Retail Medical Clinics – The Disruptive Impact of Walmart

Posted on | July 24, 2015 | 1 Comment

Mike Magee

This week’s NEJM article on the expansion of retail clinics in the U.S. begins:

“ In a tumultuous era of change propelled by public health policies and private entrepreneurial activity, the spread of retail clinics offering basic primary care, walk-in visits, extended hours, and lower prices than a doctor’s office or emergency department is unsettling the medical profession, especially family physicians and pediatricians. Most U.S. retail clinics are owned and operated by vast corporate enterprises and staffed by advanced practice nurses and physician assistants. Although relatively few assessments have been conducted of the quality of care in such clinics, some peer-reviewed studies indicate that they deliver their circumscribed set of services at least as well as physicians’ offices do.”

The article is written by the legendary Health Policy guru, John Inglehart, who goes on to lay out the numbers surrounding the new corporate face of the retail clinic business, including the latest CVS and Walgreen figures. He also reveals that Walmart is now jumping in with both feet. As he says, “Within the past year, the corporate giant Walmart announced a new health clinic strategy. Until recently, Walmart had leased space in its superstores to a clinic operator (usually a health system), but it is letting many of these leases expire. In those clinics, nurse practitioners have delivered primary care, and Walmart has contracted with a separate company (QuadMed) to arrange for community-based physicians to provide clinic oversight consistent with state regulations. But recognizing a rapidly evolving health care landscape, Walmart has announced a new model, the “Walmart Care Clinic…”

What Inglehart does not catalogue is the vast number of American corporations that sponsor their own on-site employee health clinics. He does suggest, however, that part of Walmart’s rationale and business model includes providing care to Walmart employees. Employees pay only $4 for basic services, while outside customers pay $40 per visit. It was just a year ago that this massive corporation was being slammed in the media for its low wage scale and poor health benefits. Herein lies an in-house solution at least to the health coverage issue, which by the way, could also be a profit center with customers, and potentially a lower cost solution for other corporations who have been funding their own in-house health centers.

In 2012, I wrote that “retail pharmacy clinics deliver a good product, that ‘virtual minute clinics’ as extension arms of the retail based sites might come to your home in the future, that home care for older chronically ill patients could easily be mixed with well-care like sports physicals or strep cultures for grandchildren at home, that home health care companies should consider themselves to be ‘comprehensive virtual clinical practice’ not a pay for hire service, and that the competition (doctors’ offices and hospitals), provided uneven service if you were able to get an appointment for standard care issues.”

At that time, Christine Cassel from the American Board of Internal Medicine and Thomas Bodenheimer of UCSF had penned articles on the same topic in JAMA and the New England Journal of Medicine respectively. Dr. Bodenheimer opined on how to improve access to primary care, while Dr. Cassel reflected on the expanded use of retail clinics in pharmacy settings to address the need for improved access to care.

Dr. Bodenheimer noted that current wait times in Massachusetts for a primary care appointment were 36 days for family medicine and 48 days for internal medicine. In their words, “The reason for the access problem is an imbalance between demand for care and capacity to provide care…. One answer is for physicians to share care with an empowered health care team….In most primary care practices, non-clinician team members – registered nurses(RN’s), medical assistants, health educators, and others – are not empowered to share the care…The most significant barrier is the discomfort that many physicians feel about giving up decisions regarding preventive and chronic care, which, though seemingly routine, are often complicated by patients’ various coexistent conditions, preferences and goals…Creating teams to share the care is not an end in itself. The purpose of this practice change is to address the national demand-capacity imbalance while enhancing quality and reducing clinician stress and burnout.”

Dr. Cassel’s comments were considerably more direct. She wrote, “Easy access to medical clinics in retail settings is gaining momentum in the United States…For a working person with a sudden onset of febrile illness, the retail clinic provides a solution: the person can be seen quickly the day the problem arises and most often is able to receive a simple and straightforward evaluation and treatment or recommendation to seek specialist care if indicated…the visit would be less than $100 and the pricing would be transparent. In contrast, the same minor problem could cost hundreds of dollars for an emergency department visit…The retail clinic phenomenon could be transformative for a vast number of patients in the United States.”

What was missing three years ago was adequate informational connectivity and flow between retail clinic caregivers and primary care and hospital networks, and expanded ubiquitous presence of retail clinics nationwide.

Walmart might change that.

For Health Commenatary, I’m Mike Magee.