Walmart is rolling out an effort to measure
the quality of community doctors who treat tens of thousands of its employees
in the retailer’s latest effort to make sure its workers get the right care, in
the right place and at the right time.
Because it’s Walmart, the effort is being
watched closely by other employers and could have a far-reaching impact on U.S.
doctors and other healthcare providers who are already being culled from
employer and insurance company networks for poor quality and health
outcomes. Narrow network strategies used by health plans provide enrollees
an incentive to use a doctor that adheres to quality measures and is lower cost
because they achieved a better outcome.
In Walmart’s case, the world’s largest
retailer is launching several pilots effective Jan. 1, 2020 designed to improve
quality and reduce costs in large part to eliminate unnecessary or unneeded
healthcare services. The new concepts, considered in a test phase, will be an extension
to the community doctor level of earlier efforts to guide patients to “Centers of Excellence” like
the more specialized Mayo Clinic, Cleveland Clinic and Geisinger Health System
to make sure certain heart, knee, hip and spine surgeries are done right the
first time.
Walmart, which has more than 1 million
employees, announced Wednesday the
company will test a new “featured providers” program “that helps connect
patients with local doctors who have a demonstrated history of providing the
most appropriate patient care,” Walmart wrote in a column outlining the
pilots. “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.”
Walmart is launching the “featured providers”
program with a fast-growing data analytics company known as Embold
Health, which says it uses data to “shine a light on
top-performing doctors” from data gleaned from public and private insurers to
create reports on individual doctors. Embold Health executives said its
analysis “captures” whether care is appropriate, medically necessary by
offering “benefits based on the latest scientific guidelines,” and
cost-effective in how it is delivered.
“This data will help take the guesswork out of
finding an affordable, quality local provider in eight specialties: primary
care, cardiology, gastroenterology, endocrinology, obstetrics, oncology,
orthopedics and pulmonology,” Walmart said in its column. “Walmart
will use this data to curate a group of physicians with a track record of
providing consistent quality care and then provide that to associates so they
can make more informed decisions regarding their care.”
Initially, the “featured providers” program
will begin in northwest Arkansas, the Florida markets of Orlando and Tampa and
the Dallas/Fort Worth market in Texas, Walmart said. There will be about 60,000
employees and their family members in the featured providers pilot, Walmart
said. For those who see a featured provider for care, they pay a $35 copay for
a primary care visit or $75 for a specialist visit if they are enrolled in
Walmart’s most popular plan though it can vary, executives said.
Walmart executives Adam Stavisky, senior vice
president U.S benefits, and Lisa Woods, the retailer’s director U.S. benefits
strategy and design, said they don’t plan to stop with the featured providers
effort are continuing to look at ways to improve quality and hold medical care
providers accountable. “(We’ve) been in the lab working on this for a
longtime,” Stavisky said in a call with reporters Tuesday to discuss the new
pilots.
Other employers are watching Walmart’s efforts
closely as companies grow tired of paying for poor quality of care while at the
same time watching their costs rise and their workers take on a greater share
of the premium.
“Employers like Walmart are leading innovation
within healthcare that has not been adequately responsive to the needs of
purchasers and patients.” said Elizabeth Mitchell, president and chief
executive of Pacific Business Group on Health, one of the nation’s largest
employee healthcare business coalitions with 40 public and private employer
members.
The “featured providers” program is part of a
“suite of new medical benefits” Walmart said is deigned to make it easier for
its workers to pick “high-quality physicians in local communities.”
Walmart’s other new health benefits for its
employees that will be tested include:
* - a personal healthcare assistant, which is a
concierge-like service that can help employees with billing, appointments,
coordinating transportation to appointments. It will be tested in North
Carolina and South Carolina.
* - expansion of its telehealth service for employees in
Colorado, Minnesota and Wisconsin to include “preventive health, chronic care
management, urgent care, and behavioral health for associates.”
“Through this voluntary program, patients can
video chat with a doctor from the comfort of their homes, and, if they choose,
access a personal online doctor . . . and an entire team to coordinate
specialty care, provide nutritional and diabetic counseling and coordinate
behavioral health referrals and visits billing and appointments, but also
finding a quality provider, understanding a diagnosis and addressing other
complex questions,” Walmart said.
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