By Deborah Borfitz 

November 3, 2022 | With the launch of Walmart Healthcare Research Institute (WHRI) earlier this month, the retail giant is doubling down on its efforts to be a healthcare destination for the masses, according to John Wigneswaran, M.D., Walmart’s chief medical officer (CMO). The aim is to make clinical research “equitable for all,” including people living in rural communities who have less access to trials than people in cities with an academic center nearby. 

Walmart plans to leverage its relationship with more than 150 million weekly customers to, first and foremost, “identify patients for studies that have a health equity impact,” says Wigneswaran, including clinical trials for diabetes, HIV, obesity, and asthma. As a follow-on to that, the Walmart Health division will likely get involved in decentralized clinical trials (DCTs) as a pickup location for study medications that could include patient counseling by its pharmacists. 

Like other retail pharmacies seeking a role in clinical research, Walmart has a database to identify would-be participants for trials based on the medications they take. “We have a very significant number of patients who have already opted into clinical programs,” he notes, and prescriptions filled at the pharmacy typically include the diagnosis code.  

Ninety percent of Americans live within 10 miles of a Walmart, points out Wigneswaran, and 3,991 stores (out of a total of 4,735) are in areas designated as medically underserved. These include communities with a disproportionately high number of older adults, rural residents, women, and persons who are minorities.  

For decades, clinical trials have not been representative of the population at large but people who happen to live near a research center as well as have the time and financial ability to participate. In its 2020 Drug Trials Snapshot Summary Report published last year, the U.S. Food and Drug Administration reports that 75% of trial participants are white, 11% Hispanic, 8% Black, and 6% Asian. 

In a prospective survey study conducted in 2016, patients with household annual incomes below $50,000 were also found to be 27% less likely to participate in clinical trials (JAMA Oncology, DOI: 10.1001/jamaoncol.2015.3924). The likelihood of their doing so dropped in parallel with their income. 

On the recruitment front alone, Walmart could be a tour de force. When millions of its patients were queried earlier this year, says Wigneswaran, roughly three-quarters said they were aware of the term clinical research and over half of them expressed interest in participating in studies. 

He credits the high level of interest to the language used to describe the upside of participation, notably to learn about medications and potentially improve their day-to-day life. Walmart is also mindful about not bombarding people with opportunities that aren’t relevant to them, Wigneswaran says. 

Patients can use Walmart’s newly minted My Health Journey digital tool to actively search for upcoming trials as well as track their healthcare activities, he says. The app will include patients’ medical records, insurance information, and reminders for preventive care services—and, Wigneswaran adds, can also be used to message patients directly about enrolling studies. 

Hiring Spree 

Walmart’s interest in clinical research predates its appointment last summer of Wigneswaran, who was formerly the CMO at Express Scripts and has held roles at DaVita Kidney Care and Fresenius Medical Care North America. But his hiring was followed by the rapid addition of other new executives to the leadership team, as announced by Executive Vice President of Health and Wellness Cheryl Pegus on LinkedIn. 

These have included: Brian Setzer, previously executive vice president of enterprise planning and operations at Highmark Health, appointed chief financial officer of the division; Andrea Marks, formerly vice president for the People Analytics Center of Excellence for UnitedHealth Group, who now serves as the division’s vice president of clinical performance; Kevin Host, who was president and chief operating officer of Avita, taking over as senior vice president of pharmacy; David Carmouche, M.D., formerly executive vice president of value-based care and network operations at Ochsner, who has assumed the role of Walmart Health’s senior vice president of omnichannel care solutions; and Richard Fuchs, a 10-year Anthem veteran, who has joined Walmart as senior vice president and innovation, sales and strategy. 

The company was already involved in various studies and white papers with pharmaceutical companies, says Wigneswaran. Genesis of the WHRI was part of ongoing efforts to better engage and educate patients, many of whom don’t have the opportunity to participate in clinical trials. 

WHRI is a continuation of established practices at Walmart to talk with patients not just about studies but also gaps in care and to improve health literacy around drugs, he says. It is also an occasion to “push the pharmaceutical industry” on the way protocols get designed and their health equity impacts. 

“I don’t think we’re going to be an end-to-end clinical study company,” says Wigneswaran. “[But] from a retail perspective, we have a part to play... that can solve for gaps that already exist.” Pharmaceutical companies have had a difficult time finding patients for rare disease studies, he cites as an example.   

In the press release announcing the launch of WHRI, Walmart says it has already demonstrated strong results with a referral rate three times the industry benchmark. Wigneswaran explains that industry partnerships began in earnest back in April and the figure for rare disease studies might look different. 

The process begins by querying the in-house database to get “a sense of what’s out there,” he says. An inclusion/exclusion algorithm, which involves multiple different data sets, is then used to create a list of qualified patient referrals. “It’s a fairly significant number... and we are digging further into why that is.” 

Strategic Plans 

My Health Journey is Walmart’s broad patient-facing ecosystem that launched earlier this year and seeks to engage patients before, during, and after their participation is a study. That might entail a conversation about whether they missed a flu vaccine or need further disease education, says Wigneswaran. It can also mean getting study results back to patients and communities and measuring the impact.  

WHRI is working with a wide range of study partners, including contract research organizations (CROs), pharmaceutical companies, and leading academic medical centers, he says. The list includes CTI Clinical Trial & Consulting Services (a full-service CRO) and Laina Enterprises (a platform for DCTs). 

All told, Wigneswaran adds, Walmart has “more than a handful” of collaborators where the relationship is either directly with a large pharma company or a conventional CRO. “We’ll have more to report out later on this year.” 

For now, the intention is for WHRI to run domestically, says Wigneswaran, although Walmart is a global company that operates in 24 countries around the world. Building relationships with patients in the U.S. is the top priority. 

No major capital investment or store redesign should be needed to accomplish the objectives of WHRI, Wigneswaran says, since Walmart’s omnichannel strategy—including pharmacies, clinics, and optical and dental services—provides all the necessary infrastructure.   

Walmart’s interest is in improving access to care wherever barriers exist and is intentionally avoiding labels or calling out certain racial and ethnic groups in its quest for across-the-board equity, he says. Uncontrolled asthma, for example, is more common in specific populations who may not have education on inhalers, understand new therapies that are available, and would have a hard time physically getting to clinical trial visits. Rare diseases, on the other hand, tend to cross many different demographics.