Walmart to pilot expanded healthcare benefits in 2020

by Kim Souza ([email protected]) 3,100 views 

Walmart, the nation’s largest employer with more than 1.5 million employees, has more than 1 million enrolled in the company’s healthcare plan, and the retailer plans on adding more benefits in the coming year.

Walmart announced four pilot programs for employees in select areas of the country. The first is known as at the Featured Provider network option being tested in Northwest Arkansas, Dallas/Fort Worth and Orlando/Tampa. In Arkansas, Walmart partnered with ARK BLUE to use a quality assessment filter to select a group of physicians in eight specialties: primary care, gastroenterology, endocrinology, obstetrics, oncology, orthopedics and pulmonology.

Walmart works with data analytics company Embold Health to decide which doctors make the list. The filters involve three aspects of care delivery from the appropriateness of the treatment, the effectiveness, and the cost-efficiency.

Walmart made the announcement in a call with the media on Wednesday (Oct. 2.) Daniel Stein, founder and CEO Embold Health, was on the call and said doctors who make the list must pass the quality test and must consistently deliver high-quality care that is medically appropriate. For example, Embold found some regions of the country experience higher rates of c-sections in obstetrics. Stein said rates for c-section deliveries can vary by more than 350% with some doctors having 14% and others in the same market having 49%. He said the use of knee arthroscopy rates also vary 1500% in the first year of an arthritis diagnosis when the latest science protocol has shown the procedure rarely helps patients with arthritis.

In the three test markets, employees who use the Featured Provider program will get the maximum payout on benefits. Those who chose to see doctors not on the list will pay more out-of-pocket costs, Walmart said.

Adam Stavisky, senior vice president of U.S. benefits at Walmart, said during the call the program is designed to provide employees with the quality options in the complex and confusing world of health care. He said the company’s success with the Centers of Excellence program over the past six years has yielded better outcomes for employees with overall lower medical costs.

He said according to the National Academy of Medicine roughly 30% of all health care spending is wasted, in part to unnecessary care or treatments. Walmart insists its not cutting corners but merely looking for correct diagnosis and up-to-date treatment protocol from physicians who see enough cases to be confident with consistent patient outcomes.

Lisa Woods, senior director U.S. benefits strategy and design at Walmart, said Walmart sometimes pays more for surgeries and treatments at the facilities in the Centers of Excellence program, but they do so because the outcomes are consistent and risk for re-hospitalization is low. She said getting the correct diagnosis as early as possible can also save substantial costs in care.

Another pilot is taking place for Walmart employees in Colorado, Minnesota and Wisconsin. The retailer is testing an expanded version of its telehealth program which provides all employees the option to see a virtual doctor for $4 a visit. The new pilot will expand that to include a personal online doctor and a team to help manage chronic conditions like diabetes or coordinate specialty care when needed.

Walmart employees in this pilot can book an appointment with a primary care physician within one hour and a behavioral health visit within one week. This compares to the average wait time of three weeks to schedule an appointment with a mental health professional in the United States, the company said.

Stavisky said Walmart can do this because of its partnerships with Doctor on Demand, Grand Rounds and HealthSCOPE Benefits who created a new service that seeks to make healthcare more accessible to Walmart employees.

In North and South Carolina, Walmart is testing a personal healthcare assistant which is will be a toll-free number employees can call to help navigate their healthcare needs. The service includes finding a doctor, making an appointment, to understanding billing or complex diagnosis. It also helps with coordinating transportation and finding daycare during appointments. The service, through Grand Rounds, is provided at no cost to those on Walmart’s medical plans.

The fourth pilot is something all Walmart employees in the health plan can take advantage of. Walmart said employees enrolled in a Walmart medical plan can use Grand Rounds as a source to find in-network doctors with high-quality ratings. Grand Rounds also will continue to help employees get a second opinion from an expert at no cost.

Walmart also said it is adding a $35 co-pay benefit to its most popular healthcare plan. The retailer said employees have been asking for a simpler, predictable and affordable benefit, which the new co-pay answers.

Walmart also said partnering with Covera Center of Excellence, employees and family members on the company’s medical plan can get CT and MRI scans as part of the benefits. This imaging service is now part of the Expanded Centers of Excellence program.

Walmart is expanding the covered surgeries through its Centers of Excellence program to include kidney transplants. Walmart will fly its employees to one of the Centers of Excellence and cover heart and spine surgeries, hip and joint replacements, breast, lung, colorectal, prostate and blood cancers, specific weight-loss surgeries and certain organ transplants except for cornea and intestinal.

Walmart also is investing in preventive health benefits by providing access to health club memberships at participating locations of the Tivity Health Prime Fitness Network. The cost for the employee and their family is $9 per bi-weekly pay period. Walmart said the membership includes access to fitness classes and unlimited visits. This benefit is designed to provide employees access to multiple facilities near where they work, live and travel.