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Driving Innovation In the Health Care Marketplace:

A CEO Report

Walmart

“Ahead of the game” and “changing medicine.” That’s how two experts described Walmart’s innovative Centers of Excellence (COE) program when it was announced.

When Walmart introduced COE in 2013, the goals were simple: improve the quality of medical care for associates, give them the right care at the right time at the right place, reduce their health care costs, and drive transparency by aligning interests among payers and providers to mitigate differences in the industry.

To address continually rising health care costs, Walmart’s COE program focused on high-cost procedures with high cost variability. The program marked the first time a retailer offered a comprehensive, nationwide program for heart, spine and transplant surgery at six of the leading hospital and health systems in the United States.

COE physicians are incentivized based on patient outcomes not volume of patients seen. Physicians make recommendations that are in the best interest of the patients, with established plans for performance improvement specific to the care they are assessing. All of the hospital systems offered established/accredited programs in spine and cardiac care, and Walmart worked with each one to provide unique, bundled pricing for these types of procedures.

Walmart associates and dependents enrolled in the company’s medical plans receive consultations and care covered at 100 percent plus travel, lodging and food for the patient and caregiver. Dozens of associates have saved thousands in medical expenses.

With the announcement of the new program, industry leaders applauded it:

  • “I do think that this is our future, and they’re just ahead of the game,” said Helen Darling, president and CEO of National Business Group on Health, a nonprofit membership organization of 346 employers, including Walmart. “The upside is huge for both the company and the employee and their family. The quality and safety of these centers of excellence are proven and their outcomes are better.” — Reuters and Huffington Post, October 2012
  •  In a tweet, noted writer and surgeon Atul Gawande said, “This will change medicine.”

In 2014, Walmart, Lowe’s and other large employers joined the Pacific Business Group on Health Negotiating Alliance to launch a national Employers Centers of Excellence Network offering no-cost knee and hip-replacement surgeries for employees through four U.S. hospital systems.

Walmart would like to see other companies emphasize cost and quality transparency, and we want to continue participating in opportunities that align interests among payers and providers. If we work together, we can accelerate the process.

Companies

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BRT companies provide health coverage to more than 40 million Americans. We help American workers and their families remain healthy, receive quality treatment when necessary and achieve better health outcomes. The private-sector innovations in the insurance marketplace that enable us to provide these services to our employees and their families serve as models for public programs — but additional reforms are necessary.

This report highlights the innovations we have made and the public policy changes we believe would drive value by promoting health and improving outcomes.

https://s3.amazonaws.com/brt.org/archive/0_healthcare/BRT-Health-Care.pdf