The New Wal-Mart Stores Inc. Health-Care Clinic and Drug Coverage Plans
(5/14/08)- Wal-Mart announced that it would expand its discounted prescription drug program to offer 90- day supplies for $10. It also announced it would lower the price on more than 1,000 over-the-counter drugs.
The company has begun filling prescriptions for up to 350 generic drugs at $10 for a 90-day supply at Wal-Mart, Neighborhood Market and Sam's Club pharmacies in the U.S. Almost all the prescription generics in the company's $4 program were included in the expanded $10 offer.
Wal-Mart also added several women's medications to its list of prescriptions available for $9, including drugs to treat breast cancer and hormone therapy.
Target Corp. also announced that it would match all facets of Wal-Mart's discount prescription and over-the-counter drug plan.
(3/22/08)-Look for your local Wal-Mart to become an increasing player in the health care delivery system in the United States. This will be the start of big name national retailers and pharmacy chains entering the health field in a unique way in a large way.
These operations will partner with local hospitals who may not have an ownership stake in the in-store clinic or split a stake in the facility. For companies like Wal-Mart, it gives the community within which it operates an improved image of the company by providing an accessibility to health care service. For the hospital, it provides a way to expand its access to care and extend its primary care network.
In Houston the H.E.B. grocery chain has split a stake with RediClinic and Memorial Hermann. On its web site, RediClinic describes itself as "high-quality, affordable healthcare that fits how we live today. No appointments, no waiting – and routine treatment and preventive care in about 15 minutes. RediClinic's staff provides convenient and affordable treatment for more than 25 common conditions, such as strep throat and ear infections. They also provide health screening tests, vaccinations, immunizations, and physicals". Memorial Hermann’s mission is "to improve the health of the people in the communities they serve. Memorial Hermann serves the greater Houston community through 14 hospitals and many specialty programs and services". The are finding ready partners with retail operators
Steve Case, who stepped down as AOL Time Warner chairman in 2003 and last year founded Revolution Health Group has investment in InterFit Health, driving the expansion of that company's RediClinic retail clinic division.
This type of retail clinic is expected to grow from about 500 clinics to 1500 by the end of 2008. One of the largest of these retail clinics is MinuteClinic, which in a recent survey (Sept. 2007) had 168 clinics in 24 states. On its web site it describes itself as: "MinuteClinic’s team of board-certified practitioners are trained to diagnose, treat and write prescriptions (when clinically appropriate) for a variety of common family illnesses to patients 18 months and older. MinuteClinic is in-network with most major insurers, so patients are responsible for either their copay or the price clearly listed on our treatments and services menu. For those who are uninsured or prefer to pay out-of-pocket, MinuteClinic accepts cash, checks and credit cards."
They are providing on-the-spot health service to those who do not have a primary care physician, or those who want quick emergency service for relatively minor ailments or those who have no insurance and are willing to pay low fees for service. MinuteClinic posts a price list on its web site for various treatments.
Staffing in these clinics usually consists of nurse practitioners or physician assistants, with physician supervision. While the AMA found these clinics "controversial", they decided that the clinics fit AMA policy that encourages "multiple entry points" into the health care system. The AMA has developed principles for in-store clinic operations that tries to ensure patient safety and continuity of care. The question is how well will these standards be monitored as well as whether it is ethical to "refer" patients to your own service. The latter is a concerned expressed by Susan Strate, MD, immediate past chair of the Texas Medical Association's Council on Socioeconomics who felt that the hospital partnerships will result in lowered private primary care physician visits with more patients going to hospital clinics for follow-up care. Pressure will then be put on hospital clinics to lower their waiting time for service and provide greater continuity of care, not using rotating residents as service providers. This may strain the resources of the medical center.
Another important issue is whether this type of service is fragmenting the health service delivery system, setting up a battle between private practice physicians and medical centers. Our future articles will address many of the issues expressed in this first installment.
(2/11/08)- Wal-Mart has leased space to 78 clinics in its stores across the country. The clinics are operated by independent firms, including 23 by Check-Ups, 13 by RediClinic, a unit of Steven Case's Revolution Health Company, and two by hospital companies in Wisconsin and Florida. Unfortunately CheckUps has decided to close the 23 walk-in clinics it operates in Wal-Mart stores in Florida, Louisiana, Mississippi and Alabama. Steven Case was the co-founder of AOL, which in turn was sold to Time Warner several years ago.
Check-Ups, which is based in New York, fell behind in paying its vendors and nurses late last year. It owes about $108,000 to Medtracker Personnel, a Louisiana employment agency that provides nurses for CheckUp clinics.
William Armstrong, a spokesman for Check-Ups, said Jack Tawil, the chief executive of the privately held company, was talking to investors and "evaluating which of the operations in the retail stores they should keep open."
Wal-Mart said it hoped the Check-Ups clinics would not stay vacant for long. "We are working to reopen the clinics as quickly as possible, whether or not they are operated by CheckUps," a spokeswoman for Wal-Mart said. Check-Ups still holds leases on the spaces, which are typically near the store's front entrance.
Wal-Mart said it plans to have about 400 store clinics by the year 2010. Although Lee Scott, the company's chief executive said last year that the chain could serve as landlord to as many as 2,000 clinics by 2014, the company recently announced that it would take over the clinics itself under the brand name of Clinic at Wal-Mart.
Wal-Mart would use a standardized format and jointly brand with hospitals and medical groups. The first of the new Clinic by Wal-Mart walk-in centers is expected to open in Little Rock, Ark., in April and will be run by nurse practitioners employed by the St. Vincent Health System, a three-hospital group in central Arkansas.
The company went on to say it plans to brand 200 of their new clinics with RediClinic. RediClinic plans to open one of the new units in Atlanta in April, and another in Dallas next summer. It is estimated that the drugstore chains CVS and Walgreen have opened about 700 of this type of clinic in their pharmacies in the last 15 months.
Few of the clinics are said to be operating profitably. Health financial experts estimate that a clinic will have to be open about 3 years before it becomes profitable.
About one in five of the clinic customers pay by cash, and Wal-Mart estimates that 55% if the clinic customers do not have health insurance.
Most of the clinics are headed by nurse practitioners who are limited to providing routine medical care, but a few of the clinics do have medical doctors present at varying times during the day.
(1/29/08)- In 2006, when Wal-Mart first announced it would be selling hundreds of generic prescription drugs for $4, the plan was aimed at people who did not have drug coverage plans. The company currently offers more than 350 generic prescriptions for $4. Other retailers were forced to match Wal-Mart's offer.
In a speech before 7,000 Wal-Mart store managers, Chief Executive Lee Scott indicated that the company was initiating a pilot program to help "select employers…manage how they process and pay prescription claims." For more on this topic please see our article Medicare and the Cost of Prescription Drugs - HMOs and Pharmacy Benefits Managers (PBMs) --Part III and also Drug Stores Low Cost Prescription Drug Coverage Plans
It seems therefore that Wal-Mart is putting its toes gently into the prescription benefits management (PBM) business.
(9/23/07)- The Wal-Mart Stores Inc., headquartered in Bentonville, Ark., the nation's largest private employee with over one million workers, announced some revisions to its employee health-care coverage plan starting next year, that may become the tinplate for many other health care plans for the nations largest companies.
According to the latest figures available, the company has 636,000 workers who received their health care coverage through the company, while 125,000 of its workers do not have their coverage through Wal-Mart.
Employees eligible for coverage will have the ability to choose from over 50 ways to customize their coverage to their own needs. The lowest premium option will cost $8 per month and will have a $2,000 deductible for those employees who need the least amount of medical coverage. On the other hand the most expensive of the options will have a monthly premium of $94.11 and a deductible of $350. The premiums may even be lower in some areas of the country.
The new plan will eliminate several restrictions from the prior company plan. This includes scrapping an additional deductible of $1,000 for inpatient hospital stays and $500 for outpatient surgical visits. The company will also eliminate the extra fee for spouses enrolled in a Wal-Mart plan who might otherwise be covered by their own employers.
The company helped pioneer a low-premium, high deductible coverage plan in the retail industry last year by introducing a plan with a $1,000 deductible in exchange for monthly premiums as low as $11. About 75% of retailers in the U.S. offer a preferred-provider organization with deductibles ranging from $250 to $300 as their primary option for employees, according to Hay Group, a management consulting firm.
A new option under next year's plan is one in which the employees can elect to pay higher premiums to receive health-care "credits" of $100, $250 or $500 that they can use to pay for covered medical expenses before their deductible applies. Employees enrolled in the plan can get prescriptions to any of 2,400 generic drugs for $4. This is about 1,000 more than the company sells under its drug care plan to its customers.
Brand name drugs will cost $30 to $50. About 40% of the company's workers receive their coverage elsewhere, i.e., through a spouse, a parent, a second job or a state program like Medicaid. About 10% have no coverage.
Full-time Wal-Mart employees must wait six months to qualify for coverage; part-timers will have to wait one year for coverage. The company's plan will emphasize preventive care, paid for by the company before a deductible will kick in. Health-care credits would make it possible for employees to see doctors and by prescription drugs without incurring out-of-pocket expenses.
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Allan Rubin
updated May 14, 2008
To e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com