How well is Walmart's spine center of excellence program working? 5 takeaways


Danville, Pa.-based Geisinger joined Walmart's center of excellence network in 2017 for spine surgery, providing Walmart employees access to Geisinger's spine team without additional out-of-pocket costs. A Harvard Business Review article recently outlined the program's success.

Walmart pays for the entire cost of employees to travel and receive spine care at Geisinger; employees can seek care outside of the center of excellence, but they are responsible for the bill. When the program began in 2017, employees that sought care outside of the center of excellence paid half the bill; in 2019, they are responsible for the whole bill. Walmart worked with Health Design Plus to develop bundled care contracts.

Five things to know:

1. About 2,300 employees — around half of the Walmart employees who underwent spine surgery or evaluation without surgery from 2015 to 2018 — utilized a center of excellence. During that time, 46 percent of patients underwent surgery and 54 percent received other forms of treatment.

2. The employees who underwent care at center of excellence sites reported shorter hospital stays; the COE employees stayed in the hospital for 2.5 days, compared to 2.9 days for the non-COE employees. Then, 0.6 percent of the COE patients were discharged to skilled nursing facilities, far lower than 4.9 percent of the non-COE patients.

3. Over the past three years, the readmission rate per 1,000 patients in the program was three for COE patients, compared to 65 for non-COE patients.

4. On average, patients who received care at a center of excellence returned to work after 10.6 weeks, which was 2.6 weeks sooner than the non-COE patients.

5. Cost for care was 8 percent higher at the center of excellence — $32,177 on average — compared to $29,770 at the non-COE, but the lower readmission rates, earlier discharge and lower skilled nursing facility use was a "payoff" of the COE model.

The authors of the article include Lisa Woods, head of Walmart's U.S. benefits design and strategy; Jonathan R. Slotkin, MD, a neurosurgeon who directs spine surgery at Geisinger Neuroscience Institute and serves as associate chief medical informatics officer at Geisinger Health; and Health Design Plus founder Ruth Coleman.

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