Why Traditional Physicians Will Trump Walmart's Primary Care Service Offering

A big box with plenty of
room for primary care?

Several years ago, while the Disease Management Care Blog was supervising a medical resident clinic  (an example of how they work can be found here), an elderly patient came in for an appointment.  According to the resident, Mr. Jones (not his real name) would unexpectedly lose consciousness while walking. He also complained of feeling shaky and unsteady on his feet.  Prior to entering the clinic room to see Mr. Jones, the DMCB already suspected the patient had Shy-Drager Syndrome.  One look at the his staring and unblinking face confirmed it, all in the space of about five seconds.

Which is why the physician DMCB confidently thinks its profession ultimately has little to fear from Walmart's apparent interest in establishing a national network of primary care clinics in its big box stores. 

Careful scrutiny of the Walmart Request For Information (RFI) reveals that potential partner companies are welcome to showcase their health care "solutions," "applications" and "offerings" that are "convenient, accessible, affordable, consistent, scalable and integrated."  Walmart wants these companies to leverage its retail and multi-channel clout to to reduce costs and increase access while maintaining or improving outcomes in clinical care, diagnostic services, prevention and wellness. Care services can include a host of general medical services, management of chronic as well as acute conditions, laboratory testing and "other."  Ownership, financial arrangements, data sharing, integration, technology, logistics, back office functions and the level of customization are negotiable.  To be taken seriously by Walmart, candidate companies need to have a track record of success at a national level, a credible leadership team, a business plan, timeline, access to secondary partners as necessary and familiarity with quality assurance.  There is an notable absence of any reference to the "medical home."

While the similarity of "Big Box medicine" to retail clinics could be criticized at many levels, the DMCB has heard two two major concerns from its colleagues about Walmart:

1) Walmart and the like will further "Balkanize" the system, leading to more, not less, fragmentation and

2) it will commoditize health care, leading to narrow and regimented treatment protocols that don't take the "big picture" into account.

The DMCB disagrees with the first assertion because Walmart's RFI seems to envision a highly integrated system backed up by informatics, connectivity and quality metrics that - on paper - should lead to more coordination not less.  That's good.

Yet, the DMCB thinks that there may be something to the second  assertion. It is Walmart's style to relentlessly attack costs at every part of its service cycle and the company probably believes the strategy can be applied to health care.  If that's Walmart's intention, it'll almost certainly choose a vendor that industrializes guidelines like this in a one size-fits all "protocolized" fashion all the time every time.

That's not necessarily bad, but that means there'll be little room for the kind of smart heuristics that helped the DMCB get to a quick diagnosis.  The DMCB doesn't deny being "smart," but the the point is that the best primary care intelligently combines guidelines and heuristics.  The DMCB's physician colleagues have that special skill.  Thanks to competition from Walmart (and retail clinics), they'll hone that expertise and respond with a higher, more efficient and better quality standard of care for many patients for a long time to come.

Image from Wikipedia