Revolutionizing Retail and Health – Walmart drives care into new settings

CC-Institute-Gala-3-of-32One cannot discuss consumer health without addressing the drastically changing environment of care. At Health 2.0 WinterTech: The New Consumer Health Landscape speakers from Walmart, Target, and Optum will join Matthew Holt to dive into how major retailers are disrupting the way millions of Americans not only access acute care services but also purchase prescriptions, access health education, and more. Ben Wanamaker, Senior Manager of Strategy and Operations at Walmart sat down with Matthew last week to shed light on what 2015 will bring for Walmart’s Care Clinics. 

Matthew Holt: Hi, it’s Matthew Holt and I’m here checking in with Ben Wanamaker. Ben is the Senior Manager in Strategy and Operations at Walmart, which is obviously the world’s biggest retailer. 

Ben Wanamaker: That’s right.

MH: We’re looking forward to having Ben at our WinterTech Conference, which is coming up on January 15th in San Francisco. The big part of WinterTech is looking at the new generation of health care consumers and of course, Walmart has made some moves in that area in this recent year. Well we’ll start, Ben, with the hardest profile piece, which is that you guys relatively, recently changed your overall strategy on retail clinics. Perhaps you can tell us a little bit about what you were doing before and what you’re doing now and what happened since then.

BW: Certainly. For several years Walmart has operated what’s called the Clinic at Walmart, and that was a business where we lease space in the front of our Walmart Supercenters to a clinic operator — in most cases, a health system. They would come set up shop and offer a very traditional retail health scope of services, which is primarily an acute care scope of services. That business continues today and there are a number of health system partners who operate successful clinic practices in the Walmart stores that provide a very valuable service to our customers. As we have observed the continuing evolving health care landscape, Walmart has made a strategic decision to invest in a new clinic model, which we have called the Walmart Care Clinic. Now, the Walmart Care Clinic is a Walmart-owned and controlled business where we set the price and scope of services and has partnered with an organization called QuadMed, which is a nationally recognized organization for their work in employer onsite clinics, to help us source staff and train the medical professionals in our clinics. Now, the scope of services in our clinics is quite a broad one for the retail setting. It includes all of the preventive care that you’d expect in a primary care setting. It includes all of the acute care that you’d expect in a retail setting, the cold, cough, flu, and like conditions, and it includes basic chronic condition management services as well – for patients with uncomplicated diabetes, high blood pressure, and similar conditions. We also offer a full point-of-care lab offering in these clinics. The whole Walmart Clinic model is based on the premise that we can offer quality health care at a Walmart Everyday Low Price. It’s also based on a premise that many of the customers who are already in Walmart, on an everyday basis, are not consuming or under consuming primary healthcare services. And to the extent that we make these services accessible, convenient, and affordable to them, we think it can be a valuable offering to our customers and a valuable part of the Walmart health and wellness portfolio of services.

MH: So that makes sense. It’s a nice new development. So just to be clear in the relationship with QuadMed there – is QuadMed sourcing employee or are they actually employing physicians and nurse practitioners?

BW: Great question, yeah. We’re delivering the care in the clinics with nurse practitioners and QuadMed is contracting physicians in the community to provide physician oversight in line with state regulations. QuadMed leverages its expertise in sourcing, training, and overseeing these clinicians. The relationship between QuadMed and Walmart consists of a contractual partnership where they perform some very critical and important services on our behalf as we own and operate this business.

MH: Okay. My impression is that Walmart wanted to go further into more chronic care management and have more capacity and capability in terms of overall patient care management than the retail clinics of say your competitors, Walgreens or CVS.  Is that a fitting statement?

BW: Well, we differ from our competitors but more or less what I would say is you’re correct. We believe there’s a significant opportunity to serve the chronic patient and that we have a lot of the offerings that they would need to be successful in managing that chronic condition together with our pharmacy and the over-counter offerings available in the Walmart store. Those services can really be of a great benefit to our customers and patients.

MH: In that case, is it fair to say that many of the people who come to the clinics — and they’re talking about a $40 visit; I’ve heard it’s $4 if you’re actually a Walmart employee. Is it fair to say that you’re essentially replacing either primary care or giving primary care to people who didn’t have it before? Or do you expect this clinic to work in conjunction with the current primary care physician?

BW: Our aim is to really be part of the entire care continuum for a patient. For some patients, our price points and the convenience are going to be their entrée into the healthcare system, where perhaps they have not previously consumed the primary healthcare services that they need. But we would never purport that we are the beginning and the end of many of our patients’ healthcare needs and are committed to working with our supervising physicians and the care provider communities in which we operate, to make sure that our patients really get the appropriate comprehensive care that they need. Now, for those patients whose needs are squarely addressed by our scope of services, should they choose to do so, we would be happy to serve them for all of those primary care services in our clinic. But for patients whose needs go beyond our scope of services, or for patients who have an existing primary care relationship but choose to use us on occasion for the convenience and/or affordability, we think there’s a strong value proposition for them too.  

MH: Okay. So let me ask you a little bit about your wide relationship in the business. You essentially are going to be contracting with/or establishing in each area a network of specialists in hospitals who you’ll be referring to? Can you suggest that Walmart will sort of become an entrée as some other onsite clinics have been? Is that where you’re heading?

BW: Well when someone begins there care with us, we want to be able to make them a promise that all the way through their care continuum they can expect price transparency in high clinical quality. That includes when they are referred beyond our clinic. Now, as you well know, Walmart can’t control the pricing of other providers nor would we try to. But we do care a lot about establishing referral relationships out of our clinics with very high quality practitioners in the community, both primary care and specialty providers. So, to your earlier point, we can partner with our patients and the downstream caregivers in the community to get our patients to the right place to meet their needs with a reasonable expectation of price transparency and high clinical quality.

MH: Which leads us then to the next couple of questions about the technology that you were using to both manage the process internally but also going to manage that referral piece. I don’t know how much of this really been established or how much this is public. What are you using inside the clinic in terms of medical records and then how are you managing the process of referral out, tracking where people are going, and then helping with that price transparency? How far is it going to cost?

BW: Good question. As you know, this is a difficult problem to solve and one that will be an evolution for us and many of the players in the industry. We’re using one of the top-shelf EMR practice management applications currently. And in it, have the capability to do all of the clinical and practice management functions that you’d expect in a primary care setting. We do track and follow up on referrals we send out, the results we get back, and how the level of connectedness between our referral partners and us kind of develops and deepens as we’re open. However, as you are likely aware, we just opened our first clinic in April, and we’re on a journey to slowly but steadily improve the technology infrastructure at our disposal to deliver a highly coordinated continuum of care for our patients. 

MH: Okay. That’s good. A while back, Walmart bought a company called Kosmix, which is a health care search engine offering. I think it’s now a part of all Walmart labs in the Bay Area. I’m wondering about the other part, which is connected here, which is the online information source piece. Obviously, a lot of people are going online, looking at their care and looking at the information and content online. Are you somehow working to bring that part into the equation here or most of your ignition sort coming from people start in the store to get to a retail clinic and then going from there?

BW: Great question. Spot-on in terms of where health care consumption is going. Our current offering is primarily an offering that begins with care in the store. However, we’re paying very close attention to the evolving landscape and how we can meet our customers where their needs arise, including when they rise at home, and when those needs can be met on the web. But, those prior Walmart interests in health care IT companies have not yet converged with our existing IT platform. 

MH: Probably more to come there. That’s great. Well, that’s very helpful. The last question, but you started this in a few states and a few of your stores.  

BW: Um-hm.

MH: Is the current plan to just continue expanding to different areas, or is this more of a pilot and your looking to learn, or is this part of a massive expansion?

BW: You know we’re always piloting and looking to learn and that has been how our efforts, to date, have been represented appropriately. So we are not as yet publishing any details on our growth plans for the future, though we’re encouraged about the value proposition that we’ve brought to the market, and how people are adapting it in the states where we’ve launched already in Texas, South Carolina, and Georgia. So we’re certainly learning a tremendous amount, and are optimistic about what we’re learning from that, and how that will fit into our business going forward.

MH: Great. I won’t ask you because I’ll let you go guys. I hope that when we come to San Francisco, we will be able to talk a little bit about who’s paying and what you found out from your early work about the relationship with different insurers and Medicaid and Medicare and the rest. 

BW: Yeah. And I can give you the headlines on that right now. Right now, we’re accepting fee-for-service Medicare, Medicaid and of course we’re accepting cash patients. We do have plans to contract with manage care and commercial plans going forward in the process of developing that approach and working with some initial payer partners.

MH: Well, looking to having more about that, because I think the more you go in to chronic care management, the more interesting that combination is going to be, especially given your nationwide reach. Anyway, great! Well, I’ve been talking with Ben Wanamaker. He is the Senior Manager of Strategy and Operation at Walmart. We’ve been discussing Walmart’s move and changes in its retail clinics. And Ben will be a part of the Health 2.0 WinterTech coming up on January 15th in San Francisco. Ben, looking forward to seeing you there, thanks a lot for your time today.

BW: Thanks a lot.

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