Walmart To Measure Doctor Quality In Local Markets

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.
https://www.forbes.com/sites/brucejapsen/2019/10/03/walmart-to-measure-doctor-quality-in-local-markets/#67391e9825d5