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, called the company’s new clinics “a core component of our strategy around bringing the right products and services together to form solutions and value-based … transactions.”
“It’s serving the underserved, but also, as we continue to roll these out, we’ll have another tool in our toolkit to help drive costs down in our relationships with third-party payers,” he told DSN. “We’re being very thoughtful about how these pieces fit together to form a more cohesive strategy.”
Added LaPerre, “What we have found … is that people love the model … and they are responding. We’re spending our time now assessing what’s working and what we need to do differently to better serve our customers. But we are seeing great success.”
Fashion forward: Vision Centers blend cutting-edge technology, style
Which U.S. company fits more Americans with glasses and contact lenses than any other? That would be Walmart, which also happens to operate the largest chain of vision centers in the country.
(To view the full report, click here.)
Vision centers are a huge facet of Walmart’s front-store business — and to the company’s position as a health-and-wellness destination. “Walmart has been helping customers manage their eyesight for more than 20 years,” and is “the largest seller of eyeglasses in the United States,” said Carmen Bauza, SVP baby, paper goods, chemicals, OTC and optical for Walmart U.S. “We are currently working to grow and expand our optical business to meet our customers’ needs.”
The company is also “the largest manufacturer of glasses in the United States,” noted Labeed Diab, president of health-and-wellness for Walmart U.S., with production facilities in Fayetteville, Ark.; Houston, Texas; and Crawfordsville, Ind. It also outsources eyewear manufacturing to two facilities in Mexico, in partnership with Essilor and Zeiss.
“It is in these labs where Walmart … prescription eyewear is manufactured,” Bauza explained. The lab in Arkansas near Walmart headquarters, she added, is the largest production plant for corrective eyewear in the world.
Walmart hosts leased and company-owned Vision Centers in some 3,000 of its Supercenters and discount stores, including some 2,900 centers operated independently by optometrists who lease space from the company within the centers. In addition, Walmart owns roughly 100 in-store optical centers in nine states in the mid-Atlantic, Midwestern and Southwestern regions of the country, where the company itself employs doctors of optometry or ophthalmologists.
At all 3,000 of its Vision Centers, “it’s important to offer choice to our customers,” Bauza said. “Our new eyewear brands provide a good, better, best assortment, giving our customers the freedom to choose the frames that best meet their eyewear needs at an everyday low price.”
In addition, she added, “Walmart also offers exclusive cutting-edge lens technology that provides additional comfort and enhanced acuity.”
In all, “Walmart customers can choose from more than 1,000 frames for the entire family,” said Bauza, including a recently launched brand of eyewear exclusive to Walmart, called Hard Candy.
“The customer is changing, which is driving the changes in our business,” Bauza pointed out. “In the past, the optical business was viewed as a medical need. Today the optical business has become a fashion business with medical benefits.”
Behind the changes are younger generations of style-conscious consumers, Bauza noted. “Industry growth is coming primarily from millennial and Gen-X segments, as they view frames and sunglasses as a fashion accessory to enhance their image and complement their wardrobe,” Bauza explained. Nevertheless, she said, “We are currently working to diversify and expand our assortment to meet the needs of not only fashion-forward millennials but also the aging population.”
Indeed, says Bauza, growth in the vision category is also coming from contact lenses, which “are resurging as laser correction dissipates.”
Bringing transparency to health insurance
Why would Walmart launch an insurance education service for the 140 million Americans who shop its stores each week? For one thing, because more than 60% of Americans have a tough time understanding their health insurance plan options, according to research from the Kaiser Family Foundation, and nearly 40% feel that they picked the wrong plan after enrolling.
(To view the full report, click here.)
Those troubling statistics helped spur the creation of Healthcare Begins Here, an in-store program to educate customers at Walmart pharmacies about their health insurance options and the benefits and costs of one plan over another. Walmart teamed up with DirectHealth.com to provide the service.
“For years, our customers have told us that there is too much complexity when it comes to understanding their health insurance options,” said Labeed Diab, president of health-and-wellness for Walmart U.S. “Healthcare Begins Here addresses that complexity by bringing clarity and increased choice to the insurance enrollment process through DirectHealth.com.”
DirectHealth is an online health insurance comparison site and independent licensed health insurance agency that helps Walmart customers gain access to health insurance information and enrollment support. The company also arranges for licensed insurance agents to temporarily locate at some 2,700 of its pharmacies to educate customers directly on their coverage options, and to “enroll in the plan that is right for them,” said Marcus Osborne, VP health-and-wellness payer relations for Walmart U.S., “whether that be a Medicare plan or Public Healthcare Exchange plan through online, phone and in-store services.”
The DirectHealth website is operated by TZ Insurance Solutions LLC, which is also the agency licensed to sell health insurance in all 50 states on behalf of DirectHealth. Walmart serves as the company’s marketing partner.
Walmart customers have had in-store access to health insurance information since 2005, when the company began hosting “insurance agents from individual insurers in stores to answer questions and enroll customers in specific healthcare plans,” Osborne said. However, he told DSN, “Healthcare Begins Here, through DirectHealth.com, takes this offering to the next level in response to customers who want more options to choose from.”
The education and enrollment process in Walmart stores is “timed to open enrollment” in the fall for Medicare, and from mid-November to mid-February for the health insurance marketplace open enrollment period.
“For customers over 65,” Walmart reports, “DirectHealth.com offers access to more than 1,700 plans from 12 leading carriers, including Aetna, Cigna, Humana, UnitedHealthcare and participating Blue Cross and Blue Shield companies. For customers under the age of 65, DirectHealth.com offers access to thousands of Health Exchange plans from more than 300 leading carriers.”
Customers can compare and enroll in health plans online at DirectHealth.com or over the phone.
The program has been an unqualified hit, Osborne said. “We have received great feedback from our customers on the Healthcare Begins Here program and DirectHealth.com resource,” he noted. “While we can’t share specific numbers, we can say the number of enrollments exceeded our expectations.”
“DirectHealth.com is not designed for our associates. The healthcare plans we offer our associates are among the best in the retail industry,” Osborne added.