The effort tosteer workers to certain doctors mirrors a similar approach Walmartuses with hospital care.lmart

Worried its employees aren't getting good enough care fromdoctors in their insurance networks, Walmart next year will testpointing workers in northwestern Arkansas, central Florida and theDallas-Fort Worth area toward physicians it has found providebetter service.

If the employees use these "featured providers," they will payless out of pocket, Walmart officials said Thursday.

Walmart is working with Embold Health of Nashville, a recentstartup company that uses data to analyze whether doctors provide"appropriate, effective and cost-efficient care." Embold CEO DanielStein was a Walmart executive from 2013 to 2017.

Related: Quality care isn't enough to meet the expectationsof today's health care consumers

"Rather than relying on word of mouth or social media to find a provider, patients canget information based on actual data and proven results," said LisaWoods, Walmart's senior director of U.S. benefits.

Walmart, the nation's largest private employer, would notdisclose the percentage of its doctors in those geographic areasthat have the new quality distinction or how much workers couldsave by using their services. The company hopes to take the programnationwide if successful, officials said.

About 60,000 employees and dependents in the three initial areascould be affected.

Ateev Mehrotra, associate professor of health care policy atHarvard Medical School, said Walmart's strategy could raisequestions about whether doctors are chosen more for lower cost orhigher quality.

"This sounds awesome and great in theory, to identify the bestdoctors you have for your employees to go to, but what is in theblack box formula that Embold Health is using, and how much is itthe cost and how much is quality of care?" he said.

The effort to steer workers to certain doctors mirrors a similarapproach Walmart uses with hospital care. Since 2012, Walmart hasdirected the 1 million employees and dependents on its health planto better-performing hospitals for high-cost services, such asheart and transplant surgery.

While using these hospitals — including Mayo Clinic andCleveland Clinic — may cost more than a local alternative, Walmartofficials have said the strategy saves money by avertingcomplications and unnecessary care. Several other large employershave followed a similar "centers of excellence" strategy.

Earlier this year, Walmart became the first large employer todirect its employees to diagnostic imaging facilities that itfound provide more accurate care.

Employer health experts said Walmart's initiative withphysicians is a groundbreaking step — but is also fraught withrisks such as alienating doctors and upsetting employees who don'twant to change doctors.

"It's a bold move to use the data they have and share it withemployees for their benefit," said Steve Wojcik, vice president ofpublic policy at the National Business Group on Health, a tradegroup of large employers. "It's part of Walmart's pattern todisrupt and transform health care for the better."

Stein of Embold Health said his company uses various qualitymetrics that vary by specialty to rate physicians. The companyshares its criteria with physicians, he said, so they know whatareas they need to improve to get the quality distinction. Thisincludes such measures as rates of cesarean sections for patientswith low-risk pregnancies and infection rates for patients afterelective knee or hip replacement, according to Embold Health.

Mehrotra noted, however, that it's often difficult to identifywhich doctors provide the highest quality of care because most workin large groups where patients may see multiple physicians.

The initiative to identify better-performing doctors, hesuggested, "can only be seen as a failure of their health plans,"noting that employers typically rely on the insurance companiesthat administer their plans to identify the best doctors for theirnetworks.

Walmart's test will include physicians specializing in primarycare, cardiology, gastroenterology, endocrinology, obstetrics,oncology, orthopedics and pulmonology.

Walmart officials said the initiative is aimed at helping reducethe large amount of unnecessary care that doctors provide, whichsomestudies say is as high as 30 percent.

"We hope to get a meaningful chunk of that removed from ourcosts and our associates' costs," said Adam Stavisky, Walmart'ssenior vice president of U.S. benefits. "How much we can save? Wedon't know, but we think it's material."

The initiative is one of several announced by Walmart officialsThursday, including pilot projects to expand access to telehealthdoctors managing chronic care in Colorado, Minnesota and Wisconsin,and to help workers in North Carolina and South Carolina finddoctors, provide assistance on billing questions or complex medicalissues.

Kaiser Health News isa nonprofit news service covering health issues. It is aneditorially independent program of the Kaiser Family Foundation,which is not affiliated with Kaiser Permanente.

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