Health care and health insurance reforms are happening…at Walmart!?

Walmart logoHere’s an refreshing departure from all of the federal government gloom and doom news. Four hospitals around the U.S. including Virginia Mason Medical Center in Seattle have negotiated deals with large retailers Walmart and Lowe’s to provide comprehensive surgical care for knee and hip replacements to 1.4 million of the companies’ employees.

The kicker? Zero out-of-pocket costs, co-payments, deductibles, etc. But wait, there’s more. The arrangement, completely voluntary for employees by the way, provides travel, lodging, and living expenses for the patient and a caregiver.

The announcement expands a deal struck by the hospitals with Walmart in 2012 for heart and spinal surgeries along with organ transplants. The world-renowned Cleveland Clinic has been conducting a similar program, offering fixed-price cardiac procedures for a number of major corporations including Boeing.

The programs are attractive to the hospitals and corporations for a number of reasons. The corporations are self-insured. Reducing variability and uncertainty in healthcare costs is vitally important to the businesses. The corporations are large enough to be able to offer large volumes of patients for the high volume procedures.

The hospitals, already leading in terms of low complications and readmission rates, can use the guaranteed volumes to standardize procedures and improve quality even further. In exchange, I’m sure the partners agreed on large discounts to standard prices for the expensive procedures. And the patients, although not required to participate, get the sweeteners of no out of pocket cost and free travel. Sounds like a win for everyone.

In a separate development, Walmart announced that it was converting 35,000 part-time employees back to full-time status. Although that is a tiny fraction of Walmart’s 1.4 million employees, the latest action will result in those workers qualifying for employee-provided healthcare. Late in 2012, Walmart moved many full-time employees to part-time status in an action that was criticized as offloading their healthcare expenses on to taxpayers. Critics complained the workers earned so little that they would qualify for Medicaid health insurance through the new provisions of Obamacare.

Takeaways: While hardly novel, the agreements between the corporations and the hospitals are important because they have the potential to rein in out of control and spiraling healthcare costs. The hospitals will also be able to show exactly how they achieved their cost controls and quality improvements, giving them a competitive advantage and setting a great example for the rest of the country.

If you are developing a new device or technology, this should be a wake-up call. A key to cost control will be standardization. These hospitals will be highly resistant to adopt new technologies or purchase new medical devices unless you can show proof of positive effects on procedure costs, outcomes, and quality.

If you are in the healthcare insurance business, this disintermediation may not be a significant threat in the short term but be assured that other large corporations are watching or perhaps even conducting their own negotiations with high quality, high volume providers. The trend may prove to be a disruptive innovation in the long term.

Read more:

Walmart, Lowe’s strike deal with Virginia Mason on hip, knee surgeries | Local News | The Seattle Times.

Wal-Mart Returning To Full-Time Workers-Obamacare Not Such A Job Killer After All? – Forbes.