By Phil Galewitz OCTOBER 3,
2019
Worried
its employees aren’t getting good enough care from doctors in their insurance
networks, Walmart next year will test pointing workers in northwestern
Arkansas, central Florida and the Dallas-Fort Worth area toward physicians it
has found provide better service.
If the
employees use these “featured providers,” they will pay less out of pocket,
Walmart officials said Thursday.
Walmart
is working with Embold Health of Nashville, a recent startup company that uses
data to analyze whether doctors provide “appropriate, effective and
cost-efficient care.” Embold CEO Daniel Stein was a Walmart executive from 2013
to 2017.
“Rather
than relying on word of mouth or social media to find a provider, patients can
get information based on actual data and proven results,” said Lisa Woods,
Walmart’s senior director of U.S. benefits.
Walmart,
the nation’s largest private employer, would not disclose the percentage of its
doctors in those geographic areas that have the new quality distinction or how
much workers could save by using their services. The company hopes to take the
program nationwide if successful, officials said.
About
60,000 employees and dependents in the three initial areas could be affected.
Ateev
Mehrotra, associate professor of health care policy at Harvard Medical School,
said Walmart’s strategy could raise questions about whether doctors are chosen
more for lower cost or higher quality.
“This
sounds awesome and great in theory, to identify the best doctors you have for
your employees to go to, but what is in the black box formula that Embold
Health is using, and how much is it the cost and how much is quality of care?”
he said.
The
effort to steer workers to certain doctors mirrors a similar approach Walmart
uses with hospital care. Since 2012, Walmart has directed the 1 million
employees and dependents on its health plan to better-performing hospitals for
high-cost services, such as heart and transplant surgery.
While
using these hospitals — including Mayo Clinic and Cleveland Clinic — may cost
more than a local alternative, Walmart officials have said the strategy saves
money by averting complications and unnecessary care. Several other large
employers have followed a similar “centers of excellence” strategy.
Earlier
this year, Walmart became the first large employer to direct its employees to diagnostic
imaging facilities that it found provide more accurate care.
Employer
health experts said Walmart’s initiative with physicians is a groundbreaking
step — but is also fraught with risks such as alienating doctors and upsetting
employees who don’t want to change doctors.
“It’s a
bold move to use the data they have and share it with employees for their
benefit,” said Steve Wojcik, vice president of public policy at the National
Business Group on Health, a trade group of large employers. “It’s part of
Walmart’s pattern to disrupt and transform health care for the better.”
Stein
of Embold Health said his company uses various quality metrics that vary by
specialty to rate physicians. The company shares its criteria with physicians,
he said, so they know what areas they need to improve to get the quality
distinction. This includes such measures as rates of cesarean sections for
patients with low-risk pregnancies and infection rates for patients after
elective knee or hip replacement, according to Embold Health.
Mehrotra
noted, however, that it’s often difficult to identify which doctors provide the
highest quality of care because most work in large groups where patients may
see multiple physicians.
The
initiative to identify better-performing doctors, he suggested, “can only be
seen as a failure of their health plans,” noting that employers typically rely
on the insurance companies that administer their plans to identify the best
doctors for their networks.
Walmart’s
test will include physicians specializing in primary care, cardiology,
gastroenterology, endocrinology, obstetrics, oncology, orthopedics and
pulmonology.
Walmart
officials said the initiative is aimed at helping reduce the large amount of
unnecessary care that doctors provide, which some studies say is
as high as 30%.
“We
hope to get a meaningful chunk of that removed from our costs and our
associates’ costs,” said Adam Stavisky, Walmart’s senior vice president of U.S.
benefits. “How much we can save? We don’t know, but we think it’s material.”
The
initiative is one of several announced by Walmart officials Thursday, including
pilot projects to expand access to telehealth doctors managing chronic care in
Colorado, Minnesota and Wisconsin, and to help workers in North Carolina and
South Carolina find doctors, provide assistance on billing questions or complex
medical issues.
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