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Walmart Wants To Be Nation’s Biggest Primary Care Provider

Walmart — the nation’s largest retailer and biggest private employer — now wants to dominate a growing part of the health care market, offering a range of medical services from basic prevention to management of chronic conditions like diabetes and heart disease, according to a confidential company document.

In the same week in late October that Walmart announced it would stop offering health insurance benefits to new part-time employees, the retailer sent out a request for information seeking partners to help it “dramatically … lower the cost of healthcare … by becoming the largest provider of primary healthcare services in the nation.”

On Tuesday, Walmart spokeswoman Tara Raddohl confirmed the proposal but declined to elaborate on specifics, calling it simply an effort to determine “strategic next steps.”

The 14-page request asks firms to spell out their expertise in a wide variety of areas, including managing and monitoring patients with chronic, costly health conditions. Partners are to be selected in January.

Analysts said Walmart is likely positioning itself to boost store traffic – possibly by expanding the number of, and services offered by, its in-store medical clinics. The move would also capitalize on growing demand for primary care in 2014, when the federal health law fully kicks in and millions more Americans are expected to have government or private health insurance.

“We have a massive primary care problem that will be made worse by health reform,” says Ian Morrison, a Menlo Park, Calif-based health-care consultant. “Anyone who has a plausible idea on how to solve this should be allowed to play.”

In-store medical clinics, such as those offered by Walmart and other retailers, could also be players in another effort in the health law: encouraging collaborations of doctors and hospitals who want to win financial rewards for streamlining care and lowering costs. Such collaborations, known as “accountable care organizations,” might contract with in-store medical clinics, says Paul Howard, a senior fellow with the Manhattan Institute for Policy Research. He has studied retail clinics, some of which have recently expanded to offer services beyond simple tests and vaccinations, such as helping monitor patients with diabetes or high blood pressure.

Walmart’s request goes even further, asking possible partners to provide information on how they would oversee patients with complicated chronic conditions, including asthma, HIV, arthritis, depression and sleep apnea.

While Walmart’s efforts to partner with others on health care could help lower costs for some patients and increase access to primary care services, health policy experts also say it raises questions.

Will expansion of in-store clinics, for example, further fragment care in the U.S. by drawing patients away from their established primary care doctors?  Would patients who need specialists fall through the cracks? Will patients seen by nurses or physician assistants at in-store clinics have just as good outcomes as those seen by doctors in more traditional practices?

“Maybe Walmart can deliver a lot of this stuff more cheaply because it is an expert at doing this with other types of widgets, but health care is not a widget and managing individual human beings is not nearly as simple as selling commercial products to consumers,” says Ann O’Malley, a physician and senior health researcher at the Center for Studying Health System Change, a nonpartisan Washington think tank.

And will it save money?  Because primary care services are not the main driver of health care costs in this country, “I would be surprised if this were a model that could truly attack cost problems,” says O’Malley.

Whatever it does to health costs, it may also be a way to boost foot traffic and sales in Walmart stores, says Colin McGranahan, a retail analyst for Sanford C. Bernstein & Co.

“Their traffic has been declining for over two years and they’ve been losing market share,” McGranahan says. “If you get someone in the door, you can also sell them milk and a shotgun.”

CVS/Caremark, Walgreen’s, Kroger, Target and others have recently reinvigorated efforts to open in-store medical clinics. The first such in-store clinics opened in 2000, but growth took off later in the decade.

Until recently, Walmart was the nation’s leader in opening such clinics, but has dropped to third place with about 140 such clinics, well behind industry leader CVS Caremark’s nearly 550 Minute Clinics and Walgreen’s 355 Take Care clinics, according to data tracked by Tom Charland, CEO of Merchant Medicine, a Minnesota-based research and consulting firm. About 1,300 store-based clinics are open nationwide, he says.

They have different business models. Walmart leases space to independent vendors, for example, while CVS owns and staffs its Minute Clinics.  While a few centers operated by retailers have doctors on site, most hire nurse practitioners or physician assistants to provide the care.  In 2007, Walmart CEO Lee Scott announced the firm would open 400 clinics by 2010.

But early efforts backed by venture capital money faltered and the firm failed to reach that number, says Charland. Walmart then switched strategies and began leasing to hospital systems primarily and it began to grow again. Still, last month, the firm appeared to be struggling: Walmart opened three in-store clinics, but closed 10, says Charland.

“This is an industry where people haven’t figured out how to make money,” he says.  Hiring nurses isn’t cheap – and business can be seasonal:  more people come in during the cold winter months and business can slow to a crawl in the summer.  “My guess is the whole purpose of [Walmart’s] request for information is to find someone to help them because they’ve not been able to pull it off.”

CVS, which has run Minute Clinics since 2006, expects to break even for the first time this year, says Helena Foulkes, a CVS executive vice president in charge of strategy and marketing. It plans to keep opening clinics and is doing so at a clip of about 10 a month.

“We think the market will evolve so this will become a more important model,” says Foulkes.

This story is part of a reporting partnership that includes NPR and Kaiser Health News. Kristian Foden-Vencil of Oregon Public Broadcasting, and Chris Weaver, Sarah Barr, and Christian Torres of Kaiser Health News contributed to this story.

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  2. If Walmart wants to be the largest provider of primary care services I’m sure they can do it. I’m also sure they will discover that primary care is nothing more than a loss leader for their retail market as it is for specialty health care. If Walmart wants to make a profit providing primary health care then it sould look no further than Capital Hill and attempt to terminate the influence the AMA-RUC has on CMS and HHS. In fact, if Walmart could undo the AMA-RUC influence over CMS and HHS it probably would not have to think about providing primary care services in the first place.

    If I shop at Walmart to buy items for a Thanksgiving dinner such as a turkey, potatoes, cranberry sauce, vegetables, drinks including wine, and deserts, I expect to and will pay for each individual item.

    Now, lets imagine that after I pay for my items I get the idea to see my Walmart primary care provider because I’ve been coughing for 1 week, it burns when I urinate, I have erectile dysfunction and my wife thinks I should have my testosterone level checked but my mistress thinks I should get Viagra from a Canadian pharmacy, I’m not sure how I’m doing on my diabetes, my blood pressure meds make me tired, the cholesterol drugs make my joints ache, I need refills on my Lortab, Adderall, sleeping pills, and I need prior authorization for my stomach pills because the over the counter drugs for acid reflux are too expensive. Could you fill out this form so I can get a disabled placard for my car because I had to park way out there in your parking lot. Could you hurry it up cause I don’t want the deserts I just bought to melt.

    Now, you might think I’m exaggerating, but this sort of presentation is not all that unusual. After the provider address all the issues you would think they could charge for each individual problem. Wrong!!! The insurance company or government health care program would only pay for the turkey but not all the fixings. That is how it is, that is why we lack primary care services in this country and I don’t think Walmart can fix this either. Besides, why would I want to go to a provider who only has profit in mind.

  3. How are people like you allowed to vote? No ACA took effect when it was passed. Is your head really so far up your A$$ you didn’t know that? You haven’t heard anything about mini meds being outlawed, guarantee issue for children, kids covered till 26, essential benefits, no lifetime max, escalting annual caps, none of that?

    We need to start revoking voting rights of those to ignorant to contribute meanfully.

  4. ““Now, Gallup reports that from the first quarter of 2010 (when Obama signed Obamacare into law) to the third quarter of this year, 2 percent of American adults lost their employer sponsored health insurance. In other words, about 4.5 million Americans lost their employer-sponsored insurance over a span of just 18 months. ”

    Gee, I thought the ACA didn’t take affect til 2014. Could it be job/business losses not ACA? Maybe you could give us the link so that you’re just not quoting some right-wing-rant site.

    A fuller version of the medical device tax instead of your hate spittle spewing version.
    http://www.szd.com/resources.php?NewsID=1665&method=unique

    Do you get any sleep Nate or do you just stay up nights hating?
    By the way I’m not a Democrat supporter.

  5. “Stryker, the Kalamazoo-based maker of artificial hips and knees, will cut 5% of its global workforce by the end of next year to reduce costs in the face of new fees on device makers required by the U.S. health care law.”

    Not governments fault at all is it Peter1, they had nothing to do with it

  6. “Sure Nate everyone had affordable coverage and access before evil government.”

    Not everyone but tens of millions more did.

    “Now, Gallup reports that from the first quarter of 2010 (when Obama signed Obamacare into law) to the third quarter of this year, 2 percent of American adults lost their employer sponsored health insurance. In other words, about 4.5 million Americans lost their employer-sponsored insurance over a span of just 18 months. ”

    “This is not what the Congressional Budget Office (CBO) had predicted would happen. Rather, the CBO had predicted that Obamacare would increase the number of people with employer-sponsored insurance by now. It had predicted that, under Obamacare, 6 million more Americans would have employer-sponsored insurance in 2011 than in 2010 (see table 4, which shows the CBO’s projected increase of 3 million under (pre-Obamacare) current law and an additional 3 million under Obamacare). So the CBO’s rosy projections for Obamacare (and even these paint a frightening picture) are already proving false.”

    You just keep believing the lies Peter1, Liberalism and the Democrat partry is built on fools like you.

  7. Not relevant since that is the choice of employee.

    BS, you wish it wasn’t relevant becuase you got caught looking stupid again. How can you bash Wal Mart for X number of employees not being insured then claim its not relevant that the employees declined the coverage offered them. Only in Liberalism can you make such asine arguments.

  8. “Where in your endless propoganda reposting do you have a single study showing how many Wal Mart employees declined coverage or declined a split shift job that would make them eligibile?”

    Not relevant since that is the choice of employee.

    “We didn’t have an affordability problem until government promised to make it affordable”

    Sure Nate everyone had affordable coverage and access before evil government.

    http://www.staysmartstayhealthy.com/health_care_history_inthe_united_states

  9. ” but at least that’s up to the employee not the employer.”

    Once again Peter! you show how clueless you are. All of those full time Wal Mart employees that don’t have benefits made the CHOICE to not take benefits. Where in your endless propoganda reposting do you have a single study showing how many Wal Mart employees declined coverage or declined a split shift job that would make them eligibile? All you have shown is the number of uninsured Wal Mart employees, failed to report any cause, but still blamed it all on Wal Mart.

  10. No I support government getting out of Health Care/Insurance so it was affordable enough that people don’t need assistance. We didn’t have an affordability problem until government promised to make it affordable

  11. Split shift patterns can allow for full time hours. If employees want heath care in that type of business then they’ll have to accept split shifts, but at least that’s up to the employee not the employer. Some people only want and need part time, that’s their choice, but they all need health care coverage either way.

    So Nate, do you support ACA subsidies for low income health care purchase?

  12. “Walmart and others can engineer part time hours very easily.”

    Peter1 your so clueless how the world works. You mean to say Wal Mart can single handily change that fact most people get off work around 5? Or that food establishments serve distrinct meals?

    When I worked food service people would complain about part time positions or if they were full time they were split shifts. The reality of the world was people would come in at lunch then from 1-4 they would be dead, then pick back up for dinner.

    Go in a Wal Mart and you will see distinct shopping patterns. It doesn’t do a business any good to have 3 extra FT cashiers standing around when you have no customers then when your slamed not be able to afford extra staff.

  13. “Even most large companies can’t afford to pay $7.50 per hour on top of that for comprehensive family health insurance coverage.”

    What happens after ACA when coverage is mandatory for companies. The words “can’t afford” is different from “don’t have to afford”.

    “part timers are generally not covered. ”

    Walmart and others can engineer part time hours very easily.

    “In the end, low wage workers will probably need significant subsidies to afford health insurance, especially family coverage.”

    As in the ACA? Frankly this is why health care should be decoupled from employment.

  14. “What is the percentage of sales that goes to paying lowly “associates”?”

    Margalit –

    As I said in my last comment, WMT and COST are very different business models. COST has about 1/5th of Wal-Mart’s revenues but only 1/9th as many employees which implies that the percentage of revenues that goes for employee compensation is just over half of Wal-Mart’s.
    The typical newer Costco store is slightly smaller than a Wal-Mart supercenter. However, Costco only carries 4,000 – 5,000 SKU’s many of which are there one week but not the next while Wal-Mart carries tens of thousands of SKU’s all the time. Costco generally sells merchandise in larger sizes than Wal-Mart, Target or supermarkets as well. For the purpose of determining the extent to which the company can afford to offer its employees comprehensive health insurance or not, the appropriate comparison to Wal-Mart is to Target, K-Mart, supermarkets and department stores but NOT to Costco.

    Moreover, retailing is, for the most part, a low profit-margin business as measured by net income to sales. This is especially true for supermarkets which generally earn between one and two cents per dollar of revenue after taxes. Costco and Sam’s Club (division of Wal-Mart), in effect, make almost all of their money from their membership fees and virtually nothing from the sale of merchandise itself.

  15. “At a certain point it doesn’t make since to employee that person at that cost.”

    What point might that be, Nate?

    How does Walmart’s profit margin compare to Costco’s?
    What is the percentage of sales that goes to paying lowly “associates”?

  16. According to the Kaiser Family Foundation, family health insurance coverage costs over $15K per year these days or the equivalent of $7.50 per hour for a 2,000 hour work year. In low wage industries like hospitality, restaurants and retail trade, there are millions of people earning between $7.25 and $12.00 or so per hour in wages. Even most large companies can’t afford to pay $7.50 per hour on top of that for comprehensive family health insurance coverage. They may offer coverage for the full time employee but not for the rest of the family. As Nate noted, part timers are generally not covered. Starbuck’s is an exception in that they offer health insurance for anyone who works at least 20 hours per week but the price of their products is quite high vs. competitors. Costco also offers pretty good health insurance but, as a bulk retailer, it is not nearly as labor intensive a business model as Wal-Mart or Target.

    In the end, low wage workers will probably need significant subsidies to afford health insurance, especially family coverage. That, of course, introduces the risk of gaming the system by hiding or significantly understating income, working off the books, etc. If we offered everyone taxpayer funded vouchers financed by a dedicated value added tax as broad based as those typical in Europe, the tax rate would have to be in the 20% range or higher to raise the necessary revenue. Covering everyone is a difficult conundrum any way you slice it unless the public were willing to shoulder a tax burden comparable to those in Western Europe which they aren’t and probably never will be.

  17. “Nate, everything an employee costs is an expense. But for an efficient company like Walmart that $2/hr could be $1.”

    No it can’t Peter, that would be only $172 which could barely pay for individual coverage for the most efficent plans. Seeing as how the average greeter is 60+ your not going to buy them coverage for $172 a month. Not to mention PPACA with 100% wellness, and all its other perks drove cost even higher.

    No we don’t couch how to get people on Medicaid, question answered

  18. “The most important part you don’t grasp is benefits are an expense. A normal healthplan can easily cost $2.00 per hour. The value of someone standing at the door greeting people is not even minimum wage let alone minimum wage plus $2.00 for benefits, 7% for FICA FUDA, 1% for unemployement, 1% for workers comp.”

    Nate, everything an employee costs is an expense. But for an efficient company like Walmart that $2/hr could be $1.

    ” That person at the door saying hello cost wal mart $10 per hour or more.”

    And for a huge company like Walmart your point would be? It would also mean that the “greeter” has more money to spend on their local businesses and community. You always tout the benefits of buying U.S., that it creates jobs, that it multiples the benefits.

    You didn’t answer my question, do you coach your clients on how to put their employees on Medicaid?

  19. Ya Peter its every state where a union is agitating anti wal mart propoganda, or are you really clueless where all the anti wal mart articles come from?

  20. “why would a large company like Walmart not have ALL of its employees on the company plan.”

    Wow you just don’t get it. First off no company covers all of their employees. Very few companies large or small cover part timers. Most plans, including all your liberal union buddies motivate seniors to take Medicare when they turn 65, why don’t they cover them for life and save Medicare the money?

    The most important part you don’t grasp is benefits are an expense. A normal healthplan can easily cost $2.00 per hour. The value of someone standing at the door greeting people is not even minimum wage let alone minimum wage plus $2.00 for benefits, 7% for FICA FUDA, 1% for unemployement, 1% for workers comp. That person at the door saying hello cost wal mart $10 per hour or more. At a certain point it doesn’t make since to employee that person at that cost.

    The question you refuse to answer is how does someone not having a job save the State money? The State is further ahead they be working, paying taxes, and earning some income and pay for Medicaid then the person be unemployed, still on Medicaid, plus food stamps, plus what ever else assistance.

    Why doesn’t the government provide benefits to all their interns? Why doesn’t Hollywood provide benefits for extras? Why doesn’t government provide insurance for their substitute teachers? Why is it liberals practice such rank hypocrisy?

    If you are so hell bent on increasing the number of unemployed and uninsured then require Wal Mart to insure everyone and watch a couple hundred thousand people lose their job.

    The left LOVES to abuse free labor via internships, then you want to bash Wal Mart for paying people what you consider to little.

  21. The question Nate is not the total number of employees at Walmart, it’s why would a large company like Walmart not have ALL of it’s employees on the company plan. Do you coach your clients to use Medicaid as their health plan? Would you pay a little more for stuff at Walmart to help cover all their employees? You’re always saying government is not the solution, then why doesn’t Walmart believe that?

    Looks like it’s not just WA.

    http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=0CCYQFjAB&url=http%3A%2F%2Fwalmartwatch.com%2Fwp-content%2Fblogs.dir%2F2%2Ffiles%2Fpdf%2Fmedicaid_factsheet.pdf&ei=Jo69ToG2I4aFtgecgfniBg&usg=AFQjCNGYFdGL9Ze3PDV7hUFcV4q0Btt1YA&sig2=ixcOKaxaI1C6e3XWwTNOMQ

  22. Peter1, do you search for and purposedly post worthless crap or are you that clueless how worthless your links are?

    “More than 3,100 Wal-Mart employees in Washington were benefiting from state-subsidized health coverage throughout 2004 — nearly double the total for any other company, according to two confidential state reports.”

    How many employees does Wal Mart have in Washington compared to any other company? Are you really surprised that the largest retailer in the world with more employees than any company but the federal government has more employees on assistance than anyone else? This is the type of studies and science produced by propaganda firms for idiots.

    “Democrats in the House and Senate say the reports show that Wal-Mart and some other big companies are shifting millions of dollars in health-care costs to the state.”

    Only a Democrat would be ignorant enough to make a statement like this. Then again to be liberal you must suffer a degree of ignorance to start with. Hiring someone currently on State Assistance or that would be on State Assistance without this job is some how pushing cost to the State? What exactly would the greeter at Wal Mart be doing for work if not working at Wal Mart, these aren’t people with numerous employment opportunities. This argument also ignores that Wal Mart has taken people off the public dole every time one of them does take benefits.

    Nothing is stopping the Unions from hiring these people to perform remedial jobs and giving them benefits. Why is it Wal Marts obligation to hire everyone that can’t get a job and give them benefits?

    It’s this same lack of logic that enables liberals to keep pushing for higher minimum wage ignorant of the fact it just prices people out of the labor market. Sure morons, set minimum wage at a living wage standard and see how many more millions of people will never get a job because their labor is not worth that much.

    Further how do you compare a retailer to fast food without adjusting for margins? What good does it do to put companies out of business claiming your trying to insure more people? How many people does a close business insure?

  23. I think, Barry, that with scalability, you refer (at least in part) to what I refer to as standardizability – and whatver you call it, that is the absolute key issue that a lot of people expecting the solution of this particular problem (if not solutions for most problems, in the case of libertarians) from the famous invisible hand.

    Being treated at a community hospital for a severe pneumonia is a nonstandardizable service. Yes, it could be made more standardizable if you would create a pneumonia hospital (like a specialty hospital, e.g. cardiac or orthopedic clinic), but that would work only in very densely populated areas for a very limited number of HC services. Health care services require highly coordinated (and highly flexible) interactions of multiple professionals and various services to create an extremely individualized service.
    Most HC services are NOT comparable to an airline seat which is not really an individualized product, or a car which is not one either, despite all the multiple options that one can pick when ordering. LASIK would be an exception. The best comparison for most HC services would be a legal team helping you with a complex court case – there you have a similar cooperation of lawyers, paralegals, clerks, expert witnesses … you can maybe standardize a divorce, but not a reasonable legal defense. And you can standardize certain HC services such as LASIK or high volume subservices such as MRI, but you will never be able to standardize care for a diabetic with renal failure who undergoes CABG.

  24. Dr. Mike,
    Please understand that I don’t think this model is conducive to either patient health or anything else that may be considered positive. However, Walmart is a corporation and as such it needs to make money and since there is a pain point here, there is also an opportunity for a savvy entrepreneur.
    If you follow the public narrative on how medicine should be practiced, you will see that there is a constant push to delegate primary care down to untrained resources under the heading of “team care” or “managed care”. Most visits do not require procedures and theoretically can be performed by non-physicians. All the computerized evidence-based, decision support, checklists, protocols and whatever contraptions they will come up with next, can allow a technician to see patients and manage chronic, known and previously identified conditions. There is of course no comparison to an actual doctor visit, but I believe this is what level 1 primary care will become. Level 2 primary care care may be provided by telemedicine and level 3, which includes minor procedures, will be referred to an actual doctor. If they succeed in keeping most patients at level 1, some patients at level 2 and only a few at level 3, they will make money. I am sure they will make people sign forms releasing Walmart from any liability.
    This is what industrialized medicine looks like. At one time people would not have been able to conceive buying a suit off the rack. It was a very personal affairs, with a real tailor, pins and minute adjustments to fit just right. Some people still have suits made that way. The same people will also have doctors care for them. The rest of us will go to Walmart for suits, medical care and canned tuna.

  25. Nate –
    What’s the source for these numbers? They are interesting and I’ve never seen them before. Thanks.

  26. I wonder how well these clinics do on collecting from insurers, with co-pays, deductibles, HSAs, non-covered services, etc.

  27. Can you explain where the profit comes from in coordination of care and case management? Not sure I see it. Certainly not without being a part of an ACO, but I’m not sure I can see that working either. Maybe I’m wrong, but I just see too many of the services I provide every day being unavailabe through a retail clinic, and therefore patients requiring those services and who have that clinic as their “medical home” will generate costs for the ACO that would have been avoided if they had seen me instead. He is but a short list of services that I see the retail clinic charging the patient for, and then referring them on to a specialist at additional expense: Minor procedures (biopsies, mole removals, lipomas, ingrown toenails, I&D and wound care, vasectomies, circs, simple fracture management), management of pain, management of CHF, COPD, Fatigue workups, Patients with common diseases that are not responding to common therapies: depression, hypertension, diabetes. etc.

    I see something from this list every single day, and in my experience, with the midlevels I have worked with (More than 10 so far) they almost always ask me to take care of the above. The ACO is not going to be pleased when patients keep seeing two different providers instead of just one.

  28. “worked for groceries, microwaves, TVs and CDs/DVDs not to mention generic Rx”

    Nate –

    All of those are physical products to which Wal-Mart can apply its buying power and logistics expertise. In the case of generic drugs, they are most likely selling them at a fully allocated loss in order to build traffic for the rest of the store. If a good percentage of your prescriptions are $4 generics (for a 30 day supply), you can’t pay a pharmacist $125K to $140K including benefits per year and make money especially since the typical pharmacy counter in a large chain needs 2 ½ pharmacists to staff it during the hours it’s open.. In a supermarket pharmacy, it’s closer to 2.0 pharmacists.

    Primary care doctors are mainly selling their time and expertise. Some business models are not all that scalable. Primary care is one of them. I know for a fact that neither CVS nor Walgreen are getting rich from their in store clinics staffed by NP’s. Wal-Mart is not likely to make much, if any, money at it either.

  29. worked for groceries, microwaves, TVs and CDs/DVDs not to mention generic Rx.

    The solution; no
    A solution, yes

  30. If Walmart can offer primary care to increase foot traffic to increase sales can PCPs offer toasters for sale to offset their loss of income, now not only from RUC bias to specialists but now to Walmart?

    “In the same week in late October that Walmart announced it would stop offering health insurance benefits to new part-time employees….”

    Does anyone seriously believe Walmart is the solution to our high cost problem?

  31. Jonathan, I think there is much more to this RFI than mere exploration. I think primary care like rbaer describes will be displaced by coordination and case management activities delivered by “level 1” support personnel assisted by increasingly better computerized protocols and telemedicine. Physicians will become “level 3” support for most people.
    Walmart is very well positioned to affect such changes, particularly in rural and low income areas, and I think there is decent profit to be made here, so it’s not just a boost to store traffic.

  32. I see very little overlap. PC don’t take care from PCPs, they treat mainly people that wouldn’t go to the doctor if not for the PC. They also do, or are trying to do, a lot of wellness service. If the insurance carrier has wellness plans that require HRAs and screenings they try to capture that business.

    Anything the PCs are doing is stuff that would be a waste of time for a PCP to be doing in most cases.

    The PCs i have been to have always been very aware of the PCPs roll, either offering to forward info or suggesting I follow up with a PCP

  33. rbaer, you are pretty much right. It looks like the Walmart RFI was an exploration of how they might get beyond that model of minor episodic care.

    What seems more in Walmart’s sweet spot would be to get into the device business. If they could bring the equivalent of $4 generics to the device industry, that would really shake things up.

  34. I hope that a person here who knows PC well (I myself am a specialty physician) can elaborate to what extent PC and retail clinics overlap. PCPs take care of patients often for many years, treating chronic conditions as well as managing a lot of acute situations, as well as – in the best case – overlooking a patient’s specialty care. I wonder whether the retail clinics are just little shops dealing with cold, UTI, flu shots, prescribing/recommending ABx (a lot of them unnecessary like in real medicine, probably even more), OTC drugs and diagnostic tests. IMHO that’s not primary care. But I am happy to stand corrected.

  35. Wal Mart employs 1.2 million people, I bet they know a thing or two about tracking demand and staffing for it.

    Currently your PCP is open 9-5 M-F, pretty much the exact hours majority of people don’t have available for an appointment. I had a meeting cancelled today becuase they had a last minute Dr appointment.

    I would bet there is more demand in the East and North during winter then the south and west, reallocating resources to accomodate this would be much more efficient then current.

    Wal Mart also accels at technology, can you think of someone better to give EMRs critical mass?

    They aren’t going to solve HC, no one solution or player will, but they can help solve a portion of the problem. Look what they have done to the Generic Rx market

  36. Fifty-seven percent of new Wal-Mart hires are coming from outside the ranks of the employed. When you create lots of entry-level opportunities, you are going to hire some people on public assistance. In this, Wal-Mart isn’t adding to the public burden but reducing it. For example, 7 percent of new Wal-Mart associates are enrolled in Medicaid before joining the company. After joining, the number drops to 5 percent. After two years, it falls to 3 percent.

  37. Wal-Mart’s key competitive advantages are its buying power and, especially, its sophisticated and highly efficient distribution system. Neither of those has anything to do with providing primary care.

    As the post noted, the retail clinic business is seasonal and NP’s are not cheap to hire. Doctors, of course, are even more expensive. Building traffic for the rest of the store is one thing. Making money on the clinic operation itself is quite another. The same is true of the pharmacy strategy of offering low cost generics. It’s a traffic builder, not a moneymaker on its own.

  38. “while medical care would be delivered via big screen monitors from the same source as the other plastic junk they sell.”

    Wal-Mart selling more homegrown food: As Wal-Mart tries to adapt its business to how its consumers are shopping, Tovar said the discounter is buying more fresh fruits and vegetables from American farms and plans to double orders to domestic farmers by 2015.

    “We’re going to farmers and saying we’ll buy [their] whole orchard,” Tovar said. “We take their best apples and sell them as eating apples. The others that aren’t so good we’ll turn into apple juice or sauce and sell it under our Great Value label.”

    Sourcing locally allows Wal-Mart’s customers get fresher products faster and “at better cost,” he said. Wal-Mart benefits by paying less for fuel and shipping.

    In turn, Wal-Mart said it’s able to pay farmers more and still sell the goods at lower prices vs. competitors.

    Why let the facts get in the way of a good rant right? FYI Wal Mart still pays a higher hourly wage and provides more insurance to their part timers then the unions pay their picketers. But your ok using and oppresing people as long as it benefits your beliefs.

  39. Walmart released a statement today saying:

    “The RFI statement of intent is overwritten and incorrect. We are not building a national, integrated, low-cost primary care health care platform.”

    ….which is too bad because I was “looking forward” to Walmart doing to primary care what it did to retail in rural areas.
    I wonder if they would staff their “primary care” clinics with regular (uninsured) “associates”, while medical care would be delivered via big screen monitors from the same source as the other plastic junk they sell.

    To your question Steve, I am not sure how many doctors would be willing to practice for Walmart and I am not sure how many people, even poor ones, would consider going to Walmart for “Coronary heart disease management and monitoring” or “Clinical depression management and monitoring”.

  40. Intriguing. I have asked this question of many economists, and they concede that there is no good answer. Why hasnt there been a WalMart for health care developing anywhere? You dont see this developing in any state. Since this would work across state lines, and for individual specialties there are practices working across state lines, this should have happened a long time ago.

    Steve

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