Walmart, the largest U.S. employer with a workforce of 1.6 million, is slowly building a network of in-store clinics, believing it has a place in America's health care system.

Next week the largest U.S. retailer will open two health clinics in DeSoto and Fort Worth targeting seniors and families with services for comprehensive primary care, behavioral health and dental care.

Ten clinics will be open this summer in Dallas, Fort Worth, Garland, Mesquite, North Richland Hills and Plano. Eight more are in the works around Houston.

Health care has to be accessible and sometimes that means being convenient, said Dr. David Carmouche, senior vice president of health care delivery at Walmart.

Carmouche said he had questions about Walmart's plans to establish clinics before he joined the retailer in 2021, but then he said he took a broader view of how Americans live.

Health care for most people is primary, preventative care, and sometimes urgent care, but most people aren't admitted to a hospital in a given year, he said, and there's value in bringing health care where people go regularly.

"I just think access is challenged. Having to drive across town and park in a big parking garage and maneuver complex medical offices to see a physician for 15 minutes just doesn't really work, frankly," he said. "I've been in that world. That's where I came from."

Walmart has 55 clinics in Arkansas, Florida, Georgia, Illinois, Missouri and Texas. That includes the 22 it's opening his year: 18 in Texas and four in Kansas City. Walmart opened 17 clinics last year.

"Most patients are already customers of Walmart, we're just adding an accessible service," he said. "About a quarter of our visits occur outside of 9 a.m. to 5 p.m."

The clinics are open 7:30 a.m. to 7:30 p.m. Monday through Friday and 9 a.m. to 5 p.m. on Saturday. Telehealth is available on Sundays.

Walmart Health is growing its clinic business at a slower pace than competitors Walgreens VillageMC and Amazon's One Medical. Amazon purchased San Francisco-based health clinic operator One Medical in 2022 and now has more than 125 locations. One Medical has three locations in Dallas and seven around Houston.

Walgreens, which has 83 VillageMD locations in Texas including 17 in D-FW, took a $5.8 billion charge last month to write down the value of its VillageMD clinics after purchasing a major stake in the business in 2022. Most recently Walgreens closed locations in Illinois and Indiana and pulled out of Florida.

A spokeswoman for VillageMD said there are no plans to close any comprehensive primary care clinics in Texas.

This week VillageMD released the results of a two-year study conducted at 14 Houston locations with 1,300 high-risk patients that found increased primary care visits decrease hospital admissions. The study was published in The American Journal of Managed Care.

"High-quality primary care can keep patients healthier and out of the hospital," said Clive Fields, co-founder and chief medical officer of VillageMD. "All Americans should understand that an ongoing relationship with your primary care doctor can yield better health care outcomes, improve your quality of life, and reduce future medical misery."

With 60% of adults in the United States experiencing a chronic disease, creating a primary care relationship that benefits patients and the health system at large is critical, he said.

Demographics led Walmart Health to focus on seniors in Texas where Carmouche said projections by 2050 show the population over age 65 doubling to more than 8 million.

"So, we built a model for seniors' complexity. They have multiple chronic conditions. We've designed a care model to meet those needs," Carmouche said. "Sure, we see colds and flu and sprained ankles and scrapes. But we also take care of diabetes and hypertension and multiple chronic conditions."

Texas is Walmart's largest state by store count and employees.

Walmart's 176,000 employees in the state and their friends and family are potential customers of the clinics, too, Carmouche said. The clinics are also a way for Walmart to offer advancement to store employees. That's already happening, he said.

Even with the tight labor market for health care professionals, Walmart Health, with what Carmouche described as a large recruiting effort, has been able to attract physicians and support staff.

"We're having to compete. But we've been able to sell a different experience," he said. Many providers in primary care are asked to see 30 patients a day for just a few minutes and then spend a couple of hours at home to document medical records.

"That's not our model. We're providing a better work-life balance," he said. "We've built a large care team that supports our providers."

The clinics, which are about 6,000 square feet, accept insurance but also post prices for cash-paying patients. Basic service costs at the new location in DeSoto are $80 for an X-ray and $750 for a dental crown. A chronic care management or sin or injury visit is $100. A flu test is $64, and a lipid panel is $29.

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