Bringing transparency to health insurance
Why would Walmart launch an insurance education service for the 140 million Americans who shop its stores each week? For one thing, because more than 60% of Americans have a tough time understanding their health insurance plan options, according to research from the Kaiser Family Foundation, and nearly 40% feel that they picked the wrong plan after enrolling.
(To view the full report, click here.)
Those troubling statistics helped spur the creation of Healthcare Begins Here, an in-store program to educate customers at Walmart pharmacies about their health insurance options and the benefits and costs of one plan over another. Walmart teamed up with DirectHealth.com to provide the service.
“For years, our customers have told us that there is too much complexity when it comes to understanding their health insurance options,” said Labeed Diab, president of health-and-wellness for Walmart U.S. “Healthcare Begins Here addresses that complexity by bringing clarity and increased choice to the insurance enrollment process through DirectHealth.com.”
DirectHealth is an online health insurance comparison site and independent licensed health insurance agency that helps Walmart customers gain access to health insurance information and enrollment support. The company also arranges for licensed insurance agents to temporarily locate at some 2,700 of its pharmacies to educate customers directly on their coverage options, and to “enroll in the plan that is right for them,” said Marcus Osborne, VP health-and-wellness payer relations for Walmart U.S., “whether that be a Medicare plan or Public Healthcare Exchange plan through online, phone and in-store services.”
The DirectHealth website is operated by TZ Insurance Solutions LLC, which is also the agency licensed to sell health insurance in all 50 states on behalf of DirectHealth. Walmart serves as the company’s marketing partner.
Walmart customers have had in-store access to health insurance information since 2005, when the company began hosting “insurance agents from individual insurers in stores to answer questions and enroll customers in specific healthcare plans,” Osborne said. However, he told DSN, “Healthcare Begins Here, through DirectHealth.com, takes this offering to the next level in response to customers who want more options to choose from.”
The education and enrollment process in Walmart stores is “timed to open enrollment” in the fall for Medicare, and from mid-November to mid-February for the health insurance marketplace open enrollment period.
“For customers over 65,” Walmart reports, “DirectHealth.com offers access to more than 1,700 plans from 12 leading carriers, including Aetna, Cigna, Humana, UnitedHealthcare and participating Blue Cross and Blue Shield companies. For customers under the age of 65, DirectHealth.com offers access to thousands of Health Exchange plans from more than 300 leading carriers.”
Customers can compare and enroll in health plans online at DirectHealth.com or over the phone.
The program has been an unqualified hit, Osborne said. “We have received great feedback from our customers on the Healthcare Begins Here program and DirectHealth.com resource,” he noted. “While we can’t share specific numbers, we can say the number of enrollments exceeded our expectations.”
“DirectHealth.com is not designed for our associates. The healthcare plans we offer our associates are among the best in the retail industry,” Osborne added.
Walmart eyes bigger role in specialty Rx
While building a 4,500-store retail pharmacy powerhouse in the United States, Walmart also has kept pace with the specialty pharmacy revolution and is positioning itself to play a stronger role in this most innovative, dynamic and complex area of pharmaceutical R&D and bioengineering.
(To view the full report, click here.)
“We have our own in-house specialty pharmacy in Florida, and we feel there’s still a tremendous opportunity to scale this business,” declared Labeed Diab, president of health-and-wellness for Walmart U.S. “Whether that means we grow organically, through a partnership or through acquisition — we’re looking at all of the above.”
Behind Walmart’s determination to stake a bigger claim to the specialty market is a simple fact: “The traditional prescription drug business is pretty much stagnant over the next five years, but that specialty business is growing at 25%,” Diab said.
Based in Orlando, Fla., Walmart Specialty Pharmacy is “a URAC-accredited services provider licensed to distribute specialty medications to all 50 states,” explained VP pharmaceutical merchandising for Walmart U.S. Mark Phillips. The pharmacy is staffed by “a team of experts” who manage “the entire patient journey — from onboarding, benefits investigations and prior authorizations to financial assistance, educational training and fulfillment,” he added.
“Our specialty pharmacy offers a team of pharmacists, nurses and insurance experts dedicated to providing clinical and educational support 24/7 to help customers understand and achieve their treatment goals,” Phillips said. “We also help customers with their insurance claims,” along with “reimbursement assistance for a variety of insurance programs, including Medicare Part B, Medicaid, split-billing patient assistance programs and more.”
The focus for the Orlando-based service center is to make it “easy and convenient for our customers to get their specialty medications, offering services online, at their local store or by phone,” Phillips said. Walmart offers temperature-controlled, free overnight shipping of all medications and supplies, and “customers in the Orlando area can also pick up their prescriptions at our specialty pharmacy location,” he added.
Among the many serious conditions that Walmart’s specialty pharmacists help patients manage are anemia, cancer, Crohn’s disease, cystic fibrosis, hepatitis, HIV/AIDS and infertility.
Beyond that, the company has developed “Centers of Excellence” within select Walmart pharmacies nationwide, focused on core areas, including oncology, viral infections, inflammatory conditions and multiple sclerosis, Phillips told DSN. Those centers are staffed by “dedicated teams of pharmacists, clinicians and techs to manage the entire patient experience,” he said.
Through innovation and realignment, Walmart targets frayed health system
The retail behemoth that is Wal-Mart Stores Inc. is fixing its sights on a new target: the nation’s overstretched and overly costly primary healthcare system. The result could be a major disruption of that system and the acceleration of health reform in America.
(To view the full report, click here.)
Having already conquered general merchandise and food retailing, Walmart has now embarked on a mission to transform frontline health care. The goal: to stitch together all the facets of its health-and-wellness capabilities and apply its massive scale and consumer drawing power to become America’s chief destination, not only for retail health products and services, but also for lower-cost primary care.
“Our health-and-wellness experts are leading the way for the future of health care in our stores and beyond,” the company declared confidently in a recent report.
That vision wasn’t just hatched in a modern-day meeting of company leaders in Bentonville, Ark. Founder Sam Walton sowed the seeds for Walmart’s campaign to reinvent primary health care in the United States in the early 1990s at one of the last of the Saturday morning meetings with executives and department heads he was able to attend.
Dying of cancer and undergoing intensive treatments, “Mr. Sam” spoke at that meeting about the difficulties that even the wealthiest Americans faced in trying to navigate an expensive, opaque and difficult-to-access healthcare system. How tough must it be for lower-and middle-income Americans without a lot of resources, he wondered, and what could a company like Walmart do to improve patient access, lower costs and bring pricing transparency to health care?
Plenty, it turns out. Captured on video, Walton’s urgent appeal still serves to motivate company managers with its focus on Walmart’s mission as a low-cost provider of goods and services. “We view that as a defining moment,” said Paul Beahm, Walmart SVP health-and-wellness operations. “We sometimes show that as a reminder of what he challenged us with: How do you help save people money?”
Leveraging its unrivaled scale, massive purchasing power, nationwide market penetration and community outreach, the nation’s premier retailer has already accomplished some big breakthroughs. In the process, Walmart has already begun to alter the dynamics of U.S. health delivery:
- The company permanently upended the lower end of the pharmaceutical pricing scale with its 2006 introduction of a $4 generic price point on hundreds of widely used medications, spurring a market-wide shift in multisource medications to commodity pricing.
- As the nation’s dominant food retailer — its stores sell more groceries each week than its top three supermarket rivals combined — Walmart has saved U.S. families billions of dollars in lower prices for fruits and vegetables. More recently, it’s embarked on a nationwide campaign to encourage Americans to eat healthier by offering more nourishing food choices and more information about nutritional options.
- Walmart’s more than 4,500 U.S. pharmacies already provide lower-cost prescriptions and a growing menu of clinical pharmacy and preventive-care services to millions of Americans, and its Orlando, Fla.-based specialty pharmacy division is licensed to serve chronically and seriously ill patients in all 50 states through “Centers of Excellence” specialized pharmacy providers.
- With some 3,000 Vision Centers in its stores throughout the United States, Walmart is the nation’s largest supplier of vision care services and the largest manufacturer of corrective lenses.
- Through its “Healthcare Begins Here” program and a partnership with DirectHealth.com, Walmart offers advice to shoppers on health plan options, with pharmacy-based licensed sales agents providing guidance on insurance plans and pharmacy benefits.
Now, the nation’s largest retailer is setting its sights on a grander and more comprehensive vision: to become nothing less than the nation’s go-to resource for primary, frontline health care and disease prevention. “We want to be Americans’ one-stop shop for their health and wellness needs,” said Labeed Diab, president of health-and-wellness for Walmart U.S. The goal, he added, is to position the company as “the number one provider of affordable healthcare in the country.”
The point of the spear for that new charge may be the dramatic reinvention of Walmart’s retail clinic business. The company opened 17 of the new Walmart Care Clinics last year, positioning them as a full-service, low-cost alternative to a visit with a primary care doctor for urgent and preventive care, as well as management of chronic diseases like diabetes and hypertension. By radically capping costs at just $40 per customer visit for any of the expanded services its nurse practitioners offer and its supervising physicians oversee, the new clinic concept, if expanded nationwide as expected, could help upend the current primary care model in many American communities.
Walmart’s pursuit of healthcare innovation is also changing the way it goes to market. Behind the scenes, the company is knocking down internal management silos and rethinking relationships among departmental managers and store categories in a top-to-bottom campaign to align all the components that contribute to its customers’ health and wellness.
The building blocks are already there. According to a company spokesperson, “In addition to over-the-counter medicines, prescriptions, blood pressure monitors and advice on health insurance, we have the majority of products customers actually need to live a healthy life, such as fresh produce, apparel, exercise equipment and wearable technology.”
In a real sense, Walmart is pursuing its own version of healthcare reform, regardless of what happens in either Congress or the Obama administration to either slow or speed up the pace of reform. “We recognize that our customers’ needs are changing, and we feel we are in a unique position to provide innovative solutions to help them better manage their health,” Diab said.
To that end, the chain is looking to leverage its massive purchasing and negotiating power with vendors and pharmacy benefit managers — which gives it the ability to lower prices on goods and healthcare services. “We are constantly looking for ways to leverage our size and scale to not only provide our customers with access to affordable products and services, but also drive down costs for employers and managed care companies,” Diab said. That means “working with the right companies, from insurance companies to medical providers, to bring our customers the lowest prices on the products and services they need to stay healthy.”
Walmart is also doing more to leverage its astonishing drawing power with American consumers.
“When you look at the box, whether it’s a small or large format, we have 140 million Americans who walk through our doors every single week,” Diab told DSN.
“With the offering and expansion of the assortment, we’re going to be able to capitalize on the traffic that [our pharmacy competitors] don’t have,” he added. “We know we have some work to do to get there.” It will take “a broadening of the assortment” to accomplish that, Diab said. “For example, some of our stores have a limited offering of durable medical equipment. We want to make sure that no one ever walks away from Walmart if they need a cane, a wheelchair or a walker.”
By all indications, that day is coming — and sooner rather than later. “We will continue to lead on price, and are becoming more competitive on assortment,” said Walmart’s health-and-wellness chief.