Wal-Mart is up to something, something to do with primary care. The only thing that Wal-Mart itself is saying is that it's not doing what it told potential partners it wants to do.

The commotion started with the retail giant's circulation of a 14-page request for information document from Wal-Mart's Health & Wellness division seeking “mutually beneficial proposals that will aggressively drive down costs within the healthcare system.”

The overture opened with an ambitious statement of intent: “Wal-Mart intends to build a national, integrated, low-cost primary-care healthcare platform that will provide preventative and chronic care services that are currently out of reach for millions of Americans. Wal-Mart intends to do this in an affordable and accessible way while maintaining or improving quality outcomes. Wal-Mart seeks partners who have a care model or capability that can help dramatically drive down the cost of care, while maintaining or improving quality on a national level.”

That caught people's attention, but perhaps not in the way Wal-Mart intended.

“The RFI statement of intent is overwritten and incorrect,” Dr. John Agwunobi, senior vice president and president of Wal-Mart U.S. Health & Wellness, said in a statement responding to media reports of the document. “We are not building a national, integrated, low-cost primary-care healthcare platform.”

Wal-Mart declined to provide any further on-the-record information explaining the rest of the document—which states that the company is looking for strategic partners to deliver services that would “include but not be limited to” clinical care, diagnostic services, preventive services, and health and wellness products.

“More specifically, Wal-Mart will use its retail and multi-channel footprint to offer the lowest cost primary healthcare services and products in the nation,” the RFI states.

Primary-care advocates expressed concerns about the repeated mention of lowering primary-care costs.

“There is no evidence that primary care is where the excess costs are in our healthcare system,” said Dr. Glen Stream, president of the American Academy of Family Physicians, adding that expensive procedures, subspecialty care and drugs contribute the most to healthcare costs while effective primary care can keep people out of the hospital and out of the emergency department. “That's how you will save costs in the long-run,” said Stream, who practices in a primary-care satellite office of a 175-doctor medical group in Spokane, Wash.

Dr. Joseph Stubbs, former president of the American College of Physicians and a member of nine-physician Albany (Ga.) Internal Medicine group, said there are some positive aspects to Wal-Mart's step into primary care—such as the potential to improve access—but these would all go away if the main focus is on lowering costs. “To create an on-the-cheap primary-care system is missing the point of where the costs are.”

According to its website, Wal-Mart currently operates 138 retail clinics in 28 states in partnership with such organizations as the Baptist Healthcare System in Kentucky, Mercy system in Arkansas and Oklahoma, and Central DuPage Hospital in Illinois.

Stream thinks this latest initiative is evidence that the in-store retail clinic concept is failing as a business model, and he noted that the list of services has grown from the treatment of minor acute ailments—ear aches, sore throats, rashes—to include physicals for youth athletics and managing chronic disease.

“So now they're looking to take the next step up—more comprehensive primary care,” Stream said. “But do they want high quality or are they just going to produce a product?”