The scheduling delay for a routine appointment with one of America’s 210,000 primary care doctors seems to be measured in weeks, even when the doctor’s practice is already the patient’s medical home. New patient appointments often take six weeks. For a good ophthalmologist, 2 or three months seems to be a normal wait. Medical care supply is stressed.
On the flip side, demand for medical care is rising due to several million patients never insured before Obamacare, and a steady march of baby-boomers becoming eligible for Medicare. To better align supply and demand would take about 50,000 additional primary care providers.
The $1.7 trillion a year that patients spend on health care should provide an entrepreneur with incentive to improve that marketplace. Right on time, Walmart is reentering the primary care market with a service that looks promising to consumers and policy makers alike. In past years, Walmart has provided 100 clinics in its stores leased to hospital operators. The clinics were suited to treating minor ailments such as inoculations and flu. Walmart is uprooting that timid approach and is creating real primary care sites in their stores. These primary care sites will be staffed by nurse practitioners who are licensed to treat a broader set of complaints and who are capable of writing prescriptions for many basic drugs.
Walmart will move cautiously into providing chronic care treatment, a major slice of the medical care market for seniors. Their cautious approach is wise because chronic illnesses such as diabetes are very complex and could strain the staff’s experience, at least in the short run.
Walmart already has a huge prescription service that works well for patients. Provided Walmart handles electronic patient records thoughtfully, these clinics could effortlessly interface with the primary care physicians, hospitals and specialists whenever Walmart’s patients need treatment beyond the primary care site’s scope.
Walmart plans to price the services at an affordable $40 per visit ($4 for Walmart employees). It will accept Medicare and hopes to take Medicaid, although not secondary health insurance. If Medicaid can be fit into the plan, it may alleviate some pressures in Medicaid funding. Including federal matching funds, Medicaid consumes 22% of states’ general budget. Help in reining in these costs would be welcomed.
When Walmart’s primary care sites support a large customer load, they should be attractive for affiliations with other primary care physicians. Other physicians would probably value a steady stream of paid consults from Walmart patients on chronic illness treatment. Walmart’s sites could be a platform for a concierge practice that includes home-visits and prescription deliveries.
There are other medical policy issues where a behemoth like Walmart could play a significant role. For example, pay-for-performance has been a popular conversation topic in political circles, but to date, it has delivered only minor outcomes improvement and the improvements seem to dissipate very quickly.
With luck, Walmart will find a way to avoid the siren calls of political loose ends. Its quest for good primary care at an affordable price is an essential goal for consumers.
Alan Daley is a retired businessman who writes forThe American Consumer Institute Center for Citizen Research