Welcome to Walmart. The nurse will be right with you.þþWalmart, 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 making an aggressive push to become a one-stop shopping destination for medical care.þþThe company has opened five primary care locations in South Carolina and Texas, and plans to open a sixth clinic in Palestine, Tex., on Friday and another six by the end of the year. The clinics, it says, can offer a broader range of services, like chronic disease management, than the 100 or so acute care clinics leased by hospital operators at Walmarts across the country. Unlike CVS or Walgreens, which also offer some similar services, or Costco, which offers eye care, Walmart is marketing itself as a primary medical provider.þþLike its competitors, Walmart is looking to grab a bigger share of the billions of health care dollars being spent in the United States and benefit from the changes that have resulted from the Affordable Care Act.þþWith its vast rural footprint, Walmart 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 they succeed, the company said, it is prepared to open even more.þþ“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.þþBut 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 like diabetes, for example, can result in complications that are not easy to manage.þþ“There’s not a role for retail clinics to take care of chronic, ongoing problems like that,” said Dr. Robert L. Wergin, the president-elect of the American Academy of Family Physicians. “It can provide a service, maybe an entryway into a system.”þþWhile 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 Walmart, according to Dr. David Severance, the corporate medical director at QuadMed, which is joining with Walmart to help staff and run the clinics.þþFor patients with complex issues, Dr. Severance said, the goal was for Walmart to be a patient’s first stop and part of a continuum of care. “In that circumstance, it’s our desire to get those individuals established with a primary care provider, preferably a physician within the community,” he said.þþLast year, Walgreens announced it would begin offering some primary care services like disease monitoring at its 400 clinics across the country. But it does not market the facilities as primary care clinics, a spokesman, John Cohn, said, adding that the company “strongly” encourages patients to seek continuing care elsewhere.þþ“Walgreens is still trying to be a little careful in how they talk about primary care,” said Tom Charland, the chief executive of Merchant Medicine, a health care research and consulting firm. “Walmart puts primary care out there front and center. In that sense, I think it will be more comprehensive because primary care is their stated intention.”þþAccording to its website, Walmart’s “expanded scope of coverage enables us to be your primary medical provider.”þþWhile 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.þþThe primary clinic model could offer some 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 instance — often peaks in the winter months, Mr. Charland said, and slows down significantly at other times of year.þþWalmart also says it will be better off working with just one partner, QuadMed, instead of multiple partners that each run a handful of clinics, which was the model used in its acute care clinics. With just one or two stores, it can be difficult to spot problems that may be more obvious with more locations, Mr. Charland said.þþAlong with medical assistants, nurse practitioners, who generally receive less training than doctors but can prescribe most of the same medications, run the primary clinics.þþWhile each Walmart primary care clinic has a supervisory physician who oversees compliance and prescription orders at one or two locations, those doctors do not actually treat patients. The system is the same as for acute care clinics that treat minor skin infections or a sprained ankle, but it is more unusual for facilities that provide more complicated health services, said Dr. Steven J. Kravet, the president of Johns Hopkins Community Physicians.þþ“I’m not saying there’s not a role for it. We just really have to find the right role,” Dr. Kravet said. “What you want is patients to get the right providers.”þþDisease management is big business. Most of the $1.7 billion that Americans spend annually goes to handling chronic illnesses, said Matt Nemer, a health care analyst at Wells Fargo.þþFor Walmart, that could mean a more regular stream of patients that helps increase foot traffic.þþWalmart’s same-store sales, or sales at stores that have typically been open for more than 12 months, have been on the decline in recent months, and 10 percent of sales have evaporated at big retailers as more consumers shop online, Mr. Nemer said.þþThe Walmart 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. (Walmart says that more than half of its 1.1 million employees currently receive health care through the company.) While it accepts Medicare, it does not currently 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.þþBut the primary care clinics can help drive traffic to Walmart’s pharmacies, which do accept insurance, and could stand to benefit from the growing number of people now signing up for coverage under the Affordable Care Act.þþ“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 Walmart stores. “You also need to sell them prescriptions, a bag of chips, maybe a magazine while they’re waiting.”
Source: NY Times
