Walmart's relationship with Included Health dates back to 2016 when its previous incarnation - Doctor on Demand - began providing virtual urgent care services to Walmart employees in three states. Nearly eight years later, the San Francisco company continues to be the only partner charged with delivering virtual primary care to almost 1 million people in 49 states.

In announcing a large expansion of its virtual primary care program on Tuesday, Walmart strongly endorsed its health tech partner charged with providing that care to workers and their families enrolled in its health plans: Included Health.
“They’re the partner,” responded Lisa Woods, vice president, physical & emotional wellbeing at the Bentonville, Arkansas retailer, when asked whether Included is simply one of the partners involved in the announcement.
Through the expansion, 1 million people including Walmart associates and their family members will be able to access virtual care in 49 states.
“Yesterday, associates and their families in 21 states had access to virtual primary care. Now it’s all 49,” explained Woods in an interview at the HLTH conference in Las Vegas on Tuesday. “We don’t offer in Hawaii just because of the healthcare requirements in Hawaii. And so 49 states. In addition, we’re offering physical therapy. We’re also offering digestive health, which has been a really great program. And then effective January 1st, we’re adding lab at home.”
-San Francisco-based Included Health has been a partner of Walmart since 2016 through its previous incarnation: Doctor on Demand [Included Health was created with the merger of Doctor on Demand and Grand Rounds, a digital second opinion company in 2021.] The relationship between Walmart and Included Health dates back to 2016 when Doctor on Demand began to offer virtual urgent care. Then from January 2020, it began providing virtual primary care services through a pilot with employees in three states in January 2020 and expanded to 21 states in 2023. Included offers mental health services and second opinions too. In that three-year, muli-tstate pilot Walmart has seen results executives think are noteworthy.
• Approximately 33% of those involved in the pilot were 45 and older
• About 30% were seen for a chronic condition or [preventive] care.
• Diabetes patients who used Walmart’s virtual primary care option saw a 24% average reduction in HbA1c levels.
• Similarly, patients with hypertension saw a 14% reduction in blood pressure.
• Overall, Walmart saw an 11% reduction in the total cost of care.
[It’s important to note that the above is a bit meaningless given Walmart and Included Health are not disclosing exactly how many people were part of the pilot in the three-year period. Still, it may sway folks sitting on the fence about the value of virtual care.]
The last bullet is important given that many employers are desperately looking to reduce overall costs and is a validation of the model of care that Included has built. Robin Glass, president, Included Health, explained that Walmart associates using the virtual care program can select their own doctor and then are surrounded by a care team including coaches who can keep people on track when it comes to chronic disease management.
Woods noted that Included Health’s structure, where the company employs physicians was “attractive” to Walmart. Glass expanded upon that model.
“As Lisa was teeing up, the practice of medicine that we’ve had from the beginning has been heavily focused on employed clinicians, which means that people can come back again and again and see the same doctor, the same therapist,” she explained. “The vast majority of care that we provide on our platform is through employee clinicians. We do also hire contractors so that we can handle surge capacity during peak times and things like that.”
However, while extolling Included’s care model, Glass declined to reveal exactly how many clinicians Included Health actually employs.
Why did Walmart’s employee benefits division pick Included Health? There’s no shortage of virtual primary care platforms — think Teladoc, Amwell, MDLive.
“Short answer is I was not aware of anyone on primary care at the time that we started asking questions about how do we take this simple sick model and how are we able to provide access to our associates that will help them with their diabetes, with their asthma, their high blood pressure, cholesterol,” Woods said.
Glass was quick to point out that they were an early mover in the space.
“And just to underscore Lisa point, there was literally no one else doing virtual primary care when we launched it [through Doctor on Demand],” she asserted.
Fair enough, but other than virtual primary care companies, there are also care navigation companies — for instance, Accolade, Quantum Health and others —that work with large self-insured companies to help employees stay engaged in their care. Why did Walmart not select them for its employee base?
“We’ve not implemented those types of companies. I think Included Health really does a lot of what they do for us and for our associates. So we’ve not felt the need,” Woods added.
The success of the model can also be connected to the fact that Walmart employees often live in areas with very high wait times to see a primary care doctor.
“I think initially the average wait times for a primary care physician in the country, I see anywhere between 28 and 34 days,” Woods said. “Our associates can access Doctor on Demand in a couple days. Quite honestly, we have deserts in the country, so there is no care.”
Despite the success, neither Woods nor Glass were pitching a vision where virtual care is the magic bullet that will solve both urgent and chronic care needs. The model has to be integrated to in-person care where needed and there has to be smooth handoff from the Included Health virtual care provider to a provider in the employee’s community, they said.
“That is a conversation that’s been happening internally at Included Health as recently as yesterday. How as everyone’s talking about virtual primary care, we’re actually thinking about it as virtual first primary care, fully awake and aware that there is a whole universe of care that needs to happen in-person,” Glass said. Included health just wants to be the company that’s building the tightest integration to enable that.”
Photo: marchmeena29, Getty Images