Wal-Mart is now a primary care provider — There are only two ways to respond

Wal-Mart plans to open a dozen primary care clinics within a small number of its retail stores by the end of 2014, according to a New York Times report from last week.

The retailer has opened five primary care clinics in rural markets in Texas and South Carolina, and will open a handful more by the end of the year — a move suggesting the retailer is getting more serious about playing in the healthcare arena. The openings of the five existing clinics didn't receive much media attention, perhaps, as Dan Diamond, managing editor at The Advisory Board Company surmises, because the clinics are located in smaller healthcare markets, like Sumter and Florence, S.C.

Why this play is different

Wal-Mart currently leases out space in roughly 100 of its stores to health systems, but the discount giant says the clinics it plans to operate will offer more comprehensive services beyond those — such as chronic disease management — that its leased facilities do, according to the NYT report. Plus, it can do so at a lower cost.

Wal-Mart is explicitly marketing the clinics as "primary care" service locations, writing on its website that its "expanded scope of coverage enables us to be your primary medical provider." [Emphasis mine]

This differentiates the clinics from those in CVS and Walgreens, which offer a limited number of retail-based urgent care services.

For Walgreens' part, it announced last year it would offer expanded services, like chronic disease monitoring, at its 400 clinics across the country, but the company 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," according to the NYT report. Walgreens also recently launched a consumer-friendly app for tracking health behaviors, and will reward users with vouchers for purchases (See: "Is Walgreens doing more for population health than you?")

The move by Wal-Mart to significantly expand its primary care offerings at its rural locations "within seven years," according to an announcement the company made last year, also represents diversification efforts by the retailer, which has experienced declining sales in the past five quarters.

Why the move should worry you
Wal-Mart's explicit foray into primary care should be concerning for existing healthcare providers on its own (after all the brand is known for wielding its market power to drive down costs), but also because it won't partner with local health systems, like Walgreens' Healthcare Clinic and CVS' MinuteClinic have done.

"Walmart 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," explains the NYT report.

Instead, it's selected one partner — QuadMed — to staff its clinics with mid-level providers and supervising physicians. QuadMed, which was launched in 1991 by a printing company executive fed up with rising employee healthcare costs, has traditionally staffed and managed employer-based clinics.

Plus, Wal-Mart clinics are conveniently located and cheap.

Always low prices, and definitely lower than yours  
Wal-Mart's new clinics will not accept private insurance — though a company spokesperson told the NYT it is exploring the option. Instead, it will charge just $40 per visit — the same amount many insured pay as a co-pay. It also accepts Medicare and plans to accept Medicaid at certain locations. But here's the kicker: It's roughly 1 million employees can receive services for just $4 a visit! That's something to take note of: If your health system is treating Wal-Mart workers now, it will probably treat fewer and fewer (at least for primary care services) in the years ahead.


Is Wal-Mart too late to the game?
I've written extensively on this blog about the coming disruption in healthcare; however, I've also written that legacy companies don't automatically perish if they fail to disrupt. Instead, their future success lies in their ability to adapt in the face of disruption.

Wal-Mart is poised to do both. It's adapting to other retailers', like Walgreens', disruptive entries into providing healthcare services. And it's becoming a disruptor in its own right by extending the retail-clinic model and disrupting the business model of traditional healthcare providers.

A Forbes article on Wal-Mart's primary care foray sums up the biggest reason Wal-Mart is likely to succeed: "Walmart's corporate strategy has never been about first-mover advantage — it's about distribution efficiency and cost management," said Alicia Daugherty, who oversees marketing and planning research at The Advisory Board. "Coming in a little later in the game allows them to capitalize on markets created by others, and learn from others' mistakes."

Right now, Wal-Mart's clinics are planned for rural locations, but with more than 4,200 stores across the U.S., there's no reason the company wouldn't expand if the first clinics perform well.

What does this mean for non-retail healthcare providers? Your two options
Certainly, competition for primary care services is about to get much harsher. You have two plays: Either find a way to compete with the Wal-Marts, Walgreens and CVS of the world for primary care, or make sure their providers are referring more complex cases to you.

As Kenneth Kaufman, chair of Kaufman Hall, recently wrote in an article for Becker's: 

"Even speed, strong ideas, and sizable resources do not guarantee success. For Wal-Mart and hospitals alike, innovations will need to yield sizable results to replace revenue likely to be lost due to business-model disruption. Yet, while aggressive efforts at transformation do not ensure success, staying with a legacy business model in a changing environment is an even riskier proposition."


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