The Walmart Health Care Plan That Wasn't: The Backstory From Journalists Julie Appleby and Sarah Varney

It was quite a scoop: Julie Appleby and Sarah Varney's story for NPR/Kaiser Health News on Walmart's ambitious plans to expand into primary health care was quickly picked up nationwide. The blogosphere went crazy examining the implications.

And then Walmart backpedaled in spectacular fashion, saying that its plans were "overwritten and incorrect" – which generated even more speculation about the massive retailer's real aims. The veteran health journalists followed up on Walmart's "clarification," but I wondered: was there anything the rest of us could learn from their experience? And how can journalists around the country follow up on this story, which will only get bigger in the next couple of years?

I asked Appleby and Varney to share how they reported the story and what they learned, and here is what they said:

The Walmart story began as many do: a document leaked to a reporter. The 14-page request for information from the giant retailer outlined its aim to become the nation's top provider of primary care.  

Wow, we thought. This, if true, is obviously a story, given Walmart's position as the nation's biggest retailer. Walmart already had ventured into providing some medical care through in-store clinics.

And there was also a good health policy angle: Primary care is already hard for some folks to access, either because they don't have insurance or they can't find a doctor – a situation that may worsen as more people become insured under the federal health law.

But, as with any confidential document a reporter comes upon from a source, our first job was to confirm its authenticity. Reporters from NPR, its member stations and Kaiser Health News, which have a reporting partnership, began making calls on the story. We called people we thought might have either received the document or heard of it – as well as Walmart itself. Our reporting uncovered some sources that had. But we wanted more.  Finally, a Walmart spokeswoman returned our call and she verified the document was authentic.  

However, after initially saying she could get us more details by putting a company executive on the phone for an interview, she later declined to make anyone available. So we had confirmation about the information request document, which outlined the firm's intent and sought partners to help it reach its aim.  While the document had clear statements about the firm wanting to "build a national, integrated, low-cost primary healthcare platform," and become "the largest provider of primary healthcare services in the nation," it did not provide details on how it hoped to do so. The letter itself sought information from vendors about their ability to provide a range of services, from care for the chronically ill, to diagnostic services and data management. Still, it would have been helpful if Walmart had chosen to talk with us to provide more details on its plan.

Because we had the letter and confirmation of its authenticity, we did our stories: a radio version for NPR and a text version for NPR and Kaiser Health News. We put the document up on our websites so readers could see for themselves what the company was saying.

The story, which ran early Wednesday, lit up the blogosphere – garnering lots of interest on Twitter and Facebook. It was picked up by MSNBC and others.  Apparently, it also got a lot of interest at Walmart. By midafternoon, Walmart issued a statement, which did not dispute the story. Rather, the statement said a part of its own request for information – the statement of intent – was "overwritten and incorrect."   

Walmart did not intend to build an integrated primary healthcare platform, the statement said. Still, that leaves open the question of just what it wanted to do. Walmart did not disavow the part of the information request that said it wanted to be the top provider of primary care services. Unfortunately, those details were not forthcoming, as Walmart again declined to put anyone on the phone with us to provide any additional details.

This is an important story for health care journalists to continue to follow.  Finding ways to expand primary care services in many communities will be a key issue as the health law goes forward in 2014, adding millions ore insured through both private insurance and the state-federal Medicaid program.

Walmart and others are clearly interested – but can they get into this market and will it help? CVS, Target – even Safeway – are all expanding in-store medical clinics. Business reporters can look at these models – which have been around since 2000 – to follow their evolution. The industry has been cyclical, struggling with bringing in enough revenue.

Do businesses now see new opportunities under the health law?  What kind of law changes – scope of practice, etc. – have these clinics encouraged – and are there more to come? What are the fights in your state over "scope of practice" laws that spell out just what duties nurses and physician assistants can perform? Doctors generally oppose laws that expand what non-MDs can do, but with a growing shortage of physicians, many experts say the only answer will be expanding the role of non-physicians.

We think there are plenty of threads in this story for us and others to follow.

- Julie Appleby and Sarah Varney

Photo credit: Walmart Stores via Flickr