Earlier this month, a flurry of stories appeared in U.S. publications (including this one) noting that Wal-Mart was expanding its presence in the nation's healthcare system. Though it has already sold prescription drugs, co-branded with Medicare drug plans and rolled out 100 walk-in clinics, the announcement that the giant retailer was going into primary care created a massive splash.
Sure, if another giant retailer opened six in-store clinics and announced plans for several more this year, both the healthcare and the retail industry would take note. After all, some of the most feverish change taking place in the healthcare system is occurring at the edges of primary care practices.
But with Wal-Mart being the power behind the new clinics, observers seem ready to declare the end of primary care as we know it. And it's not hard to understand why. After all, Wal-Mart is offering care at a very low price ($40 to see a nurse practitioner), will accept both appointments and walk-ins and plans to operate them seven days a week. Not only that, it's offering patients access to several basic diagnostic tests at low prices, including bladder infection, cholesterol and mono tests for $8, plus hemoglobin A1C, urine protein and HIV tests for $15. Sounds like another category killer, doesn't it?
The disposable patient
Before you declare Wal-Mart the next big thing in primary care, though, let's ask a question. While CVS Caremark's retail clinic chain MinuteClinic is reasonably successful, with more than 800 locations in 28 states and District of Columbia, why doesn't it control the primary care marketplace now?
After all, I'd say a pharmacy benefit manager has an extremely tight grip on logistics, and the company's 7,600 CVS/pharmacy locations offer prime opportunities to pick up existing retail consumer flow. And with $126.8 billion in revenues for 2013 alone, CVS is not exactly hurting for cash to develop the business. But despite the fact that the retail clinics have been in operation since the year 2000, I don't see my local primary care doctors closing their doors anytime soon.
The reason, I'd argue, is that people don't respond well to being processed—overtly at least—as though they were a consumer product. Toilet paper doesn't mind what you have to do to make the logistics work out, doesn't suffer from complex problems that can't be fixed at one quick meeting and certainly doesn't care if you know its name. People, on the other hand, are quite sensitive to little things like relationship-building and the perception that what they're getting is high-quality care, not just a low-priced quick fix. In short, they don't like feeling disposable.
Don't get me wrong: I'm sure Wal-Mart will see some success from its primary care venture; The need for low-priced care for minor illnesses does exist, as MinuteClinic's moderate success demonstrates. And if Wal-Mart goes the extra mile and does things to make people feel comfortable and wanted—which it certainly could if it chose—it could pick up more market share than any other primary care retail operator.
But people still see healthcare as a high-touch personal service, which they should. While they'll go without continuity of care, comfort and personal recognition if they absolutely must, they'll invariably turn to the personalized experience and relative privacy of a real medical practice whenever they can. Wal-Mart didn't get to be the global powerhouse it is by caring for people, but rather, by organizing things. And if Americans are allowed to keep even a scrap of dignity, they'll still have the option of visiting a PCP when they need care.