Walmart encourages travel within the US for treatment

 

For health systems, the deals Walmart is signing with providers mean a guaranteed stream of patients when the retailer contracts to send them to doctors and hospitals for improved health outcomes. Walmart employees needing spinal surgery, for example, will have to travel at the company's expense to one of eight designated hospitals.

A third-party administrator works with Walmart and an accountable care organisation (ACO) to administer employee medical claims. An ACO includes doctors, hospitals, and other providers, contracting with employers and health insurers to improve quality and health outcomes, lower costs, and keep any money saved from year to year based on the arrangement with the health plan.

Walmart says it is committed to value-based care models, and claims that the national trend is moving away from fee-for-service medicine.

Walmart is self-insured and the programme that has been voluntary since 2013 has cut down on unnecessary procedures. The retailer will pay for medical costs and all related travel expenses for patients on the company's health insurance plan, including a caregiver.

Under the new rules covered employees may choose to have a number of procedures, including transplants, heart surgeries and knee and hip replacements, at one of the approved hospitals with all expenses paid. Participation in the programme will still be voluntary for these other types of surgery.

Walmart chose to mandate travel for spinal surgeries after finding that about half of those who chose that option learned they didn't need surgery after all. Rather than trying to save money on health care costs, it is about ensuring that employees get appropriate care at the nation's top medical facilities.

Walmart's approved medical centres for spinal surgery are the Mayo Clinic's three locations -- in Rochester, Jacksonville. and Phoenix; Mercy Hospital Springfield in Missouri; Memorial Hermann Health System in Houston; Emory Healthcare in Atlanta; Virginia Mason Health System in Seattle; and Geisinger Medical Centre in Danville.

These health care centres of excellence were chosen for their demonstrated expertise in high-risk procedures.

It is part of a broader shift in the USA health care system away from the traditional fee-for-service model of treatment to a value-based model, that rewards health care providers financially for positive patient outcomes, rather than giving providers incentive to perform more tests and treatment.

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