Blog | Innovation and Disruption

Analysis: Walmart’s Centers of Excellence program goes local

Blog | Innovation and Disruption

Analysis: Walmart’s Centers of Excellence program goes local

  • Several news outlets recently reported Walmart’s rollout of a healthcare pilot program for its employees includes a curated list of high-quality providers.
  • The program initially is being offered to Walmart and Sam’s Club workers in three areas of the country.
  • The goal is to eventually offer the program to the 1 million Walmart and Sam’s Club workers and family members on the company’s health insurance.

Multiple sources, including an Oct. 2 Associated Press article, are reporting what we’ve long anticipated. The AP reported: “Walmart is rolling out a health care pilot program for its employees that will refer them to a curated list of high-quality, lower-cost providers but offer fewer choices than under the current plan.

“Through the program, Walmart will help employees connect with local doctors in areas like primary care, cardiology and obstetrics” according to the AP. “It is working with Nashville-based data analytics company Embold Health, which will cull through vast amounts of data from public and private insurance plans to come up with recommended providers based on effectiveness and cost-efficiency. Walmart will in turn use that data to curate a list for employees. The program will cover U.S. Walmart and Sam’s Club workers in Orlando and Tampa Florida, the Dallas-Fort Worth, Texas area and Northwest Arkansas starting Jan. 1. The story continued: “The goal is for the services to eventually be available to the 1 million Walmart and Sam’s Club workers and family members on the company’s health insurance program. The retailer also plans to share its practices with other companies (emphasis added by Chad Mulvany).”

“As part of the pilot program, Walmart is expanding its telehealth program where workers get diagnosed with a live doctor via video,” according to the AP. “Currently, Walmart offers basic telehealth to nearly everyone on its medical plans for minor medical issues like a sore throat. However, as of Jan. 1, workers in Colorado, Minnesota and Wisconsin can opt to access a personal online doctor and a team to manage chronic conditions like diabetes as well as preventative care. Walmart’s test will include physicians specializing in primary care, cardiology, gastroenterology, endocrinology, obstetrics, oncology, orthopedics and pulmonology.”

The story continued: “A human personal health care assistant will also be available for workers in North and South Carolina as a go-to resource on billing questions, making an appointment and understanding a diagnosis (emphasis added by Chad Mulvany). The initiative to identify better-performing doctors, according to an expert interviewed for the article, ‘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.’”

Takeaway

Three takeaways:

  1. If Walmart is truly going to share this with other companies, I would expect to see more organizations adopt these types of models if they prove successful. The tactic is certainly in line with strategies I would expect from Haven (however, I question whether or not if Haven’s members would really be willing to narrow their networks in the current economy given the skill mix of their workforce).
  2. If Walmart does align with or acquire a health plan, I would fully expect something like this to be an integral part of many of its products. A key concern of employers is managing specialist referrals which this model by Walmart provides. Also, many of the specialist types targeted would be useful in managing spend in the Medicare Advantage population as well.
  3. It makes some sense to me that Walmart would provide its employees with a care navigator to help them understand their diagnosis (and, I’m assuming treatment options, particularly in complex cases.) While the physician/care team should be walking the patient through a shared decision-making exercise, few care teams have the time or the capability to do so. And this is a solution that realizes that weakness and provides a resource to help the patient choose the care pathway that is best aligned with their preferences, goals and values. I could read the second two activities this role will assist with – scheduling appointments and a “go-to resource on billing” – one of two ways:
  • The most benign (and inferred) way to read this is that “resource on billing questions” really means helping the patient understand their benefit design so the discussion of treatment options includes a discussion of potential costs associated with those options. And “making an appointment” isn’t about the actual act of scheduling as much as it is helping the  patient choose the provider who is best aligned with their treatment preferences.
  • The simpler (and less flattering) way to read it, is that despite continued improvement, the revenue cycle is complex and  requires assistance navigating it. 

Organizations should work to simplify, centralize and standardize scheduling processes where possible to reduce patient and administrative burden. This is becoming an imperative as more services can be provided in an ambulatory setting which opens them up to a greater array of competitors.

On the billing side, HFMA has long provided resources and best practice examples. Refer to the following to learn how best to communicate with patients about their financial obligations:

About the Author

Chad Mulvany, FHFMA,

is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office.

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