Dive Brief:
- Walmart is launching a program that connects employees with high-quality local doctors across a range of specialties, the company said Thursday. Patients will have to pay more if they choose to see a provider not on the recommended list.
- The initiative, called Featured Providers, is in partnership with Embold Health, a Nashville-based healthcare data analytics company, and will begin Jan. 1 for Walmart’s 2020 medical plans. Embold Health combs through reams of data from public and private insurance plans to determine which providers are best in terms of cost-effectiveness and patient outcomes. Walmart will then provide that list to its employees.
- Walmart, the country’s largest private employer, is trialing the program in Northwest Arkansas, Orlando and Tampa in Florida, and the Dallas-Fort Worth area for its U.S. Walmart and Sam’s Club employees. The goal is to eventually expand the program to the more than 1 million Americans who receive medical benefits through Walmart.
Dive Insight:
Healthcare costs are rising faster than inflation and wages, and the country’s largest payer group — employers — are scrambling to lower costs without sacrificing quality of care for their beneficiaries.
Lisa Woods, Walmart’s senior director of U.S. benefits, is “optimistic” the initiative will improve health outcomes at the company while lowering health spend. “Once the quality is right, the cost savings will come along with it, both for the company and for associates,” she said in a statement about the new initiative.
According to the Institute of Medicine, an estimated $ 640 billion in wasteful medical spending is driven by doctors delivering unnecessary, low-value care or not following evidence-based guidelines
Walmart has been particularly active in looking for new ways to cut costs for its employees. It has a Center of Excellence Network that seeks to reduce unnecessary spinal surgeries by contracting with 12 high-quality facilities around the country, including Mayo Clinic and Mercy Hospital Springfield in Missouri.
Employees who decide to get surgery outside of the Network have to pay out-of-network costs.
Walmart’s partner in the new program, Embold Health, was started in 2017 by Daniel Stein, who was CMO of Walmart Care Clinics from 2015 to 2017 and Walmart’s director of medical and clinical services from 2013 to 2015, according to his LinkedIn profile.
The company sells its data-based platform identifying top-performing doctors in a community to payers, employers and providers. It works by analyzing a de-identified patient dataset from Blue Health Intelligence, a subsidiary of the Blue Cross Blue Shield Association, to evaluate provider quality.
Workers are allowed to go to providers not on the company’s curated list, but it will cost more. The list will include doctors across eight specialties: primary care, cardiology, gastroenterology, endocrinology, obstetrics, oncology, orthopaedics and pulmonology.
Walmart also announced Thursday a program in North and South Carolina testing a concierge service called Personal Healthcare Assistant. It is available by website, app or phone and aims to help employees with billing and appointments, finding a doctor or understanding a diagnosis.
The company is also expanding its virtual care program in Colorado, Minnesota and Wisconsin to include preventive health, chronic care management, urgent care and behavioral health. It partnered with telehealth provider Doctor on Demand and health tech companies Grand Rounds and HealthSCOPE Benefits for the service, which provides video visits with a doctor for $ 4.