Save money. Live better. It’s Wal-Mart’s corporate motto, but put it in the context of health care and add a third line targeted at improving care for individuals and you’ve got something awfully close to Don Berwick’s triple aim for health care reform. If cost is the real cancer in the U.S. health care delivery system—and we think it is—why not look to America’s low-cost leader for the cure?
When reports started hitting the news this week about a request for information Wal-Mart sent out to its vendors in late October announcing the mega-retailer’s intent to “build a national, integrated, low-cost primary care health care platform that will provide preventative and chronic care services that are currently out of reach for millions of Americans,” alarms went off in health policy circles across the country.
The company has since backpedaled on the statement of intent. John Agwunobi, M.D., M.P.H., M.B.A., head of Wal-Mart’s health and wellness division, released a statement on Nov. 9, 2011, saying, “We are not building a national, integrated, low-cost primary care health care platform.”
Well, that’s a relief.
What struck me about the RFI wasn’t just the ambitious statement of intent, now characterized by the company as “overwritten and incorrect,” it was the list of services Wal-Mart plans to offer: chronic disease management of everything from diabetes, asthma, and hypertension to sleep apnea, osteoporosis, HIV, and clinical depression.
A few years back, Wal-Mart announced plans to open more than 400 retail health clinics in its stores from coast to coast. As of now, it operates about 140 clinics. The company exerted its massive purchasing power and brought us $4 generic pharmaceuticals. And now it wants to bring its cost-cutting strategies to the chronic disease management market.
The trouble is the price points of primary care services and chronic disease management services aren’t the cause of our health care cost crisis. The real problem is the effect on system-wide health expenditures when chronic diseases aren’t managed properly. So maybe Wal-Mart’s idea of enhanced retail clinics could improve access to those services thereby improving population health and lowering overall health care costs, but I doubt it.
I tend to agree with AAFP President Glen Stream, M.D., M.B.I., who told National Public Radio that Wal-Mart’s proposal takes health care in the wrong direction. “I would still be gravely concerned that this is going to fragment care at a time when we now clearly understand that people having a usual source of comprehensive and continuous care in a single location is one of the main features that drives high-quality care, good patient health outcomes, and drives down costs.”
Today, family physicians across the country are transforming their practices to make them more accessible to their patients, and to evolve our delivery system into one that coordinates patient care in an efficient manner to make sure patients receive the right care at the right time and in the right setting. The 2010 AAFP Practice Profile survey shows that significant percentages of our members offer many of the same conveniences that retail health clinics offer. More than 73 percent offer same-day or open-access scheduling. More than 48 percent have extended office hours, and more than 31 percent offer weekend appointments.
Wal-Mart’s interest in expanding its line of health care services is a big indication that primary care is on the rise. Here’s yet another indication. The Baltimore Sun reported this week that Maryland state officials plan “to increase the number of primary care health professionals by as much as 25 percent in the next decade through a wide range of goals that include increased educational opportunities, financial incentives, and tort reform.”
Competition for primary care services is about to get fierce, folks. Wal-Mart knows where the money is and where the demand is. Seems to me family medicine is in a great position for strong market growth.
– Jonathan N