Serving the medically underserved: Walmart gears up for Care Clinic rollout
A new and radically different concept for frontline health care emerged last year when Walmart unveiled its first Walmart Care Clinics in Texas, Georgia and South Carolina. If things go according to plan, patients and health plan payers across the United States can look forward to a cheaper and more affordable alternative to the family doctor for nearly all their primary care needs.
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The chain quietly opened 17 Care Clinics in 2014 in a multi-market pilot, offering patients not only walk-in acute care, but many of the services patients would get from their local physician practice — and at a far lower cost. If Walmart rolls out the new clinic model nationwide, its potential for disruption in the primary healthcare space is anybody’s guess.
“Since 2005, Walmart has leased space in its stores to local health systems and other healthcare providers, who provide basic acute care” in about 90 stores with pharmacies across the United States, explained Jennifer LaPerre, senior director of retail clinics. “he Walmart Care Clinic is different — it is owned by Walmart.”
More important, said LaPerre, “the Walmart Care Clinic also goes beyond basic acute care and offers the services expected from a primary care provider, such as wellness and preventive care and management of chronic conditions.”
Staffed by licensed nurse practitioners and overseen by a supervising physician in a hub-and-spoke advisory framework, the clinics offer “a number of primary care healthcare services,” LaPerre added, including:
Wellness and preventive care, including health screenings, vaccinations and lab testing;
Basic acute care, including diagnosis and treatment of illnesses like flu and strep;
Management of certain chronic conditions, such as diabetes, asthma and high blood pressure; and
Referrals to specialists as needed.
“It’s just like going to your primary care physician,” noted Labeed Diab, Walmart president of health-and-wellness. “This is not just acute care or chronic care; this is all of the above. We’ll see you for a cough or upper respiratory condition, but we’ll also see you for diabetes, hypertension or high cholesterol.”
For the 17 clinics opened last year on a trial basis, Walmart worked with outside clinic-care providers, LaPerre explained, “to help source and manage the nurse practitioners, medical assistants and supervisory physicians.”
The launch of Care Clinic came after careful study of the current state of primary care in the United States — and of the unmet or underserved needs of millions of Americans. “We really looked at the [clinic] space,” said LaPerre. What her team found, she said, is that “75% of the healthcare industry spend is in chronic condition management. So it would not be diligent of us to enter the space where everybody exists if we didn’t serve the chronic condition needs. So in addition to prevention and wellness and acute care, we want to be able to serve the diabetic. And we spent a lot of time talking about that.”
Besides effectively replicating the frontline services offered by primary care doctors, said LaPerre, “the Walmart Care Clinic creates a new price position for retail health services that aims to give our associates and customers greater access to quality, affordable health care.”
That new price position is revolutionary. “For most Walmart associates and their families who are on a Walmart health plan, the ... Care Clinic office visit costs them only $4, and qualified preventive services received at the clinic will cost them zero dollars.” LaPerre noted. “For our customers, an office visit to the Walmart Care Clinic will cost $40.”
In addition, said LaPerre, “the Walmart Care Clinic will also accept traditional fee-for-service Medicare and Medicaid,” and is “currently looking into accepting third-party commercial insurance as part of the pilot program.”
Serving the underserved
Behind the concept: the recognition by Walmart healthcare managers that “many of the communities we serve need greater access to affordable healthcare solutions,” LaPerre said.
“Our goal is to join the continuum of medical care in the communities where we operate,” said LaPerre. “The services we provide within the clinic are all within the scope of services of a nurse practitioner. We also have a referral network in place if the needs of the patient are beyond the nurse practitioner’s care.”
Thus, she said, “we work collaboratively with patients’ primary care physicians.”
That’s not always an immediate option, since “nearly half of the patients we see do not have a primary care doctor,” LaPerre added. Indeed, she said, “47% of our patients are coming to our clinics without a PCP relationship. So we believe it’s a win for the industry, because ... we’re serving where [patients] weren’t receiving care in the past. So we’re creating consumption.”
“Secondarily, we’re also serving as part of a continuum of care in the community. So we do not look at our strategy in isolation of the communities in which we serve,” added LaPerre. “It’s all about connecting to other providers, so that we can have a synergistic relationship.”
When choosing where to locate a clinic, Walmart will weigh several key factors. One big one, said LaPerre, will be to open a Care Clinic in communities “where there are primary care provider shortages ... today and in the future.”
Also important to the location strategy, she said, are areas that have a high population of Walmart store associates, whom she anticipates will be a prime beneficiary of the Care Clinic model. “It was super important to us. It’s very strategic that we focused on our associates, and where our associate density exists,” she said.
“Thirdly, we’ll look at locations where there’s a high propensity for chronic disease,” LaPerre added. “And last but not least, where there’s an underserved, uninsured or high Medicaid population.”
Besides lowering primary health costs and boosting patient access to care, Walmart has another goal for its Care Clinics, said LaPerre: to make the notoriously opaque and complex pricing structure of the U.S. healthcare system more transparent and understandable. Along with that need, she said, most patients today don’t have the information they need to make an informed decision about which primary care doctor or practice they should choose.
“We have more work to do on this,” LaPerre explained. “Part of our assessment is looking at technological solutions. We have a lot of opportunity to become more sophisticated. And one of our great focal points — especially given the fact that we’re serving both associates and our customers — is how we build solutions that identify high-quality, low-cost providers. And there’s not really an off-the-shelf solution to identify that today, but it’s something we’re working toward solving.”
Paul Beahm, Walmart SVP health-and-wellness operations, call