Walmart, the largest U.S. employer with a workforce of 1.6 million, is slowly building a network of in-store clinics, believing it has a place in America’s health care system.
Health care has to be accessible and sometimes that means being convenient, said Dr. David Carmouche, senior vice president of health care delivery at Walmart.
Walmart is venturing into health care, with in-store clinics in six states the retailer says offer accessible, affordable and convenient primary care services.
Carmouche said he had questions about Walmart’s plans to establish clinics before he joined the retailer in 2021, but then took a broader view of how Americans live.
Health care for most people is primary, preventative care and sometimes urgent care, but most people aren’t admitted to a hospital in a given year, he said, and there’s value in bringing health care where people go regularly.
“I just think access is challenged. Having to drive across town and park in a big parking garage and maneuver complex medical offices to see a physician for 15 minutes just doesn’t really work, frankly,” he said. “I’ve been in that world. That’s where I came from.”
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Also the largest retailer in the U.S., Walmart Health is poised to open two clinics in Texas this week targeting seniors and families with services for comprehensive primary care, behavioral health and dental care.
Walmart has 55 clinics in Arkansas, Florida, Georgia, Illinois, Missouri and Texas, where Walmart is the state’s largest employer. That includes the 22 it’s opening this year: 18 in Texas and four in Kansas City. Walmart opened 17 clinics last year.
“Most patients are already customers of Walmart, we’re just adding an accessible service,” he said. “About a quarter of our visits occur outside of 9 a.m. to 5 p.m.”
The clinics are open 7:30 a.m. to 7:30 p.m. Monday through Friday and 9 a.m. to 5 p.m. on Saturday. Telehealth is available on Sundays.
Walmart Health is growing its clinic business at a slower pace than competitors Walgreens VillageMC and Amazon’s One Medical. Amazon purchased San Francisco-based health clinic operator One Medical in 2022 and now has more than 125 locations.
Walgreens took a $5.8 billion charge last month to write down the value of its VillageMD clinics after purchasing a major stake in the business in 2022. Most recently Walgreens closed locations in Illinois and Indiana and pulled out of Florida.
VillageMD recently released the results of a two-year study conducted at 14 Houston locations with 1,300 high-risk patients that found increased primary care visits decrease hospital admissions. The study was published in The American Journal of Managed Care.
“High-quality primary care can keep patients healthier and out of the hospital,” said Clive Fields, co-founder and chief medical officer of VillageMD. “All Americans should understand that an ongoing relationship with your primary care doctor can yield better healthcare outcomes, improve your quality of life, and reduce future medical misery.”
With 60% of adults in the United States experiencing a chronic disease, creating a primary care relationship that benefits patients and the health system at large is critical, he said.
Demographics led Walmart Health to focus on seniors in Texas, where Carmouche said projections by 2050 show the population over age 65 doubling to more than 8 million.
“So, we built a model for seniors’ complexity. They have multiple chronic conditions. We’ve designed a care model to meet those needs,” Carmouche said. “Sure we see colds and flus and sprained ankles and scrapes. But we also take care of diabetes and hypertension and multiple chronic conditions.”
Even with the tight labor market for health care professionals, Walmart Health, with what Carmouche described as a large recruiting effort, has been able to attract physicians and support staff.
“We’re having to compete. But we’ve been able to sell a different experience,” he said. Many providers in primary care are asked to see 30 patients a day for just a few minutes and then spend a couple of hours at home to document medical records.
“That’s not our model. We’re providing a better work-life balance,” he said. “We’ve built a large care team that supports our providers.”
The clinics accept insurance but also post prices for cash-paying patients. Basic service costs range from $80 for an X-ray and $750 for a dental crown, depending on market. A chronic care management or injury visit is approximately $100. A flu test is about $64 and a lipid panel, $29.
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These are the people most likely to be burdened by medical debt in the US
These are the people most likely to be burdened by medical debt in the US
Of every five adults in America, two are currently saddled with debt from a medical procedure, emergency room visit, dental procedure, or other health care expense.
Care Better analyzed data from the Kaiser Family Foundation to visualize which groups of Americans are most likely to hold medical debt. The numbers come from a survey fielded from Feb. 25 through March 20, 2022. The survey included 2,375 adult respondents and is nationally representative of the overall American population.
The responses reveal an uneven distribution of medical debt, dampening the economic potential for a subset of the American population. Stakeholders in the health care sector pin this on a variety of factors, including lack of insurance. Americans who don't have health insurance are more likely than those who are insured to carry medical debt. But insured Americans report carrying medical debt, too.
The average health care plan sponsored by an employer carries a deductible higher than what many Americans report they can afford in emergency out-of-pocket expenses, according to the American Hospital Association. Nearly 2 in 5 Americans reported in 2022 that they couldn't afford a $400 emergency expense, and the typical deductible is around $1,400 per year.
The AHA reports that every year, its members provide tens of billions of dollars worth of uncompensated care for those who need it, and encourages health plans to ensure "that the coverage they offer provides protection against unaffordable bills and medical debt."
Over the last decade, health care costs have risen faster than inflation in most years, and they have certainly increased faster than wages, which were largely stagnant prior to the COVID-19 pandemic. These costs are hitting Americans with the lowest incomes and highest expenses the hardest.
America's medical debt is far from evenly distributed
The lowest-earning Americans tend to be the ones most likely to carry medical debt or dental debt, according to Kaiser Family Foundation survey data. Fewer than half of Americans making $90,000 per year or more have carried that debt in the last five years, whereas more than two-thirds of those earning $40,000 or less have had medical debt in that same time period.
Americans with higher costs due to raising children also report higher levels of medical debt. Roughly 3 in 5 parents with kids under the age of 18 are saddled with unpaid bills of some sort, compared with about 1 in 3 nonparents. Racial inequity is also present when it comes to the medical debt burden in America, with Black and Hispanic Americans being more likely to carry medical debt than their white counterparts.
Though a quarter of adults report they could pay off their medical debt in two years, about 1 in 5 report that they may never pay it off. When medical and dental costs become insurmountable for Americans, many borrow in order to make the debt right in the short term, accruing interest via credit cards or loans in the long term. The adults burdened by this debt report making financial sacrifices, including a significant number who say they've borrowed from family members or drained savings accounts.
Those Americans also report an emotional toll from the debt, dimming their outlook for the future. Unpaid bills may prompt health care providers to deny someone care down the road. They are often sent to aggressive collection agencies and might see their credit scores suffer. Lower credit scores make it difficult to qualify for a vehicle loan to commute to work, purchase a home, or borrow in case of future emergencies.
These harms to the financial health of Americans have led to calls for new policies, including a proposal by the Consumer Financial Protection Bureau to remove medical bills from consumers' credit scores.
Hospitals themselves have stepped in to offer financial assistance and cover unpaid medical bills where possible, but even they have taken a harder stance in recent years, pressuring insurers to provide more affordable terms for Americans.
Since 2012, all but a handful of state legislatures have expanded Medicaid coverage to even more lower-income households. In states that have, uninsured rates have fallen considerably. Those changes have led to a lowering of the overall costs of uncompensated care in those states and helped support local economies.
Unfortunately, more people could find themselves saddled with medical debt in the years ahead, as a result of declining rates of insured Americans this year. COVID-era bailout bills expanded eligibility for, and automatically enrolled a record number of Americans in, health insurance, but those programs came to an end this year, and millions of lower-income Americans appear poised to lose coverage.
Story editing by Jeff Inglis. Copy editing by Tim Bruns.
This story originally appeared on Care Better and was produced and distributed in partnership with Stacker Studio.
