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BENTONVILLE, Ark. — In the realm of health and wellness, the endpoint is where Walmart begins. After first gaining a thorough understanding of patients, customers and their needs, the company has set out to construct a dynamic ecosystem that promises to transform the way in which Americans get and stay well. In light of the positive impact it is having on the well-being of the 140 million people in the United States who visit its stores and website each week, the editors of Chain Drug Review have named Walmart its Health Care Provider of the Year.
Brian Setzer
“At the end of the day, Walmart’s core mission of enabling customers to save money so they can live better is drawing us to our strategy,” says executive vice president of health and wellness Brian Setzer. “That idea is going to live well beyond my time here. If we can figure out how to apply it to health care, we’ll win along with our customers.”
For Setzer, the company’s health and wellness business, which includes pharmacy, vision care, self-care and a small but growing number of innovative Walmart Health Centers, is more than a job. It’s personal.
“I’ll tell you a story about a person who is our ideal patient,” notes Setzer, who joined the company in 2021 as chief financial officer for the health care business, after long experience in the insurance industry. “Her name is Diane. She’s 81. She lives by herself. None of her family’s close by. She can’t drive anymore, and she takes a ride-share to Walmart at least once a week.
“Envision a world where she sees her primary care doctor, she sees her dentist, and if she has behavioral health needs she can take care of them. She sees her optometrist, she gets her glasses, she picks up her medications, she picks up her O-T-Cs, and she gets her fresh food — all in one stop. In addition, all of those things can be delivered to her or handled virtually if she doesn’t feel like coming in the store that day. That’s what Walmart offers.
“We have a unique ability to serve her needs that no one else in the country can match. Other organizations have parts and pieces of that, but no one can bring that total assortment of health care products, services and related things together. That’s our journey.”
In this instance, “our journey” not only refers to Setzer, his associates and Walmart’s customers generally. Diane is his mother.
“When I got the phone call from a recruiter for this opportunity two and a half years ago, my immediate thought was I want to be a part of changing health care for her,” he explains. “Where she lives, Walmart doesn’t have a health center yet, but we have everything else. With a ride-share service it’s pretty simple for her to get to a Walmart two miles away, instead of going to a large hospital system, with parking lots and elevators and multiple buildings to negotiate. If we take all the pain and complexity out of the equation, and do it in a place where she’s already comfortable, imagine how much healthier she’s going to be.”
The commitment to supporting customers’ health and wellness permeates the entire company. Setzer indicates that Walmart’s executive leadership team and board of directors is engaged in efforts to enhance access, lower costs and improve patient outcomes.
“Health and wellness is a regular topic at board meetings. It’s an anchor for us,” he says. “The remarks that Sam Walton made in the 1990s are a touchstone that keeps coming up. We’ve been thinking about fixing health care for a long time. It’s a big problem to solve.”
A year before his death in 1992, Walmart’s founder spoke about his frustration with the nation’s health care system: “We’ve got to get the hospitals and doctors in line. We’ve got to get those charges under control,” he said, citing his experience as a cancer patient faced with opaque pricing and substantial markups for health care services. “Now, what it means is that these people are skinning us alive.
“So, we need to work on a program where we’ve got hospitals and doctors and workman’s comp and pharmacies gaining, and saving our customers money and our employees money. And we haven’t even started to do that. And if we don’t get it done this year, I’m going to get real upset.”
Meaningful progress has been considerably slower in coming than Walton envisioned, but the company, which for decades has done much to limit prices in the pharmacy and self-care sectors, is now poised to exert greater influence on overall health care expenditures. With a network of 48 health centers in operation and an additional 28 in the pipeline, Walmart is fostering the shift of primary care and related services, including diagnostic testing, dentistry and behavioral health, to the convenient, low-cost setting of its stores.
“When people talk about the cost of health care, they need to remember that it’s because people get very sick and they consume health care services too late, and they’re the most expensive services,” Setzer explains. “If we can pull all that forward and see a patient when she’s well and keep her well, the cost of health care will come down.
“Our services are at the lower end of reimbursement. Primary care is the lowest reimbursement in the world. If you do it often, you do it right and you keep people healthier, you reduce the total cost of health care.”
The company is currently taking that approach with Medicare Advantage patients. The initiative is in keeping with the Centers for Medicare and Medicaid Services’ stated goal that all Medicare beneficiaries be covered by valued-based care programs by 2030. Setzer predicts that the private sector will eventually follow suit.
“That is a journey that I think will take a long time,” he says. “But we’ve actually had conversations with some of our insurance partners, including UnitedHealth Group. We announced a 10-year collaboration with them last year, and we are talking with others as well. We have this vision that once we have crafted our model and refined it around seniors, other people will naturally want to make use of it.
“Again, I think about my small hometown in east Tennessee. Imagine an employer there that might have a manufacturing company of a hundred people. If we could contract with them to provide primary care services and take risk for their employees, that can work for both of us. Now, the economic construct around a Medicare Advantage plan is such that it’s particularly beneficial to do that first.”
In September 2022, Walmart and UnitedHealth launched a collaboration to improve the patient experience and outcomes for Medicare beneficiaries. Currently available at 31 Walmart Health centers in Florida and Georgia, the initiative, which will eventually reach hundreds of thousands of seniors in multiple states, leverages the complementary strengths of the companies, including analytical support to facilitate value-based care from UnitedHealth’s Optum subsidiary. A cobranded Medicare Advantage plan in Georgia is another aspect of the collaboration.
“We’re on a journey to transform health care, connecting more people to the right care at the right time — at a cost that makes sense,” Walmart chief executive officer Doug McMillon said at the time the deal was announced. “This collaboration puts the patient at the center of health care by leveraging the strength and complementary skill sets of our two companies to accelerate access to quality care.”
Late last year, Walmart signed care coordination pacts with Ambetter from Sunshine Health, which provides coverage for individuals through the Florida health insurance marketplace, and Orlando Health, a nonprofit network of community and specialty hospitals in Florida. Building on an existing relationship with Centene Corp., Ambetter’s parent, the former agreement designates Walmart Health Centers as a preferred provider under the Ambetter Value Plan in seven counties.
The deal with Orlando Health calls for the two organizations to coordinate care for patients in greater Orlando. The closer alignment of their efforts is designed to enhance transitions of care and streamline the patient experience.
“By collaborating with Walmart Health and focusing on care coordination in the shared patient populations, we’ll be better positioned to more quickly identify patient needs and improve outcomes together,” says Cary D’Ortona, senior vice president of Orlando Health and president of Orlando Health Medical Group.
In a significant departure from the prevailing health care paradigm, under which physicians and hospital systems have economic incentives to maximize the number of costly services they provide, Walmart aims to intervene early and stave off problems.
“Most health care is delivered in fee for service and expensive treatment,” Setzer notes. “Ours is keeping people healthy through lower-end primary care visits. Everyone is at a different place on the spectrum on how they’re dealing with this, but there is no doubt in my mind that, by the time I retire, this model of retail-based primary care clinics focused on value-based care is going to be a major factor across the country.”
One remaining challenge Walmart has to contend with is getting the word out about its health care offerings. As is the case with other retailers, many consumers don’t realize what health and wellness offerings are available to them, whether it’s long-established departments like pharmacy or the health centers, the first of which debuted in 2019. The same holds true for insurance providers.
“One of the payers wanted to do some work with us, and we went to our Dallas, Ga., health center and took them on a tour,” Setzer recalls. “Once they got over the threshold, they indicated, ‘We didn’t know it was this.’
“Many of the clinic models in the marketplace include a very small, limited set of services. We have expanded that out and have primary care, dentistry (including crowns that are made on site), behavioral health, a big community room and community health workers — it’s a very different proposition. Walmart Health Centers are high-quality facilities.
“Our net promoter scores are extremely high, and patients keep coming back. Once we get them through the door, we win. The trick is making sure they’re aware of what’s here, and they see that we provide high-quality health care services.”
Walmart expects to do well by doing good. The ubiquity of its stores — more than 4,600 of them across the U.S. — along with the company’s relentless focus on everyday-low prices, make the retailer a compelling destination for health and wellness consumers.
“Clearly that customer, that patient, is already in our stores, so why not receive health care services there?” Setzer says. “It’s going to be super convenient for them to think that way.
“There’s something about having that trusted relationship with patients that allows them to think differently about Walmart. If you hear Doug [McMillon] talk about the flywheel, the things that deepen the relationship with the customer, including great primary care and dentistry, it’s logical that they’ll buy other products and services from us.”
Viewed through that lens, Walmart’s health and wellness strategy is a win for consumers, the health care system and the company. The stories on the pages that follow take a closer look at what makes the company Chain Drug Review’s Health Care Provider of the Year.
