KeyCare CEO Lyle Berkowitz, MD on the blistering pace of retail healthcare moves.

Value-Based Care

Walmart & UnitedHealth’s VBC Collaboration

Fresh announcements seem to be piling into the retail healthcare snowball on a daily basis, and it looks like Walmart and UnitedHealth Group don’t plan on missing out on the fun.

Walmart and UnitedHealth Group inked a 10-year partnership to deliver care to hundreds of thousands of Medicare Advantage beneficiaries through value-based arrangements, with three pillars supporting most of the collaboration:

• Beginning in January, Walmart and UHG will launch a co-branded MA plan in Georgia, dubbed UnitedHealthcare Medicare Advantage Walmart Flex.

• UHG will provide Optum analytics and CDS tools to Walmart Health clinicians, starting with 15 locations throughout Florida and Georgia.

• Walmart Health’s Virtual Care solution will now be in-network with UnitedHealthcare’s Choice Plus PPO plan, giving ~20M members access to the service.

At first glance, the partnership makes sense for both sides, offering advantages of scale that could only be achieved from a collaboration between the nation’s largest retailer and its largest payor.

• Walmart gains access to UHG’s deep clinical expertise and Medicare Advantage resources, giving it exposure to the upside of risk-based contracts without having to fully enter the complex insurance market. 

• In return, Walmart’s expansive footprint provides UHG with healthcare access points all across the country, including in geographies where Optum’s own physician network isn’t active (yet).

The Takeaway

UHG and Walmart have a clear recipe for cooking up a big impact: UnitedHealthcare covers more lives under Medicare Advantage plans than any other payor, and 90% of Americans live within 10 miles of a Walmart store. Only time will tell whether the partnership turns into a nationwide success story, but it’s hard to think of another duo that would have a better shot at pulling it off.

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The Wire

• RPM Use Extremely Concentrated: A Health Affairs study sparked a ton of conversation last week after finding that just 0.1% of “high-volume providers” accounted for 69% of all general RPM use (n = 20M MA enrollees, Jan. 2019 – March 2021). The authors also found that only 0.75% of all physicians had any RPM claims, causing them to conclude that there’s still plenty of runway for RPM growth as more physicians adopt new tech.

• Verily Raises $1B for “Arms Race”: Verily took on $1B in an investment round led by its parent company Alphabet, gearing up the life sciences unit for a health tech arms race following Amazon’s acquisition of One Medical. Verily also announced that its current president Stephen Gillett will be stepping into the CEO role “as it becomes a more operationally and commercially focused company,” a move that some analysts noted mirrors the recent restructuring of Alphabet’s self-driving car unit that paved the way for a possible spin-off.

• Cleveland Clinic Plan of Care: Becker’s published a conversation with Cleveland Clinic’s Associate Chief Experience Officer Judith Welsh, MD, on the health system’s plan of care visits, which she called “a total disruptor to how we do business.” Plan of care visits bring nurses and physicians to patient bedsides to ensure everyone has a clear understanding of the care plan and pre-discharge milestones. The visits have been so successful that Cleveland Clinic now tracks them over other experience scores like patient likelihood to recommend, and Dr. Welsch’s discussion definitely makes them seem like a useful blueprint for more organizations.

• Telehealth Diagnoses Highly Accurate: Mayo Clinic researchers found that diagnoses from preliminary telehealth consultations matched in-person visits in 86.9% of cases, adding yet another piece of evidence in favor of expanding telehealth flexibilities. The study analyzed 2.4k Mayo Clinic patients who had a tele-diagnosis made prior to a 90-day in-person follow-up, resulting in agreement levels between 77.3% for ENT specialists and 96% for psychiatrists.

• Privia + OhioHealth: The Wall Street Journal recently published a solid writeup on the “slow but undeniable” shift to value-based care, highlighting how companies like Privia Health are reworking incentive structures to focus on outcomes. For Privia’s part, “slow” might be stronger language than necessary: the physician enablement company just entered a new partnership with OhioHealth to launch a medical group for independent providers that’s designed to help them remain independent as they move into VBC arrangements.

• Congestive Heart Failure Victory: MaineGeneral Health reached an overall congestive heart failure readmission rate of 0% in four of the last nine months after working with Health Recovery Solutions to implement a new RPM program. The 90-day RPM program includes personalized education, at-home care team visits, and connected devices (tablet, scale, pulse oximeter, heart rate monitor), which combined to produce impressive results considering the health system saw a 26.7% CHF readmission rate during spring 2021.

• CertifyOS Series A: Provider intelligence startup CertifyOS closed $14.5M in Series A funding to support the development of its automation software for clinician credentialing and enrollment. CerifyOS’ platform handles cross-state credentialing for several major clinician types (physicians, RNs, PAs), and it aims to distinguish itself from other “new-age” credentialing platforms like Verifiable and Medallion by becoming a “one-stop shop” for anything related to compliance and provider data network management.

• Healthcare Employment Gains: New data from the Bureau of Labor Statistics indicated that the healthcare sector added 48k jobs in August, led by gains in physician offices (+15k), hospitals (+15k), and nursing facilities (+12k). The only subsector to lose jobs was home health services (-1.8k). Despite this year’s gains now totaling 412k jobs, healthcare hasn’t fully recovered losses from the beginning of the pandemic, with employment trailing 37k jobs (-0.2%) behind February 2020 levels.

• Headspace Acquires Shine: Headspace Health completed its acquisition of the Shine app, a mental wellness platform dedicated to providing inclusive care experiences for the BIPOC community. Shine’s meditation and self-care content will be integrated into Headspace Health’s consumer app and enterprise offerings (Shine’s 90 enterprise clients now have the option to transition to Headspace for Work), while the company’s employees will join Headspace to help close the equity gap in mental healthcare.

• Cyber Insecurity Update: A recent survey of 641 healthcare IT employees found that 20% of organizations saw increased patient mortality rates after experiencing a cyberattack, primarily due to delayed procedures and testing. Ransomware had the largest negative impact on care, leading to delayed care (59%) and longer patient stays (64%) in a majority of cases.

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