First, the easy news. Deal volume in the first quarter of 2018 was on par with the previous quarter’s total of 380 deals. Preliminary data show 378 transactions were announced in the first quarter, making for a decline of 1% that will likely be erased as more deal activity is uncovered. Compared with the first quarter in 2017, however, deal volume was down 14%, versus the 439 deals reported then.

Deal value for the quarter is where the data deviates from previous norms. The first quarter in 2017 posted a very robust $59.6 billion in disclosed deal value. In the fourth quarter of the year, deal value leapt to nearly $115.0 billion, thanks largely to the $77 billion proposed acquisition of Aetna (NYSE: AET) by CVS Health (NYSE: CVS). Check out the April 2018 issue of Health Care M&A News for the deal volume and value charts, by sector.

In the first quarter of 2018, deal value stayed in the stratosphere. Preliminary data show total spending of $112.9 billion, which is 2% lower than the previous quarter, but 90% greater than the same quarter in 2017. This quarter’s total was boosted by Cigna’s (NYSE: CI) $67 billion acquisition of Express Scripts Holdings (NYSE: ESRX), the last large publicly traded pharmacy benefit manager (PBM).

This second quarter started off with another major deal in the wings, as Walmart (NYSE: WMT) is reportedly in talks to acquire Medicare specialist Humana (NYSE: HUM), with a market cap currently around $35 billion. Shortly after The Wall Street Journal broke that news, CNBC reported that the giant retailer is also in talks to buy PillPack, a start-up online pharmacy that helps to manage multiple prescriptions by packaging pills together and delivering them. CNBC cited two sources who said the price would be less than $1 billion.

Both deals could fall apart, but they wouldn’t be Walmart’s last attempts to join the battle to buy healthcare companies that already serve hundreds of thousands, if not millions, of consumers.

Ironically, the chief driver behind the scramble to marry retail and healthcare is a company that hasn’t made any acquisition announcements, Amazon.com (NASDAQ: AMZN). In January the online giant teamed up with Berkshire Hathaway (NYSE: BRK.A) and JP Morgan Chase (NYSE: JPM) to announce their partnership in an as-yet-to-be named company to cut healthcare costs and improve services for their U.S. employees.

No further details have been released, but the news was enough to spur speculation that Amazon would move beyond its established position in bulk medical supply sales via its Prime Medical Store, and into the prescription delivery business. Given its strength in home delivery via the Amazon Prime service, those fears are well founded.

The CVS/Aetna deal is meant to create “community health hubs” within CVS’ enormous geographic footprint. The hope is that “all health care is local” wins over online shopping and deals. The deal is drawing close scrutiny from legislators at the state and federal levels, and has only been cleared by both companies’ shareholders.

The Cigna/Express Scripts gives Cigna a major access point between its members and prescription drug delivery. With that may come lower drug prices for Cigna members, as well as other offers.

Should Walmart succeed in its healthcare acquisitions, it won’t be enough to thwart its long-time retail competitor Amazon. Walmart has actively advertised its home delivery capabilities since the beginning of this year, and told analysts on an earnings call in February that it expects U.S. e-commerce sales to increase approximately 40% in fiscal 2019.

Humana currently sells Medicare drug plans through a partnership with Walmart, but an acquisition would also bring a 40% share of Kindred Healthcare’s (NYSE: KND) Kindred at Home business, which Humana agreed to buy last December in a joint acquisition with TPG Capital and Welsh, Carson, Anderson & Stowe. The latter two companies will own 60% of that business, which was valued at approximately $3.1 billion. Humana has the right to buy the remaining ownership interest over time through a put/call arrangement. Kindred shareholders agreed to the deal on April 5, 2018. It’s unclear how much Walmart’shareholders would welcome a home health business.

What does this mean for deal makers? Prepare for the retailization of health care, not to be confused with the consumerization of health care. Retailers are moving into the industry and bringing their business plans, cost analyses and bargaining power. The deals they strike will benefit shareholders perhaps more than they’ll benefit consumers.

But for consumers who are accustomed to shopping online and knowing the price of the product or service before they decide to buy, the change from the present system of hospital charge masters, unexpected bills from third parties and changing price quotes will be welcome.

We’re looking forward to more big deals in 2018, and certainly more details around the Amazon/Berkshire Hathaway/JP Morgan venture. Although it will only cover those companies’ U.S. employees, the promises to cut costs and provide transparency can’t be taken lightly from companies that depend on the good will of their customers.