The waters have been rough for telehealth providers and retail clinics in the past couple years —  to know that, one has to look no further than the stock prices of Teladoc and Amwell. Yet, amid this tempestuous sea, industry observers did not expect the crew of Walmart to raise the white flag of defeat on its healthcare effort..

在过去的几年里，远程医疗服务提供商和零售诊所的处境艰难——要知道这一点，人们只需看看Teladoc和Amwell的股价。然而，在这波涛汹涌的大海中，行业观察家们并没有预料到沃尔玛的全体员工会在其医疗保健工作中举起失败的白旗。。

If any company could navigate those choppy waters, many thought it would be Walmart, given how successfully the retailer has maintained its presence in so many parts of the American urban and rural hinterlands. However, on Tuesday, the Arkansas-based retail mainstay announced that it is shuttering Walmart Health division because “there is not a sustainable business model” for the venture to continue.

考虑到沃尔玛在美国城乡腹地如此多的地区成功地保持了其影响力，许多人认为，如果有任何一家公司能够驾驭这些波涛汹涌的水域，那一定是沃尔玛。然而，周二，这家总部位于阿肯色州的零售巨头宣布，它将关闭沃尔玛健康部门，因为“没有可持续的商业模式”让这家合资企业继续下去。

The admission only reinforced the tired but potent cliche – healthcare is hard. .

这一承认只会强化一个疲惫但有力的陈词滥调——医疗保健很难。。

Established in 2019, the division comprises 51 retail primary care clinics across five states and a virtual care business. On Tuesday, Walmart announced that it is shuttering this division because “there is not a sustainable business model” for the venture to continue.

该部门成立于2019年，包括五个州的51家零售初级保健诊所和一家虚拟保健业务。周二，沃尔玛宣布将关闭该部门，因为“没有可持续的商业模式”让该合资企业得以继续。

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With the Rise of AI, What IP Disputes in Healthcare Are Likely to Emerge?

随着人工智能的兴起，医疗保健领域可能会出现哪些知识产权纠纷？

Munck Wilson Mandala Partner Greg Howison shared his perspective on some of the legal ramifications around AI, IP, connected devices and the data they generate, in response to emailed questions.

Munck Wilson Mandala合伙人格雷格·豪森（GregHowison）在回答电子邮件中提出的问题时，分享了他对人工智能、IP、连接设备及其产生的数据产生的一些法律后果的看法。

“We understand this change affects lives — the patients who receive care, the associates and providers who deliver care and the communities who supported us along the way. This is a difficult decision, and like others, the challenging reimbursement environment and escalating operating costs create a lack of profitability that make the care business unsustainable for us at this time,” Walmart said in a statement..

沃尔玛在一份声明中表示：“我们理解这一变化会影响生活——接受护理的患者、提供护理的同事和提供者以及沿途支持我们的社区。这是一个艰难的决定，与其他人一样，具有挑战性的报销环境和不断上升的运营成本造成了缺乏盈利能力，使得护理业务目前无法持续。”。。

Unaffected by this announcement are its nearly 4,600 pharmacies and more than 3,000 vision centers that aren’t part of the Walmart Health division.

不受此影响的是沃尔玛旗下近4600家药店和3000多家视觉中心，它们不属于沃尔玛健康部门。

Walmart’s decision reflects just how difficult it is to achieve profitability in the primary care and telehealth markets — and how this challenge is being exacerbated by rising healthcare costs, labor shortages and outdated business models.

沃尔玛的决定反映了在初级保健和远程保健市场实现盈利的难度，以及医疗保健成本上升、劳动力短缺和过时的商业模式如何加剧了这一挑战。

Will retail entrants ever be successful in their efforts to integrate into healthcare?

零售进入者能否成功融入医疗保健？

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A Personalized Approach to Medication Nonadherence

个性化的药物不依从性方法

At the Abarca Forward conference earlier this year, George Van Antwerp, managing director at Deloitte, discussed how social determinants of health and a personalized member experience can improve medication adherence and health outcomes.

在今年早些时候的Abarca Forward会议上，德勤董事总经理乔治·范安特卫普（GeorgevanAntwerp）讨论了健康的社会决定因素和个性化的会员体验如何改善药物依从性和健康结果。

Building primary care clinics from scratch has always been a slow and capital-intensive route, pointed out Rebecca Springer, lead private equity analyst at PitchBook.

PitchBook首席私募股权分析师丽贝卡·斯普林格（RebeccaSpringer）指出，从头开始建设初级保健诊所一直是一条缓慢且资金密集的路线。

Looking from a fee-for-service lens, primary care is known to be a low-margin, volume-oriented specialty. If the provider’s goal is to take risk, it requires an “enormous up-front investment” to build a clinic footprint dense enough to really drive down healthcare costs across a population — as well as make sure that the population is large enough to be actuarially sound, Springer explained..

从收费服务的角度来看，初级保健是一个低利润、面向数量的专业。斯普林格解释说，如果医疗服务提供者的目标是承担风险，那么它需要“巨大的前期投资”，以建立一个足够密集的诊所足迹，从而真正降低整个人群的医疗保健成本，并确保人口足够大，在精算上是合理的。。

In her view, there are three main questions when it comes to retailers in primary care — the first one being: Will retailers be able to fully integrate and profitably run healthcare assets?

在她看来，当涉及初级保健零售商时，有三个主要问题-第一个是：零售商是否能够充分整合和盈利地运营医疗保健资产？

“The jury’s still out on that one,” she said. “It’s not easy, but CVS and Amazon may succeed.”

她说：“陪审团还没有决定。”。“这并不容易，但CVS和亚马逊可能会成功。”

That may well be true down the road, but the evidence so far doesn’t inspire confidence in that outcome. Amazon threw in the towel on its hybrid primary and urgent care business nearly two years ago. This year, CVS Health has begun shuttering dozens of its pharmacies in Target stores, and Walgreens announced that it will close 160 of its VillageMD primary clinics..

这很可能是真的，但到目前为止的证据并没有激发人们对这一结果的信心。近两年前，亚马逊放弃了其初级保健和紧急保健混合业务。今年，CVS Health已开始关闭其目标商店中的数十家药店，沃尔格林宣布将关闭其160家VillageMD初级诊所。。

The second question has to do with retail healthcare settings’ ability to support the kind of longitudinal patient relationships needed to succeed in value-based primary care. So far, we haven’t seen much evidence of this at scale, Springer stated.

第二个问题与零售医疗机构支持纵向患者关系的能力有关，这种纵向患者关系是成功实现基于价值的初级保健所必需的。斯普林格说：“到目前为止，我们还没有看到太多大规模的证据。”。

The final question is whether retail healthcare can actually achieve a more holistic view of the patient by leveraging consumer data —  and we’re “nowhere close to answering that one,” according to Springer.

最后一个问题是，零售保健是否可以通过利用消费者数据来真正实现对患者的更全面的看法，而我们“离回答这个问题还差得很远”，斯普林格表示。

She noted that Walmart’s decision to shutter its healthcare unit aligns with industry trends.

她指出，沃尔玛关闭其医疗保健部门的决定符合行业趋势。

“Scaling back retail care delivery and virtual primary care has become as ‘trendy’ in 2024 as accelerating these offerings was in 2021,” she remarked.

她说：“2024年，减少零售保健服务和虚拟初级保健服务的规模已成为“潮流”，就像2021年加速这些服务一样。”。

Headwinds can be strong

逆风可能很强

Healthcare labor costs are increasing drastically, and providers are leaving the industry in droves. These circumstances restrict retailers’ ability to deliver care that is convenient and highly accessible — yet that is their key value proposition for consumers — noted Arielle Trzcinski, a principal analyst at Forrester, in an email sent to MedCity News..

医疗保健劳动力成本急剧上升，医疗服务提供者正成群结队离开该行业。Forrester首席分析师Arielle Trzcinski在发给MedCity News的一封电子邮件中指出，这些情况限制了零售商提供方便且易于获得的护理的能力，但这是他们对消费者的关键价值主张。。

“Administrative burden and costs from health insurers have also increased, with some large health systems dropping major insurers and plans in response,” she added. “Consumers are being left to search for a new provider that is in-network mid-plan year. Retailers that bill insurance are not insulated from these additional issues.”.

她补充说：“医疗保险公司的行政负担和成本也有所增加，一些大型医疗系统放弃了大型保险公司和相应的计划。”。“消费者只能在计划年中寻找一家新的供应商。为保险买单的零售商不能与这些额外问题隔离开来。”。

Additionally, large health systems have more opportunities to unlock profitability in primary care than retailers do.

此外，大型卫生系统比零售商有更多的机会释放初级保健的盈利能力。

Primary care is often a loss leader for health systems — but this category serves a critical role as a feeder of patients to specialty care and surgical service lines. Without those higher revenue opportunities, retailers must achieve high levels of adoption and volume to achieve profitability, Trzcinski explained..

初级保健通常是卫生系统的损失领导者，但这一类别在将患者送入专科护理和外科服务线方面起着至关重要的作用。Trzcinski解释说，如果没有这些更高的收入机会，零售商必须获得高水平的采用率和数量才能实现盈利。。

Clearly that didn’t happen at Walmart Health.

很明显，沃尔玛健康中心没有发生这种情况。

Another healthcare analyst — Kate Festle, a partner in West Monroe’s healthcare M&A group — pointed out that retail clinics tend to follow an encounter-centric model where patient interactions with the clinician are confined to the visit.

另一位医疗保健分析师凯特费斯特（KateFestle）是西门罗医疗保健并购集团的合伙人，她指出，零售诊所往往遵循以遭遇为中心的模式，患者与临床医生的互动仅限于就诊。

That model can work among healthy populations, but it is less effective for chronic condition management that requires higher-touch, asynchronous communication between visits, Festle said.

Festle说，这种模式可以在健康人群中使用，但对于需要在就诊之间进行更高接触度和异步交流的慢性病管理来说，效果较差。

“Investment in care coordination technologies is possible but expensive — representing another cost dilemma for retailers focused on margin expansion,” she remarked.

她说：“对护理协调技术的投资是可能的，但代价高昂——这是专注于利润扩张的零售商面临的另一个成本困境。”。

Primary care and telehealth are unforgiving markets

初级保健和远程保健是无情的市场

Similarly to the retail healthcare market, the telehealth market hasn’t fared very well this year. Just a week ago, Optum disclosed its plans to shut down its virtual care unit. And two of the country’s largest telehealth providers — Teladoc Health and Amwell — have both enacted major rounds of layoffs this year..

与零售保健市场类似，远程保健市场今年表现不佳。就在一周前，Optum披露了关闭其虚拟护理室的计划。国内最大的两家远程医疗服务提供商——Teladoc Health和Amwell今年都进行了大规模裁员。。

These events, along with the Walmart news, reflect the realities of the total addressable market for telehealth, which is “effectively zero,” said Sanjula Jain, Trilliant Health’s chief research officer.

Trilliant Health首席研究官桑朱拉·贾恩（SanjulaJain）表示，这些事件以及《沃尔玛新闻》（Walmart news）反映了远程医疗总目标市场的现实，“实际上是零”。

“Healthcare operators tend to adopt the ‘if we build it, they will come’ mentality but that has not panned out when it comes to telehealth utilization,” she declared.

她宣布：“医疗保健运营商倾向于采用‘如果我们建造它，他们就会来’的心态，但在远程医疗利用方面，这种心态并没有奏效。”。

Companies that want to enter the healthcare delivery market need to know that facilitating access does not guarantee adoption, Jain added. She noted that this false notion is why we continue to see supply exceed demand.

Jain补充道，想要进入医疗服务市场的公司需要知道，便利获取并不能保证采用。她指出，这种错误的观念正是我们继续看到供应超过需求的原因。

According to the fundamentals of economics, prices get lower when supply exceeds demand. In some instances, lower prices can create more demand — but that has not proven to be the case in the telehealth market, Jain pointed out.

根据经济学的基本原理，当供给超过需求时，价格就会降低。Jain指出，在某些情况下，较低的价格可以创造更多的需求，但在远程医疗市场上情况并非如此。

Old models simply don’t work

旧型号根本不起作用

Admitting that Walmart’s business model is not sustainable underscores a larger issue plaguing the U.S. healthcare system, said Monica Cepak, CEO of Wisp, a telehealth provider that offers upfront pricing instead of working with insurers.

远程保健提供商Wisp的首席执行官莫妮卡·塞帕克（MonicaCepak）表示，承认沃尔玛的商业模式不可持续，突显出困扰美国医疗保健系统的一个更大问题。Wisp提供预付款定价，而不与保险公司合作。

“Walmart shuttering its in-store clinics and discontinuing its telehealth program emphasizes the challenging reimbursement environment and escalating operating costs many healthcare providers are struggling with today,” she stated. In doing this, Walmart is loudly saying that these existing business models are not profitable.”.

她说：“沃尔玛关闭了店内诊所，停止了远程保健计划，这突显了当今许多医疗保健提供者面临的具有挑战性的报销环境和不断上升的运营成本。”。在这样做的时候，沃尔玛大声说，这些现有的商业模式是无利可图的。”。

Ashok Subramanian — CEO of Centivo, a health plan for self-funded employers — sees things differently.

AshokSubramanian是Centivo的首席执行官，Centivo是一个为自筹资金的雇主制定的健康计划，他对事情的看法不同。

To him, the main takeaway from Walmart Health’s shutdown is that companies need to stop attempting to layer new solutions on top of the existing system. This approach will never be an effective way to deliver coordinated care or truly improve access, he wrote in an email.

对他来说，沃尔玛健康倒闭的主要收获是，公司需要停止在现有系统之上分层新解决方案的尝试。他在一封电子邮件中写道，这种方法永远不会是提供协调护理或真正改善获取途径的有效方法。

“Walmart highlighted a ‘broken business’ model as the reason for closing its brick-and-mortar and virtual care services. What is actually broken is the entire model of financing uncoordinated, fragmented healthcare services at uneven prices with no correlation to quality,” he explained.

他解释说：“沃尔玛强调了一种‘破碎的商业’模式，这是其关闭实体和虚拟医疗服务的原因。实际上，破碎的是以不均衡的价格为不协调、分散的医疗服务提供资金的整个模式，与质量无关。”。

What does this mean for the future of retail healthcare?

这对零售保健的未来意味着什么？

Going forward, large retailers will likely start thinking about their role in healthcare in a much more employer-focused manner, predicted Springer of Pitchbook.

Pitchbook的斯普林格预测，未来，大型零售商可能会开始以更加以雇主为中心的方式考虑自己在医疗保健中的作用。

Just as retail interest in primary care clinics helped drive investment in the space a few years ago, she thinks there will soon be growing investment in employer-facing solutions for primary care, chronic condition management and benefits navigation.

正如几年前零售业对初级保健诊所的兴趣推动了该领域的投资一样，她认为，很快就会有越来越多的投资用于面向雇主的初级保健、慢性病管理和福利导航解决方案。

“[Employers] have national, diverse employee populations, and like all, employers are facing rising healthcare costs. If you can solve it for your employees, maybe you can roll it out to other employers too. This is the direction Amazon seems to be taking, and Walmart also has a nationwide program for its employees with Included Health that has seen some early success,” Springer remarked..

斯普林格说：“[雇主]拥有全国性的、多样化的员工群体，与所有人一样，雇主也面临着不断上涨的医疗保健成本。如果你能为你的员工解决这个问题，也许你也可以将它推广到其他雇主。这是亚马逊似乎正在采取的方向，沃尔玛也有一个全国性的员工健康计划，已经取得了一些早期的成功。”。。

Included Health is a benefits navigation startup that sells its platform to employers. Robin Glass, the company’s president, wrote in an email that she doesn’t think the Walmart news represents a bad moment for telehealth or primary care providers. Instead, she thinks the news is “a clear signal of an appetite to clear the way for a new chapter of modern healthcare.”.

Included Health是一家福利导航初创公司，将其平台出售给雇主。该公司总裁罗宾·格拉斯（RobinGlass）在一封电子邮件中写道，她不认为沃尔玛新闻对远程医疗或初级保健提供者来说是一个糟糕的时刻。相反，她认为这条消息是“一个明确的信号，表明人们有意愿为现代医疗保健的新篇章扫清道路。”。

Ideally, this new era will be characterized by less commodity solutions and a deeper focus on longitudinal support for patients, Glass wrote.

格拉斯写道，理想情况下，这个新时代的特点将是减少商品解决方案，更加关注对患者的纵向支持。

“This is good news for consumers, clinicians and for companies like us who’ve been building a more robust and holistic modern healthcare experience -— one that goes beyond being convenient and transactional to highly personalized and seamlessly connected to all of healthcare’s highest-quality resources and settings.”.

“这对于消费者、临床医生和像我们这样的公司来说是个好消息，因为他们一直在构建一种更加强大和全面的现代医疗保健体验，这种体验超越了方便和交易，而是高度个性化，并无缝连接到所有医疗保健最高质量的资源和环境。”。

Another healthcare leader — Derek Streat, CEO of DexCare, a startup offering health systems a platform to help them coordinate and manage digital care — noted that the Walmart news is a cautionary tale of the complexities that affect the country’s “fragile” healthcare system.

另一位医疗保健领导者DexCare的首席执行官德里克·斯特雷特（DerekStreat）指出，沃尔玛新闻警示人们注意到，影响该国“脆弱”医疗保健系统的复杂性。

This delicate system will be pressure tested as more people live with chronic conditions, physician burnout reaches crisis levels, more Americans reach the age of 65, Streat explained.

斯特雷特解释说，随着越来越多的人患有慢性病，医生的职业倦怠达到危机程度，越来越多的美国人达到65岁，这个微妙的系统将受到压力测试。

To get ahead of these challenges, healthcare providers must move away from a fragmented view of care and toward a predicted model, he declared. This approach must be backed by technology that can manage how, when and where care is accessed, he added.

他宣称，为了应对这些挑战，医疗保健提供者必须从零散的护理观点转向预测模型。他补充说，这种方法必须得到能够管理如何、何时何地获得护理的技术的支持。

“The fact that Walmart, atop the Fortune 100, cannot make a buck in healthcare should be a wakeup call for the industry at large. The hurdle is not technology, but changing how we operate,” Streat said.

斯特雷特说：“沃尔玛（Walmart）位列《财富》100强榜首，在医疗保健领域无法盈利，这一事实应该给整个行业敲响警钟。障碍不在于技术，而在于改变我们的运营方式。”。

Photo: ComicSans, Getty Images

照片：ComicSans，Getty Images

Topics

主题

DexCare

DexCare

Forrester

福雷斯特

Included Health

包括健康

Pitchbook

Pitchbook

profitability

盈利能力

retail clinics

零售诊所

retail health

零售健康

telehealth

远程医疗

Trilliant Health

Trilliant健康

Walmart

沃尔玛

West Monroe

西门罗

Wisp

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