Walmart’s plan, if implemented, would operate through an expansion of “retail clinic” services. Retail clinics, located within retail stores such as grocery stores, drugstores and big box stores provide walk-in care for a limited number of acute illnesses and preventive care services. These clinics, largely run by nurse practitioners and physician assistants, tend to mostly treat populations underserved by primary care physicians, and 90 percent of care is given to mild preventive treatment including sinusitis, immunization, blood screening and lab tests. Walmart already operates 140 of the nearly 1,300 retail clinics across the nation, serving over 3 million patients annually. In other words: retail clinics are big business.
But this business has very different implications for patients than it does for providers, or businesses, or the health care system as a whole. For patients, retail clinics mean access to basic preventive treatments at lower costs. Clinics accept most insurance co-payments, and patients without insurance typically pay only $40 to $70 for a clinic visit, which is about 30 to 40 percent less than the bill from a regular doctors office. It’s
nearly 80 percent less than emergency room care. Moreover, retail clinics often offer more convenient hours than regular doctors offices, and 40% of patients who visit retail clinics report that they would have otherwise sought care at an emergency room, suggesting some alleviation of costs to the health care system.
However, the story is far less rosy for physicians as well as many patients who need continuous care. Clinics almost exclusively treat simple patients, while more complex cases are referred to physician offices. Some primary care physicians worry that retail clinics are disruptive innovators and financially hurt MD markets. This is largely because retail clinics tend to skim off the healthiest patients who can be seen at higher volume, leaving traditional primary care settings to see more complex and, often, older patients without increased reimbursements from payers. Put simply: what’s left for traditional primary care clinics is more work and less pay. In this manner, primary care providers could be forced out of business in some areas by Walmart’s expansion.
While systematic cost savings can be achieved through expanded primary care models including retail clinics, questions exist as to how Walmart’s expansion might fit into new models of care that are being championed by providers and payers alike. The medical home and
Accountable Care Organizations (ACOs), both touted by sweeping new legislations like the federal
Affordable Care Act, demand high levels of coordinated care. In fact, in some states, private insurers require providers to sign
contracts that demand care coordination. With this in mind, questions arise as to how, if at all, retail clinics will adopt coordinated care approaches. Will expanded provider networks enter partnerships with Walmart? Will Walmart take the plunge into ACO certification and perhaps cast even wider nets of provider offerings?
While Walmart’s potential plan to build a massive primary care network should be commended for its ability to expand preventive care access to Americans, many questions remain regarding Walmart’s intentions as well as the overall impact such expansion would have on providers, networks, and patient populations alike. Only time will tell whether primary care can help deliver Walmart’s motto to Americans: “Save Money. Live Better.”
