One of the largest integrated networks in Georgia is partnering with retail giant Walmart to launch a new bundled payment model for employees at 55 locations throughout the Atlanta metro area.
Under the new agreement, announced last week, employees at Walmart, Sam’s Club and Walmart Distribution Centers will be able to access more than 2,000 Emory Healthcare physicians. Walmart employees that select the Emory Accountable Care Plan will have free preventative care and will be responsible for co-pays for primary, specialty and urgent care.
The agreement offers a slightly different twist than the typical ACO arrangement by incorporating bundled payments along with benefit design and narrow network incentives, says Hunter Sinclair, vice president of value-based care consulting at The Advisory Board Company in Washington, D.C.
“I think it is this combination of levers that makes it more likely to be successful,” he told FierceHealthcare. “My open question on this contract—and most employer contracts—is does it have enough scale to be worth the trouble on both sides.”
The risk, he added, is that the long lead time before open enrollment leads to lower participation from employees and an adverse selection of participants.
As part of the agreement, Walmart has also named two of orthopedics and spine and joint surgical facilities to its Centers of Excellence Network. Under that designation, Walmart employees in certain locations will be able to visit Emory spine and joint surgical specialists for free with Walmart will paying a set amount for each surgery. For some patients, travel-related costs will be covered by Walmart.
“More and more large, self-insured employers like Walmart are looking for new and creative solutions as a potential way to decrease costs of health care plans for employees, while improving the overall quality of the care," Patrick Hammond, CEO of Emory Healthcare Network, said in a statement. "This partnership is a win-win for everyone involved.”
The partnership comes as Walmart is reportedly eyeing a takeover of Humana, signaling its interest in carving out its own space in the healthcare industry.
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Walmart launched its Centers of Excellence program in 2013 with six designated hospitals, including the Cleveland Clinic and the Mayo Clinic. In 2017, the company doubled the number of facilities in the program based on early returns.
Increasingly, employers are looking for ways to bend the health care cost curve. Most notably, Amazon, JPMorgan Chase and Berkshire Hathaway announced a partnership earlier this year aimed at providing “simplified, high-quality and transparent healthcare at a reasonable cost.”