Walmart has no shelf space for hospitals' shoddy healthcare

If you want to witness one of the most compelling examples of healthcare "disruption" today, gather hospital and health system leaders in a room and hand a microphone to Lisa Woods, senior director of U.S. Health Care at Walmart. 

Armed with numbers, facts and anecdotes, Ms. Woods has held attention at the 16th Annual World Health Care Congress by detailing the design, goals and outcomes of the corporate giant's Centers of Excellence Program, which launched in 2013 and is available to the 1.1 million people on Walmart's medical plan. 

Her speaking engagement comes on the heels of a comprehensive feature story she co-authored for Harvard Business Review on the topic, which was published in March. Under the program, Walmart partners with top health systems that have demonstrated appropriate, high-quality care and outcomes for defined episodes of care, such as joint replacements and spine, cardiac and weight loss surgeries. Current COEs include Geisinger in Danville, Pa., Cleveland Clinic and Johns Hopkins Health System in Baltimore, among others. 

Before delving into the program's findings and next steps, Ms. Woods' first message to attendees at WHCC in Washington, D.C., was more of a dare: Go home and take down your billboards advertising ER wait times. 

"I'm going to challenge you all to go home, talk to your hospitals and tell them to take it down," she told attendees during the keynote panel Sunday evening. "We talked to [our local] hospital about why that's not a good idea. It's about communication and collaboration with the community and the hospitals. We don't have those billboards any more in northwest Arkansas." 

What brings a billboard down? The fact that it's inappropriate for every patient to seek care in a hospital emergency room. It also helps when you call from a company with half a trillion dollars in annual revenue and 1 percent of the country's eligible workforce as employees, i.e. Walmart. 

But it doesn't take a roadside advertisement for Ms. Woods and her team in Bentonville, Ark., to talk about appropriateness of care. They spend a lot of time on the subject. "To us that means making sure our associates get the right diagnosis and the right treatment plan," she noted Sunday. "Then quality is how we ensure they go to the best doctors, the best health systems and receive the best quality [care] available." 

Details shared about the frequency and severity of the inappropriate care Walmart associates have received drew audible gasps from attendees, both Sunday evening and again during Ms. Woods' solo session Monday afternoon. 

Consider associates who received a diagnosis of cancer from their local medical providers. Of those who were approved by Mayo Clinic, which is Walmart's Center of Excellence for cancer, to travel to Rochester, Minn., for an evaluation, more than 10 percent learn that they, in fact, do not have cancer. They receive a different diagnosis entirely, while 55 percent receive a different treatment plan. Some Walmart associates have learned that their cancer diagnoses were based on biopsies that were never completed at their local hospitals or medical groups, said Ms. Woods. Walmart launched the COE for breast, lung and colorectal cancer in 2015, it quickly became the company's most utilized center. (There are other staggering numbers for other COEs and conditions, like the 54 percent of Walmart associates who were told they need spine surgery locally, only to visit a COE to learn they could avoid surgery in their treatment.)

Walmart is doing more than determining the top health systems to which it will refer associates for defined episodes of care. That process starts with health systems, not hospitals or individual physicians. Ms. Woods and her team gather massive amounts of publicly available data on health systems, distribute requests for information and conduct detailed on-site visits, which involve determining precisely which physicians do and don't participate in the COE. Ms. Woods clicked her PowerPoint to a listing of health systems Walmart is in direct contract with for defined episodes of care; the listing of health system names was the most photographed slide by by the 50-plus attendees in the room. 

But in addition to sifting out the best providers in the country, Walmart is also acquiring information about which healthcare providers in the United States have failed its associates with inappropriate care and misdiagnoses. Ms. Woods said the deficiencies and variation in care are not limited to one region. "Unfortunately, it is all over the country. It's everywhere," she said. 

So, what's next for Walmart? Ms. Woods hinted at three developments, the first two more defined than the last. 

First up: The company is ramping up its telehealth offerings to put associates in touch with high quality providers for care that is not available in COEs. Ms. Woods noted that patients have returned from COEs to say they didn't know "healthcare could look like that." In response, the company adjusted copays for virtual visits from $40 to $4 and is partnered with Grand Rounds so associates can receive second opinions, remotely, from leading experts the specific condition in question. 

Next: Walmart is readying Quality Centered Networks in Radiology. Many of the Walmart associates who travel to a Center of Excellence do so because of false positive images or a bad read. Walmart partnered with a third party to create an imaging network, which will start with about 50,000 procedures focused specifically on MRIs and CT scans. "It's the right machines and the right readers, with negotiated rates," she said.

And as for the last, more ambiguous development — Ms. Woods noted she would only say what she "can share," which seems to resemble the COE program in reverse: "We are taking our associates to good care, why can't we bring good care into the communities or at least help them figure it out?"

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