Gov. Nikki Haley and two high profile health care advisors boarded a private plane to Bentonville, Ark., more than a year ago for a closed-door meeting with Wal-Mart executives. They hoped to convince the largest retailer in the country to launch a new primary care strategy in South Carolina.

Healthy Connections Checkup

The South Carolina Medicaid agency launched a new program called Healthy Connections Checkup on Friday.

It will provide preventive screenings and family-planning benefits to an estimated 300,000 residents who fall below 194 percent of the federal poverty level.

The program is less comprehensive than traditional Medicaid, but it will cover adults who are ineligible for the regular low-income health insurance program.

It's also much less expensive to administer. Healthy Connections Checkup costs the state approximately $300 per person per year, compared to at least $3,000 a year for regular Medicaid.

"We've put public health and prevention and screenings front and center where it should be," said Medicaid Director Tony Keck.

Critics argue that the program is well-intentioned, but that it will not benefit uninsured patients who are truly sick because it only covers the cost of screening, not actual treatment.

Keck replied, "There are many, many organizations that see people for free or for a reduced cost. When we find people who need care and aren't able to pay for it, we can connect them."

For more information, visit

"We told Wal-Mart, 'We think this is perfect,'" said Tony Keck, director of the state Medicaid agency, who attended the meeting.

It seems Wal-Mart agreed. On Thursday, the company opened its fourth and fifth "Care Clinics" in Sumter and Florence.

The first three clinics, staffed by licensed nurse practitioners, are already up and running in Texas.

Although most stores have long included low-cost pharmacies, these five sites represent the company's first foray into primary care.

Wal-Mart has not announced where it will expand the model beyond the two pilot states.

"For our associates and dependents on the health plan, you can come and see a provider in the Wal-Mart Care Clinic for $4. Four dollars! That is setting a new retail price in the health care industry," said Jennifer LaPerre, senior director for the company's health and wellness program, during the Sumter clinic's grand opening Thursday.

Wal-Mart has long drawn criticism for the health care benefits it offers its low-income employees. A May report published by the Americans for Tax Fairness estimates Wal-Mart's 1.4 million workers rely on $6.2 billion worth of public assistance programs every year, including food stamps and Medicaid. The new Care Clinics are open for both employees and customers, but employees will pay a fraction of the fees charged to the general public.

A spokeswoman for the company said she anticipates 1,200 Wal-Mart staff in Sumter and Florence will benefit from the new clinics.

Customers pay $40 for appointments and additional fees for lab work. The Care Clinics only accept fee-for-service Medicaid and Medicare plans. Privately insured patients pay the same amount for services as uninsured patients.

Advocates for the new model call it cutting edge. They say the Care Clinics increase access to the health system by putting providers right in the front of Wal-Mart stores where thousands of people pass by every day. Many of those shoppers live on middle-to-low incomes and need help managing chronic conditions like diabetes and hypertension. Meanwhile, critics worry that the seen-as-you-need-to-be-seen clinics may undermine traditional doctor-patient relationships.

"That's not a medical home," said Shelli Quenga, programs director for the nonprofit Palmetto Project. "So how do we say, 'It's OK to go to this place for intermediate care, but you need somebody who knows you?'"

Both South Carolina sites were strategically chosen because many of the state's sickest, low-income residents live there.

"I think this is good news and bad news," said Sumter Mayor Joe McElveen. "The bad news is, I guess, the two are being opened in Florence and Sumter because we have lots of people who need service. The good news is that it is affordable."

Keck said South Carolina's significant physician shortage demands new solutions and leaves no room for detractors to complain.

"We have to have every access point possible in the system," he said. "We should be happy about it."

Bernadette Simmons, an assistant manager at the Sumter Wal-Mart, does not have health insurance through the company - she's been employed there since May - but she only paid $36 for a visit and lab work during her first appointment at the new clinic on Thursday.

"You cannot beat that," the 45-year-old said. She had some pain in her feet and her knee that she wanted checked out, and the nurse determined that her blood pressure was "borderline." An outpatient practice in town would have charged her $86 for the visit alone, she said.

"This (clinic) is needed in the community because everyone doesn't have insurance and really can't afford to go to the doctor because of the expense," Simmons said. "It's been the talk. It's been buzzing. We're very excited."

Haley was not available to answer questions about the pilot program, but her spokesman Doug Mayer said in a statement that the clinics "won't just make us healthier but will help to drive down costs, and that's a win for every person in our state."

The Arkansas trip was not paid for by the state, Mayer said. Department of Health and Environmental Control Director Catherine Templeton also attended the meeting with Wal-Mart executives, he said.

Reach Lauren Sausser at 937-5598.