmes is probably one of my biggest concerns regarding Wal-Mart. That said as far as providing low-cost clinics to patients, I think there is definitely a huge need for an approachable brand to keep people out of emergency rooms. Don’t get me wrong, the quality of care can’t be anywhere near that of a typical provider. But just having some sort of clinic that low income patients can go to, that’s not an emergency room does have value. We can criticise wal-marts unethical practices and low-quality/cost dealings, but there’s not doubt there is a need for more low-cost clinics.

  4. You missed the Recent launch of new digital health kiosks to select Wal-Mart locations through SoloHealth;
    and they could launch an ‘exchange’ that would pound flat the government imposed widget;
    not much different than the Tax liaison agreements that they have with Jackson Hewitt and most recently Met Life.
    they only have their toe in the market now, the decide to walk through that door with their full force – it all changes.

    • Dan Diamond says:

      Thanks, Brian – good points.

      I actually spoke to someone about the new kiosks too, but didn’t keep that detail in the final story for space. And perhaps that’s telling; when it comes to Wal-Mart, the company clearly could have such a broad, significant impact on health care, that it’s tough to squeeze everything that they’re doing / could do into 1,000 words.

  5. Francis says:

    I think Dr. Rick Lippin, above, got it right when observing we “hit bottom in healthcare if WALMART becomes the provider of choice.” Walmart’s history of regulatory compliance is spotty at best when managing its own employees. I hate to think this is the new standard of care for everyone.

  6. Ron Hammerle says:

    Through luck, accident or wisdom, Walmart will probably not try a “me too” version of the start up, stand alone, limited service, nurse practitioner clinics that other retailers have tried.

    Count on them, however, to transform healthcare, utilizing the supply chain management, information technology, low prices and global distribution system that made them the world’s largest retailer, the largest private employer in multiple countries and the destination each week for more than 200 million customers.

    Rick and Francis need not worry about them trying to serve “everyone.” But the global leaders in a half dozen other major industries recognized– or later discovered– Walmart’s role in transforming markets. So have two of America’s most prestigious medical centers of excellence, which already understand Walmart’s emerging role in transforming a dysfunctional medical marketplace.

    Ron Hammerle
    Chairman and CEO
    Health Resources, Ltd.
    Tampa, Florida

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