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Health Care Delivery System Continues to Evolve as Walmart Enters the Marketplace

By Jim Knaub

The New York Times recently reported on Walmart’s expansion of primary care medical clinics in six of its stores in Texas and South Carolina. The program aims to go one step beyond the quick walk-in clinics that have proliferated in recent years, according to the article. While these new clinics will still be staffed by limited license practitioners such as nurse practitioners, they hope to offer a broader range of primary care services, including some disease management services. The office visit charge will be $40, according to the article. The initial sites accept Medicare, but not other third-party insurance at this time. (Walmart employees and their dependents insured by the company will be charged $4 per visit.) Medicaid and other insurance plans are under consideration, according to a Walmart spokesperson.

So what does a Walmart test program mean to radiology? Probably nothing for now. These clinics are not offering any imaging services and probably won’t anytime soon, but that could change. It’s hardly a stretch to imagine that the retail giant with a nationwide footprint might want to carve itself a slice of this country’s $1.7 trillion health care market.

Imaging services don’t seem like an obvious choice—perhaps a mammogram service could make sense given the company’s presence in rural, underserved areas—for a Walmart incursion into health care. In addition, QuadMed, Walmart’s partner in running the clinics, operates employee-sponsored primary care programs. The concept could simply be a test program to help manage Walmart’s insurance and health care costs, which makes sense for a company that employs approximately 1.1 million people in the United States.

But it’s also possible that the company is assessing the potential for some larger future role as a primary care provider and/or gatekeeper, an idea that already has some primary care physicians concerned.

“There’s not a role for retail clinics to take care of chronic, ongoing problems like that,” Robert L. Wergin, MD, FAAFP, president-elect of the American Academy of Family Physicians told The New York Times. “It can provide a service, maybe an entryway into a system.”

Primary care physicians should be concerned about potential gatekeepers to the system. And referral specialists should be monitoring these efforts in case they need to build relationships with these potential gatekeepers. Some next generation of such clinics could provide a foothold and patient base to support a more complete primary care practice. The folks at Walmart know a thing or two about competing on price, a notion that many in health care would shudder to think about.

Insurers and providers are narrowing networks and trying to lock up patients while providing value in health care. Hospitals and radiology groups need to keep an eye on these emerging components of the health care delivery system. Whether Walmart’s program grows in that direction remains to be seen, but it is one of many care delivery strategies that deserves monitoring in case a future opportunity develops.

— Jim Knaub is editor of Radiology Today.