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story.lead_photo.caption This June 25, 2019, file photo shows the entrance to a Walmart in Pittsburgh. (AP Photo/Gene J. Puskar, File)

Walmart Inc. outlined four health care benefit pilot programs for its U.S. employees Wednesday. The self-insured retailer said its objective is to increase access to more affordable and more effective care, which it expects will help workers' pocketbooks and the company's bottom line.

The pilots will start Jan. 1 with Walmart's medical-plan year. Three will only be available to employees in select areas initially but may eventually go nationwide, company officials said. A fourth will be immediately available to the Bentonville-based retailer's more than 1 million covered U.S. employees and their families.

The new services build on findings from Walmart's Centers of Excellence program, said Adam Stavisky, the company's senior vice president of U.S. benefits, in a conference call with reporters. That program, created in 2013, pays all expenses for covered employees or their family members who opt to have a procedure such as a transplant, heart or spinal surgery, or knee and hip replacement, at one of the approved medical centers.

Stavisky said the Centers of Excellence program has helped patients avoid unnecessary treatments and achieve better outcomes while reducing their medical costs.

Lisa Woods, Walmart's senior director of U.S. benefits, said in a statement that the Centers of Excellence program "has changed lives by connecting associates with top specialists for certain serious medical conditions and procedures, giving them easy access to the best, most appropriate care possible and helping avoid misdiagnoses."

"Lack of clarity and transparency can often result in unnecessary procedures, wasting time and money and putting patients at risk of complications," Woods said. As the nation's largest private employer, she said, Walmart has "a clear opportunity to offer simpler, quality solutions to a big portion of the country."

Woods said in the conference call that Walmart pays more for surgery performed at the centers, which include all three locations of the Mayo Clinic; Mercy Hospital Springfield in Missouri; and Geisinger Medical Center in Pennsylvania. But, she said, "if you get employees the right care and quality care, you end up paying less downstream."

The first pilot program Stavisky described is a referral service called Featured Providers. Initially being tested in Northwest Arkansas, the Orlando/Tampa area and Dallas/Fort Worth, the program will help patients find local doctors with "a demonstrated history of providing the most appropriate patient care."

To do this, Walmart is working with data analytics firm Embold Health. The Nashville, Tenn.-based company synthesizes data from public and private insurers in what Stavisky called "the largest database of its kind" to generate reports on individual physicians. Walmart will use the data to provide employees with a list of "affordable, quality" local providers in eight specialties: primary care, cardiology, gastroenterology, endocrinology, obstetrics, oncology, orthopedics and pulmonology.

Embold Health's founder and Chief Executive Daniel Stein previously served as chief medical officer for Walmart Care Clinics. The network of small, in-store clinics in Texas, Georgia and South Carolina offers basic primary-care services.

Walmart is testing the second program, a free concierge-type service called the Personal Healthcare Assistant, in North Carolina and South Carolina, Stavisky said. Through a website, phone number or app, employees on Walmart's medical plans can use the service for a variety of health needs such as making appointments, contacting billing services, finding a provider and learning more about a diagnosis. The service can also help with related needs like coordinating transportation to appointments and finding child care.

The third program provides low-cost telemedicine services to covered Walmart employees in Colorado, Minnesota and Wisconsin. Available services include preventive health, chronic care management, urgent care and behavioral health.

For $4 a visit, patients can video chat with doctors and access an online primary care physician and an entire team to coordinate specialty care, provide nutritional and diabetic counseling, and coordinate behavioral health referrals and visits. To offer these services, Walmart is working with companies Doctor On Demand, Grand Rounds and HealthSCOPE Benefits.

Lastly, all U.S. employees on Walmart's health plans can search for in-network physicians through the website or app of Grand Rounds, a San Francisco-based health care navigation firm. According to a Walmart news release, the doctors providing "high-quality care" will appear at the top of the search results. Employees are already able to use Grand Rounds to get a second opinion from a doctor at no cost.

In response to a question regarding possible pushback from doctors and hospitals about curating providers based on performance, Stein said most doctors get little feedback about how they perform relative to others. "You can't improve without that feedback," he said. "We're getting [doctors saying] thank you, for going about this the right way, and thank you for sharing this."

The Wall Street Journal reported in March that Walmart was working with Stein's firm to identify top-performing doctors in local communities and then steer employees to those physicians. Other large employers are following suit, and consulting firms like Embold Health are springing up to accommodate them.

Walmart's overarching goal, Stavisky said, is to improve the nation's health care system. Giving provider groups information that helps them improve their practices benefits not only Walmart employees, he said, "but the communities in which we operate, which is virtually all of America."

Business on 10/03/2019

Print Headline: Walmart unveils employee health care pilot programs

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