Walmart is expanding its popular and successful Centers of Excellence program for spine surgery. See the recent press release below signed by Sally Welborn, Walmart’s executive charge of benefits. Walmart, a true leader in benefit innovation, is taking the next right step in the evolution of Centers of Excellence.
When Walmart workers, called associates, use Centers of Excellence, deductibles and copays are waived…plus all expense paid travel for the patient and a companion.
Incentives and disincentives
Starting next year, if covered folks at Walmart have spine surgery outside of a Center of Excellence it will be considered out of network and paid at only 50%.
This is a huge step and is reminiscent of the early days of PPOs, Networks, and HMOs. Most began as programs that if you got care at PPO provider, your deductible and co-pay was waived. In a few short years, those programs evolved into ones that paid regular benefits with deductibles, etc., if you used PPO doctors, but applied higher deductibles and copays if members went out of network. Of course in most HMOs, if members went out of network, nothing was paid.
What Walmart is doing now, while a very logical extension of what benefit plans have been doing for over 30 years, is a huge step forward in truly controlling waste, over-treatment, and misdiagnoses in health plans.
Kudos to Sally and her team for leading the way.
Here is the press release:
The Right Care at the Right Time: Expanding Our Centers of Excellence Network
Starting next year, Walmart will double the number of world-class medical facilities available to our associates who have been told they need a spine surgery. Whether you’re a cashier in Wyoming who’s been with the company for six months or you’re a 20-year associate running a store in Miami, if you have Walmart health insurance, you have this benefit.
We are adding the Mayo Clinic facilities in Arizona, Minnesota, and Florida to our current list of Centers of Excellence (COE) for spine surgeries, which are Mercy Hospital Springfield in Missouri, Virginia Mason Medical Center in Washington, and Geisinger Medical Center in Pennsylvania. Our COE program is about more than just access to these facilities and their specialists; it covers these procedures at 100%, including travel, lodging and an expense allowance for the patient and a caregiver.
Walmart started offering this benefit in 2013 and our data tells us we are making a difference for our people, but we want to do more. That’s one of the reasons for adding more eligible medical facilities to the program. Other reasons these medical facilities were selected are that each facility:
• Fosters a culture of following evidence-based guidelines, and as a result, only performs surgeries when necessary.
• Structures surgeons’ compensation so they are incentivized on providing care based on what’s most appropriate for each individual patient and looking at surgery as a last option.
• Is geographically located throughout the country to provide high-quality care to participants in one of Walmart’s health benefits plans.
Why would Walmart offer a benefit like this? It’s pretty simple – we care about our people and want them to receive the right care at the right time.
Research, as well as our own internal data, shows about 30% of the spinal procedures done today are unnecessary. By utilizing the Centers of Excellence program, our associates are assessed by specialists who are incentivized differently to get to the root cause and prescribe appropriate treatment.
Preventing a surgery that someone doesn’t need is only part of our Centers of Excellence. The other, even more important aspect is making sure our people receive the right diagnosis and care plan for their pain. In The New Yorker, renowned surgeon and public health researcher Atul Gawande underscored the importance of this approach:
“It isn’t enough to eliminate unnecessary care. It has to be replaced with necessary care. And that is the hidden harm: Unnecessary care often crowds out necessary care, particularly when the necessary care is less remunerative. Walmart, of all places, is showing one way to take action against no-value care—rewarding the doctors and systems that do a better job and the patients who seek them out.”
Walmart is not alone in this approach to appropriateness of care. One example is the Choosing Wisely initiative, which is backed by recommendations from more than 70 specialty societies including the American Academy of Orthopaedic Surgeons, North American Spine Society and the American College of Surgeons. The stated purpose of Choosing Wisely is to help patients choose care that is supported by the evidence, not duplicative of other tests or procedures already received, free from harm and truly necessary – we couldn’t agree more.
To further encourage our associates to take advantage of this offering, next year, spine surgeries at one of our six Centers of Excellence medical facilities will continue to be covered at 100% with travel and lodging paid for the patient and a caregiver. If the surgery is performed outside of a COE facility, it will be considered out of-network and paid at 50% in most cases.
Our associates are very important to us, and we want to make sure they and their families receive the highest level of quality care available.
We have seen spine surgeries performed often when they are not necessary. By making these changes in our benefit offerings next year, Walmart wants to make sure that our associates and their family members are diagnosed correctly and that they get the best possible treatment.
— Sally Welborn, Sr. Vice President – Global Benefits, Walmart