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Walmart’s new employee health plan will rate Tampa Bay doctors

Walmart’s pilot system uses doctors’ histories to determine whether they’ll be inside their network.

Some local doctors are about to face a new bit scrutiny in 2020: Are they Walmart approved?

The world’s biggest retailer is testing a hands-on pilot program in the Tampa Bay region that will compile doctors’ histories of care to determine which have the best results the most often. Physicians who meet Walmart’s standards will become the in-network doctors for their employees, the retailer told reporters during a Wednesday conference call.

Doctors who miss the mark won’t be covered by Walmart employee health insurance.

“We fundamentally want to have better health and better health care,” said Adam Stavisky, Walmart’s vice president of U.S. benefits. “That’s our main goal.”

The program is also being tested in Orlando, Dallas and Fort Worth, Texas, and part of Arkansas, where Walmart is headquartered. In total, 60,000 Walmart employees will have the new network setup. Walmart calls its approved doctors “featured providers.”

Walmart is using analytics company Embold Health and a scientific advisory board to compile the data on local physicians in the following eight specialties: primary care, gastroenterology, endocrinology, obstetrics, oncology, orthopedics and pulmonology.

Stavisky said Walmart and its advisers will use data to examine whether doctors are offering appropriate care that follows best practice guidelines; if it is clinically effective; and if the care was cost efficient.

Stavisky used a couple of examples of what Embold has noticed so far, such as looking at how often obstetricians deliver through cesarean sections.

The average c-section rate is about 14 percent for low-risk pregnancies, according to Embold. But in some regions, c-section delivery could vary as much as 350 percent among doctors.

It also looked at knee surgeries for arthritis sufferers. If patients had arthritis in their knee, Embold looked at how often physicians sent them to surgery the first year pain presented when waiting on such a surgery is recommend by reviewed medical journals?

“I think it’s about time major employers take more of the health value associated with their employees and their employees’ families under control,” said Jay Wolfson, a professor at the University of South Florida’s College of Public Health and an expert on health care policy. “They’re paying for it directly and they’re paying for it indirectly."

Walmart executives said they expect to save money over time because the program will lead to healthier and more efficiently cared for employees.

“They are large enough and smart enough that they can do it right and everyone else can learn,” Wolfson said.

Walmart said Embold will refresh its data every quarter so doctors have the opportunity to move into the “featured providers” group.

In total, Walmart is testing four separate health care pilots in different markets across the country. One gives covered employees a “personal online doctor” and another promotes a “personal health care assistant” to help navigate the health care system.