What do American retailers see in the medical business? The answer, befitting the country’s byzantine and rent-filled health-care system, is both simple and complex
long white coat, stethoscope, genially soothing manner and wonky eagerness to discuss “population health management” and “patient-centred” medicine, Ronald Searcy seems the Platonic ideal of a primary-care doctor. The most unusual thing about him is where he works: a compact facility complete with examination rooms, dentist’s office, phlebotomy lab and-ray room tucked into a Walmart in north-west Arkansas.
Walmart is not the only big company expanding its medical offerings. Earlier this year Amazon acquired One Medical, a concierge practice with offices in cities across America. Dollar General, a discount retailer, has set up a partnership with DocGo, which runs mobile health clinics, and has launched a pilot programme at three shops in Tennessee. Walgreens and, both retail pharmacies, have robust primary-care offerings; last year more than 5.
The complex part reflects changes in how insurers, including Medicaid and Medicare, pay for coverage; as well as changes in how consumers are willing to get it. Start with the insurers. The predominant payment model is fee-for-service, in which insurers reimburse doctors for each visit or procedure. Its advantage is simplicity.
From 2016 to 2021, however, the share of health-care spending on “alternative payment models” rose from 29% to 40%. In a survey in 2022 most payers believed that these payment models, in particular those that let doctors share in the upside of keeping patients healthy, would rise. This approach, known as “value-based care,” is an artefact of the Affordable Care Act.
Retailers entering or expanding their primary-care offerings are also betting on consumer habit. The most recent Consumer Pulse Survey by Accenture, a consultancy, showed that nearly one-third of consumers—and more than one-third of those between 18 and 35—were open to getting medical care at a grocery store or big-box retailer, and more than 90% of customers would trust a retailer with their medical data.
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