Tag Archives: choosing wisely

Walmart Shows Way on Health Benefits

Walmart, a true leader in benefit innovation, is taking the next right step, expanding its popular and successful Centers of Excellence.

When Walmart workers, called associates, use Centers of Excellence, deductibles and co-pays are waived. All travel expenses are paid for the patient and a companion.

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 only 50% of the costs will be covered.

This is a huge step and is reminiscent of the early days of preferred provider organizations (PPOs), provider networks and health maintenance organizations (HMOs). At the beginning, if you got care through a PPO, your deductible and co-pay were 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 co-pays if members went out of network. Of course, in most HMOs, if members went out of network, nothing was paid.

See also: Walmart’s Approach to Health Insurance  

What Walmart is doing now, while a very logical extension of what benefit plans have been doing for more than 30 years, is a huge step forward in truly controlling waste, overtreatment and misdiagnoses in health plans.

Kudos.

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.

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.

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 [have incentives to provide] care based on what’s most appropriate for each individual patient and look 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.

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 [given incentives] differently to get to the root cause and prescribe appropriate treatment.

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.
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.

See also: There May Be a Cure for Wellness  

A Proposed Code of Conduct on Wellness

So many wellness industry misdeeds to expose, so little room on the internet.

This posting will start out as one of my typical shock-and-awe postings featuring a wellness vendor raising the bar for dishonesty and employee harms. Uniquely, though, we will close with a surprisingly uplifting slam-bang conclusion that could change the wellness industry forever…but only with your help.

The Bad News

It’s that time of year again, when traditionally the C. Everett Koop Award Committee bestows an award upon a fellow committee member or award sponsor, in recognition of doing the best job of fabricating dramatic savings while making only trivial improvements in employee health. That’s par for the course, and isn’t even news any more.

See also: The Yuuuuge Hidden Costs of Wellness

However, this year, the Koop Award Committee apparently decided that actually improving employee health was too high a bar for a wellness program to clear, so the committee gave the award to a committee colleague, Wellsteps, for a program in which the health status of Boise School District employees deteriorated. We’ve done the arithmetic so you don’t have to. The award application below shows that 5,293 employee biomarkers improved, while 6,397 got worse.

Screen Shot 2016-08-14 at 7.46.59 PM

In addition to the objective failure of the program, consider employee self-reported health. The single most important question to ask to gauge the state of someone’s health is: “How is your health?” Wellsteps buried the answer to that question at the end of a long list, but squint hard enough and you can see that Boise employee self-reported health status declined, by a small but statistically significant (p=0.0007) amount:

Screen Shot 2016-08-14 at 7.48.39 PM

There are many other problems with this program, too. Wellsteps is shaming even the lightest drinkers, attributing massive savings to improved health despite the deterioration in health, suppressing data showing increased health spending and flouting clinical guidelines. All that is covered in this Linkedin Pulse.

In all fairness, here is the response from Wellsteps’ Troy Adams (best known in the wellness industry for posting that ”It’s fun to get fat, and it’s fun to be lazy”) to my initial observations that Wellsteps is harming employees and fabricating savings. Surprisingly, I agree with both points:

  1. Yes, the Wellsteps data is “rock solid;” and,
  2. Yes, having just walked into from 92-degree heat, I am at least temporarily full of “hot air.”

The Good News

Fabricating savings is part of the Koop Award DNA, but bestowing an award on a vendor that actually harmed employees crosses a bright red line. Rather than complaining about it (or more accurately, in addition to complaining about it), I thought it might be time to take steps to prevent this type of performance from being considered acceptable, let alone prizeworthy.

So I convened a group, including WELCOA‘s respected and forward-thinking new CEO, Ryan Piccarella, and leading wellness gurus Jon Robison and Rosie Ward of Salveo Partners. Together, we crafted a very simple and minimalist Code of Conduct. (I don’t want to take more than my share of the credit. This was a joint effort. I just happened to be the one who initiated the email chain.) In full, it appears below. It is definitely “minimalist,” a Code of the first-do-no-harm variety. And yet, as low a threshold as it is, many vendors – including Wellsteps and many previous Koop Award winners – would not be able to meet it.

What we would ask of ITL’s readership is:

  1. Circulate this posting/the Code widely;
  2. As brokers or customers, insist that your vendor(s) follow the Code of Conduct…and add it as an actual contractual term;
  3. As brokers or vendors, announce that you will be following the Code. (While this blog is my own effort, I am also affiliated with Quizzify. Quizzify will be announcing this week that it intends to make this Code of Conduct a contractual term, meaning that failing to adhere to it would constitute a breach of our obligations under the contract.)

The Employee Health Program Code of Conduct

Our organization resolves that its program should do no harm to employee health, corporate integrity or employee/employer finances. Instead, we will endeavor to support employee well-being for our customers, their employees and all program constituents.

Employee Benefits and Harm Avoidance

Our organization will recommend doing programs with/for employees rather than to them, and will focus on promoting well-being and avoiding bad health outcomes. Our choices and frequencies of screenings are consistent with U.S. Preventive Services Task Force (USPSTF) and CDC guidelines and Choosing Wisely.

See also: Wellness Promoters Agree: It Doesn’t Work  

Our relevant staff will understand USPSTF guidelines, employee harm avoidance, wellness-sensitive medical event measurement and outcomes analysis.

Employees will not be singled out, fined or embarrassed for their health status.

Respect for Corporate Integrity and Employee Privacy

We will not share employee-identifiable data with employers and will ensure that all protected health information (PHI) adheres to HIPAA regulations and any other applicable laws.

Commitment to Valid Outcomes Measurement

Our contractual language and outcomes reporting will be transparent and plausible. All research limitations (e.g., “participants vs. non-participants” or the “natural flow of risk” or ignoring dropouts) and methodology will be fully disclosed, sourced and readily available.