When Catalyst for Payment Reform hosted a webinar that provided a glimpse into Walmart’s healthcare strategy and management plans, Lisa Woods, senior director of U.S. benefits, talked about a new program to simplify and improve healthcare, particularly primary care, for Walmart’s million-plus associates and their families.
She alluded to Walmart’s well established and continuously expanding Centers of Excellence (COE) programs, as well as two new programs. First is a personal healthcare Assistant, powered by healthcare navigation firm Grand Rounds, that helps Walmart associates with billing and appointment issues, finding a quality provider, understanding a diagnosis, coordinating transportation, arranging child care during appointments and addressing other important patient needs.
Walmart has also broadened its telehealth offerings, including for preventive health, chronic care management, urgent care and behavioral health. All video visits have a $4 copay, and associates can book an appointment with a primary care physician within one hour and a behavioral health visit within one week, making services highly accessible. Partners for this program are Doctors on Demand, Grand Rounds, and Healthscope Benefits.
Daniel Stein and Matthew Resnick, from physician profiler partner Embold Health, described how their data collection/analytics approach identifies physicians with histories of providing the most appropriate care. In three markets – Northwest Arkansas, Tampa/Orlando and Dallas/Ft. Worth – Walmart’s “Featured Provider” program will connect patients to the high-performing providers that Embold has identified in eight specialties: primary care, cardiology, gastroenterology, endocrinology, obstetrics, oncology, orthopedics and pulmonology. Walmart has been a key partner in the development of Embold Health – Stein, the CEO, Stein is a former Walmart medical director – and its efforts to accurately profile the quality of healthcare delivery at the individual physician level. The health outcomes improvements and savings associated with only using high-performing physicians should be profound.
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The changes that Walmart has announced reflect a laser focus on solving specific problems, like overtreatment and patient difficulty with navigating the system, that plague all primary care programs. The company has been tinkering with and testing different primary care models for a decade or more. As with its COE program, the goals of Walmart’s new healthcare programs are a more refined, disciplined and methodical set of innovations focused on driving better care, a better patient experience and lower cost and that, for the most part, are not yet available to most primary care patients elsewhere in U.S. healthcare.
As a side note, it’s worth recognizing that, in an ideal world, the major health plans – e.g., United, CIGNA, Aetna, Anthem – with many millions of lives covered, would have pioneered these approaches to manage healthcare risk, to improve health outcomes and to reduce cost. The fact that payers haven’t been motivated along these lines is a reflection of the perverse incentives that have driven the U.S. health system for decades, that all patients and purchasers are up against and that have facilitated the kinds of innovations discussed here.
Walmart attacked these problems because it is at risk for its population and its costs. Few employers have the resolve and the resources available to develop key innovations that can move an industry like healthcare forward.
Not surprisingly, Walmart appears to see an opportunity here and has larger plans. Walmart almost certainly believes its healthcare efforts are applicable beyond its own population, and, like Haven, Kroger and Costco, has staked out a healthcare business strategy. Primary care are logical services to begin with, and Walmart has announced that its pricing will be 30% to 50% below conventional primary care prices. Walmart’s focus on improving experience, health outcomes and cost, combined with its national footprint and deep resource base, could immediately catapult it to the first rank of competitors in this space.
No doubt, Walmart has its eye on providing primary care services to groups as well as individuals. Relationships with health plans would allow the company to share in the savings it generates through the primary care platform and associated programs.
Think about the territory covered here. Walmart intends to:
- Develop highly price competitive primary care clinics across the country.
- Offer very low-cost telemedicine that can be a convenient pathway to primary care and other care, streamlining care processes.
- Implement a personal healthcare assistant that can simplify navigating the healthcare system and expedite a much enhanced patient experience.
- Connect to the highest-performing local physicians and regional COEs in each specialty, driving appropriate and disrupting inappropriate care and cost, in strong contrast to the inappropriate care and cost patterns that have come to dominate U.S. healthcare.
- Develop some tie to health plans that would allow the company to benefit from the health outcomes improvements and savings that its management approaches create.
