Walmart Health is closing. This is a big reversal for a company that was poised to be a disruptor in the healthcare industry. The closure raises questions about whether other retailers like Amazon and CVS Health can succeed in the market.
In the CareTalk Episode, "Why Walmart Threw in The Towel on Healthcare," hosts, John Driscoll & David E. Williams dive into why Walmart Health is shutting its doors and the potential impacts on primary care.
Episode Transcript:
David E. Williams:
Walmart Health is closing. That's a big reversal for a company that was poised to shake up healthcare, and it raises questions about whether other retailers can succeed. So why is Walmart Health shutting down? And why now?
Welcome to CareTalk, America's home for incisive debate about healthcare business and policy. I'm David Williams, president of Health Business Group.
John Driscoll:
And I'm John Driscoll, a senior advisor at Walgreens.
David E. Williams:
Come join the ever-growing CareTalk community on LinkedIn, where you can dig deep into healthcare business and policy topics, access CareTalk content, and interact with the hosts. And please be sure to leave us a rating on Apple or Spotify while you're at it. A very high rating, ideally.
John Driscoll:
So, David, what's going on with Walmart? I thought you could buy everything at Walmart.
David E. Williams:
You can buy everything at Walmart, John, except I guess health care. Now they have decided that they're going to get out of health care. Now, what does that mean? It means that they're they're closing their health centers. They'll still have pharmacy they'll still have vision care, but these big clinics that they were opening, they are now not going to open more. And they're going to close the ones that they have.
John Driscoll:
So, David, I think that the thing that just contextually Walmart's one of them, it's probably the largest retailer in the world. They are leaders in the area, everything from groceries to housewares to clothing. And they have, they have really revolutionized everything from the supply chain, buying stuff cheap. To distribute things at scale and materially bring down the cost of everyday things for most Americans, and they have repeatedly said they're going to take on health care in 20 percent of the American economy, a very high-cost area where people are penny-pinched.
And dollar oppressed where the patients consistently are having a harder and harder time paying for things, Walmart does live its missionary as almost a messianic missionary belief in its founder's belief that its mission was to just deliver a better deal for the working class American I would think healthcare would be an ideal target.
What did they do and what went wrong?
David E. Williams:
John, let's wind it back to something that they had done some years ago, probably 15 years ago or so, where they introduced the 4 generic drugs. What had happened, John, at the time was they had realized that you know, these generic drugs were the cost, the wholesale cost was extremely low, sometimes pennies. And yet people were being charged a copay, 50, 100, you know, some high amounts. And they said, let's actually go and just acquire these drugs cheaply and just sell them retail for four dollars.
So there's a lot of products you could acquire for four dollars a month. Now, they didn't do that through the health care system, John. They went around health care. They went around health insurance. And I think that is actually what you're seeing here is a reason for their, their lack of success. They're not able to get outside the third-party reimbursement when they get into, into healthcare services, unlike with some of the products.
John Driscoll:
So again, you're overcomplicating it, but let's break it down into, into, into, into, into different pieces. They are staying in the pharmacy and, I believe the optical, correct, the care business. So you can get vision and you can get your drugs there. And while this goes back a ways over a decade ago, they put about, I think it was two or 300 drugs very much some of the most commonly prescribed drugs in America and materially brought the prices down for those drugs But not any others Interestingly, they just did that four dollars and it and they got an enormous amount of attention And the belief was okay if they can really materially bring down drug costs Imagine what they could do with everything else In health care, they have about 51 primary care clinics that have x-ray machines and you can see a doctor and a nurse practitioner and they had plans to grow over 22 more.
And the theory was. That they would actually and David, I know that you may have been involved with some of this working with them that they believed they could and had great confidence that they could materially bring down the cost of seeing a doctor or a nurse practitioner and getting your problem solved, even on a unit price basis. So basically, to materially bring down the cost of primary care, and there's a primary care crisis, particularly in a lot of the crisis, meaning there aren't enough doctors in some of these rural areas where Walmart's the dominant, last dominant player, that they believe they could, you know, materially bend the cost curve. Does this kind of suggest that the cost curve bent them?
David E. Williams:
Well, John, let's, it all depends on the meaning of they. You know, so I think, yes, the senior people at Walmart, usually the people that had titles like chief medical officer believe that and we're driving that I'm not convinced at the top of the house CEO and CFO were ever true believers in health care The things they do well have to do with logistics with supply chain with squeezing vendors with understanding the needs of customers who are paying cash It doesn't have to do with health care and I don't think they ever had the conceit that they were going to solve health insurance issues that they were going to actually solve all of all of healthcare.
I think a lot of us out there in the pundit, you know, the punditry actually did want them to do that. And we saw those types of advantages and we, we are sort of cheering them on. I'm not sure they ever really bought into it at the very top level.
John Driscoll:
You're, you, you're just a lifetime skeptic. They've had great, they've had a great I think they did a joint venture in Medicare with Humana that on enrollment, that went very well for part D. They've done very well in generic drugs. They've done very well in bringing. How can you suggest that they can't solve the problem here? I've got a point of view here, but, you know, you're the, you're the consultant who talks to everybody. What went wrong?
David E. Williams:
Well, Medicare is marketing, which they're good at and the drugs are products that they went outside the traditional health insurance industry. The problem here with primary care is that the business model for primary care in this country is mostly that it's a loss leader. For hospitals that are doing expensive and sometimes unnecessary things to patients, you've got your loss leaders. So if you're only competing for the loss leader side, you're going to lose money. And I guess one of the reasons it's hard to offer care in rural areas. There's just not a lot of supply. Now, some physicians aren't just going to move to small towns because Walmart is hiring.
John Driscoll:
I think that's true. I, I think there's a bigger problem at play here as well, that the, the best way to make primary care work probably and work quite well. And there are some, even though the models have been beaten up, including Walgreens village model, but I've seen the, when you integrate primary care into risk, where you actually take the risk on outcomes on a per member per month basis. And we've had some good experiences there at the village in some markets where you clearly see the value of the primary care coordination of particularly folks with chronic illness who's got multiple diseases and it dramatically reduces the emergency room visits and hospitalizations. So it can work, but I kind of agree with you.
I don't see what I think the flawed assumption here Was that you could truly bring down the cost of basic primary care, you know, assessment and then send you to someone else when, you know, you've got a pretty strong high fixed cost of doctors, nurses, then those labor costs are going up and the physical infrastructure. And then I guess the other question I'd have is, do you think people were really comfortable Going to see the white coat in the clinic as opposed to the white coat in the meat section? You know, is there a brand? No, but is there seriously a product market fit problem here?
David E. Williams:
Well, John, the reason I'm laughing is because when you go see the guy with the white coat in the meat section, usually has blood all over it, which doesn't bother you so much if it's just The butcher, but it might bother you, or if maybe the baker, it might bother you. And it's definitely going to bother you if it's the candlestick maker or the physician. So that I guess could be an issue, but you sort of said it with where the, where the model is going to be going with primary care, right? You said, you know, certain village markets you'd see if you, if you integrate a risk model in, well, guess, guess what is totally far away from, you know, Walmart's expertise.
They're not an expert in that. What's interesting is that CVS. Which of course has, unlike, you know, Walgreens has, you know, Aetna it has the PBM. So they, they are actually more in a position to try that. They're still not necessarily going to succeed. And we'll see what Amazon manages to do. But I think it's just far away from, you know, what Walmart actually does. The things that you say, and I agree could work for primary care. No, I think you have to make primary care viable on its own if you expect Walmart to participate.
John Driscoll:
Again, primary care does lose money for, for most, most hospitals and they make money on all the referrals and most integrated medical groups. Again, tilt more towards specialists where the money is and away from primary care where it's not. And so when you think about this, Walmart has been pretty successful in almost everything it's done. There are some markets where it's, it's, it's had some challenges, but where they choose to really commit.
They figure out a way to win. And I am, I can't tell you, having negotiated and partnered with Walmart and different jobs at, at Medco and at Cast Light, both as a partner and as a negotiating partner on the other side of the table, they are completely consistent in terms of, you know, a better deal for the American consumer.
They're the most consistent culture company that I've, that I've met, and it's, and they're amazingly large. I mean, they've got a million employees in the U. S., and that consistency has, I think, helped them to really drive consistent innovation in, in everything from, again, supply chain to store layout and delivery. But I think that it's only when they fully commit. And I think that while healthcare is always interesting, it's not necessarily gotten a level of resources and long-term commitment that would kind of give it the oxygen and runway to mix two metaphors or two do the wrong analogies enough time And resources to prove to create a novel model because we do have to reinvent health care in the US. David we just yeah at some point we're going to be a health insurance plan connected sometimes to a country as opposed to a country that covers everybody in health insurance. And I think it's, it's people like, you know, Doug McMillan and the team at Walmart that he's the CEO of Walmart, that it, that I was kind of hoping that they would reinvent it. It's frustrating to me that they have left and I think a little too soon.
David E. Williams:
Well, John, let's talk about why they thought they might have been able to be successful because I don't think it was just a conceit. They have some real advantages. I remember touring the model of these new big health clinics that they were having, and they're quite different from a clinic, let's say, at a CVS, and in fact, I remember getting a tour. And the person giving me the tour pointed out that the conference room that they had within the center was bigger than these big, you know, health stops or whatever they CVS the CVS was creating these health these, these healthcare centers that they were very excited about.
And so there's a much larger, you know, real economies of scale. Some of those little clinics in a store, you know at a at, at, at a pharmacy, or not really big enough. The idea here, is you're going to be able to do more and it would be a place that you'd be able to go and you're going to Walmart. Anyway, so what they found, I think, is that the economies of scale weren't so great because you get stopped up in the, you know, these labor costs and certain ways of doing business because of the, because of the insurance and because of the way the hospital systems are structured, how they make money. And then I think what's also a little, the thing that was curious to me is that soon after announcing that they were going to be building about 75 new clinics over the next several months. Then they stopped immediately after that. Shortly after that, I think that most likely has to do with reviewing.
The actual plans for building these and saying, Hey, you know, the construction costs are too high. We're never going to make money. Let's just cut it off now.
John Driscoll:
I think that I still go back to when you're trying to reinvent an industry, you've got to give it time, space, and resources. And I don't think it happened. I thought some of the early work they were doing around leveraging AI in assessment and using, you know, machines to replace some of the endless paperwork and questions you get in that were very effective. They were showing a higher precision to get to the right diagnosis quickly and with a person, they were looking at different labor models. I was really excited about how they were exploring, not just to repeat what other folks were doing, but to explore new modes. It's for me a tragedy, It'll be really interesting to see how CVS fares.
CVS has obviously committed a tremendous amount of capital to their Oak Street clinics. They're talking about integrating it with retail And they've suffered a little bit in the marketplace for some misses in the anticipated Medical cost being a lot greater than those that are anticipated it'll be interesting to see when they're challenged with a slowing margin or a lowered margin that whether they what path they take, because if you think there's a role for retail to reinvent health care. I don't think retail is going to reinvent health care and then you've got to watch you know the elephant of the room Amazon. So David, what's your view of what Amazon's up to?
David E. Williams:
God only knows John, you asked me to be a mind reader before I think the telltale sign for CVS If they start to fail in health care is if they start selling cigarettes again That'll be a good indicator that they're backing off from health care for Amazon, you know Amazon had its own internal attempt to do virtual care, which they backed away from. But then they acquired One Medical. So I think they have quite a ways to go and they are integrated into people's lives beyond what a typical retailer is and they have an opportunity to experiment and they, they are innovators. I mean, they try to do new and different things. So I think Amazon is actually likely to continue to charge down the path in health care, and they got a little lot of different places that you don't even necessarily see, like selling medical supplies to physician offices.
There's a lot of different places that they actually can get involved now. Walmart. I'll just mention one thing on the side there. They have been innovative. in the past, but I actually think they're sort of stepping away from that. The other thing that they did this year is they closed down what they call store number eight which was their innovation center, which existed somewhat outside of the business, but was actually, I thought, a pretty interesting model where they had things that they would bring innovation in that could grow alongside the business or within the business, but wouldn't be wouldn't be crushed by this big monster. So, I understand why Walmart wants to put it innovation back within the company, but I think it's actually more of an attempt to shift back to basics and maybe the healthcare exit decision goes along with that.
John Driscoll:
Well, we got to go back to Amazon for a second. I'm a skeptic, I don't think Amazon's got a trust problem that people don't realize. And actually, if you look at the volumes on virtual care, they're actually kind of growing a little bit. So I don't think they're going to be a trusted player in health care. I suspect that when you look at health care versus virtual care, AI and cloud computing and all those other things that you and cyber all that, you know, a lot more about than I do that's going to be a lot more attractive.
I think that this is going to be a little bit like their head fake into grocery with you know, with their the, their, their, their, their move that everyone thought was going to transform grocery when they bought whole foods and all it did was transform the bank accounts of the whole foods investors. I'm willing to be wrong, but not if I'm talking to you.
David E. Williams:
Yeah, I think that's fair. John. Let's get back to that comparison of the say, pharmacy-based retailers versus Amazon. So I would say that from a trust standpoint, you know, what the, what, what the retailers like Walgreens and CVS have in common is that they do have trusted pharmacists that are there. Now, the pharmacists are under pressure. So, they may not always be able to give the experience that the patient might want, but the trust is there.
David E. Williams:
Whereas Amazon, I don't even trust them to get the you know, the package to my door. I mean, you certainly don't trust, their motive. I guess, you know, if Tesla starts getting into virtual care, then they may have less trust than Amazon, but that would be about it.
John Driscoll:
Well, David, I think that's all we got on retail and healthcare. If we're ending up with Tesla, we've overshot the mark.
David E. Williams:
All right, John. Well, I'll take your cue for it, although I think some of the cameras on the Tesla could be used for virtual care. That's it for yet another episode of CareTalk. We've been talking today about Walmart. I think that's what we've been talking about, their exit from, from healthcare and a few other things along the way. I'm David Williams, President of Health Business Group.
John Driscoll:
And I'm John Driscoll, Senior Advisor at Walgreens.
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