The Wall Street Journal recently published an article with the attention-grabbing headline, "Why the Walmart Model Doesn't Work in Healthcare."

• Walmart recently announced it was closing down more than 50 health centers, but it's not alone in pulling back from investments in doctor's offices.
• Walgreens has also been closing clinics and told the WSJ it would reduce its stake in VillageMD, and CVS is reportedly looking for a private-equity partner to help fund Oak Street, the primary care chain it owns.
• That's a stark contrast to only a couple of years ago, when, as the Journal puts it, "it seemed inevitable that the doctor's office was increasingly going to be a big-box service — something you do on your way to the snack aisle."

The WSJ's answer to the question posed in the headline, in one word: labor.

• It doesn't matter how big you are, employing doctors and other clinicians costs a certain amount, and each one can only work so much.
• That's especially true given today's health workforce shortages.

The intrigue: Owning doctor's offices can still be lucrative — just ask big health systems.

• The key is to make the doctor "a conduit for capturing value elsewhere," per the WSJ, like through referrals for services with higher margins than primary care.
• Other business models with potential are value-based care and subscription models (more on that below!).

My thought bubble: No one's figured out a way to make good money from primary care, which is bad news for society as a whole because it results in a less healthy population that pays more for care down the road.

• Annual physicals may be the key to catching cancer early, but they're never going to generate the same profit margins as knee replacements — or chemotherapy.

Another primary care business model is charging patients membership fees — which is becoming more common, KFF Health News recently reported.

Why it matters: Amid a large and growing shortage of primary care providers, what's supposed to be the bedrock of our health care system is slowly morphing into something that those with extra cash can better access.

• Alternatively, those trying to find a new primary care doctor are calling primary care practices only to discover they're not taking new patients.
• That's true even for those who have insurance.

Between the lines: "Concierge medicine potentially leads to disproportionately richer people being able to pay for the scarce resource of physician time and crowding out people who have lower incomes and are sicker," Adam Leive, a researcher at University of California at Berkeley's Goldman School of Public Policy, told KFF Health News.

By the numbers: Between 5,000 and 7,000 U.S. physicians and practices provide concierge care, according to Concierge Medicine Today (the existence of which, KHN rightly points out, says something!).

• Annual fees can range widely, from One Medical's $199 (not including an Amazon Prime discount) to $10,000 or more for practices like Massachusetts General Hospital's.

The bottom line: It's getting harder to find a doctor, at least without a long wait. That's partially because some of them are only taking patients willing to pay extra.

Speaking of things that only certain patients can afford — add weight-loss drugs like Ozempic and Wegovy to the list.

• We knew this was coming. But it's still important to pay attention to how it's playing out, and the New York Times recently published a good piece doing just that.
• Specifically, public payers around the country are deciding they just can't afford to cover the drugs.
• For example, per the NYT: West Virginia's Public Employees Insurance Agency canceled a pilot program to cover weight-loss drugs earlier this year, North Carolina's state employee insurance plan also ended coverage of weight-loss drugs, most Medicaid programs cover GLP-1s only to manage diabetes, and Medicare covers Wegovy and Zepbound only when prescribed for heart problems.

Why it matters: "We've separated between the haves and the have-nots," Joanna Bailey, a West Virginia family physician and obesity specialist, told the NYT.

• At the same time, affordability is a serious issue for public plans that have a limited budget, or whose expenses must be passed on to taxpayers.

What we're watching: The math of covering drugs that have a list price of nearly $1,000 a month (not accounting for rebates) adds up quickly in a country where more than 2 in 5 adults have obesity.

• Not covering the drugs for weight loss is one thing, particularly because Medicare's policy is not to do so.
• But GLP-1s are being tested against all kinds of other diseases, from addiction to Alzheimer's, meaning this math problem is on track to only become more challenging.

National health spending exceeded $5 trillion annually for the first time in March of this year, Altarum recently estimated.

Why it matters: That's a lot of money! Still, everything else is getting more expensive too, and health spending was 17.7% of GDP in April.

• It's worth noting that utilization is driving health spending increases more than price growth.