Walmart, Emory Healthcare working together on new ACO

Dive Brief:

Emory Healthcare and Walmart are coming together with an aim to improve quality of care and lower healthcare costs.
One piece, Emory Accountable Care Plan (ACP), is an accountable care organization (ACO) that will serve Walmart associates in the Atlanta area.
Walmart also named Emory University Orthopaedics & Spine Hospital and Emory Orthopaedics & Spine Center as national Centers of Excellence (COE) for Walmart associates in need of spinal and joint replacement surgery.

Dive Insight:

This partnership is the latest example of employers contracting directly with providers in hopes of improving care and health outcomes while also reducing costs. Walmart, the country's biggest private employer, has been at the forefront of this trend. It is reportedly in early talks to acquire Humana, the second largest provider of Medicare Advantage plans.

The new ACP will be the primary health plan coverage for employees at 55 Walmart, Sam’s Club and Walmart Distribution Center locations in the Atlanta area. The ACP is an ACO that's a collaborative effort involving physicians, hospitals and payers or employers.

The Emory ACP will allow Walmart employees to get care from more than 2,000 physicians in the network.

Meanwhile, Walmart’s COE is a fixed bundled payment program for specific procedures. In this case, Walmart associates who need spine or joint care can visit one of the company’s COE across the country.

The idea behind the program is to give high-quality care to employees via a value-based payment program with no out-of-pocket costs. Walmart covers all travel-related costs to the centers, including airfare and lodging for the patient and caregiver.

Starting this year, Walmart started considering non-CEO facilities as out-of-network options if an employee decides to not go to a center.

The centers allow the retailer to have a greater influence on costs. For instance, the program doesn’t reward for surgery. Instead, clinical evaluations figure out the best course of action, which could be injections or physical therapy instead. That’s because the company estimates that 30% of spine procedures are unnecessary.