Walmart is testing new medical benefits starting in January that it says are designed to make it easier for more than 1 million of its employees with health insurance to find quality care.

A pilot program in Dallas-Fort Worth, Orlando and Tampa, Fla., and Bentonville, Ark., where Walmart is based, will select physicians in each market who score high on quality of care.

The featured physicians will be identified by Nashville-based Embold Health, a firm that researches doctors' performance. The doctors will be selected from those accepting new patients who meet the standards for eight specialties: primary care, cardiology, gastroenterology, endocrinology, obstetrics, oncology, orthopedics and pulmonology.

The prescreening is based on objective data vs. asking a friend for a referral or doing a search for a physician with an office nearby, said Adam Stavisky, senior vice president of U.S. benefits at Walmart.

"This matters," he said, "because physician care varies dramatically."

While the insurance industry has had networks of doctors in plans for some time, this is the first network based on quality of care, he said.

Physicians are evaluated on whether they follow the latest research, adhere to clinical guidelines and consistently deliver the best outcomes. Stavisky quoted research from National Academy of Medicine that said 30% of all health care spending is wasted in part due to unnecessary care.

Other pilot programs Walmart announced Tuesday include a personal health care assistant service in North and South Carolina that will be a source for all patient needs including billing questions, making appointments and understanding diagnoses. The program, through San Francisco-based Grand Rounds, is free to employees on Walmart's medical plans. It can also coordinate transportation and find day care options during appointments.

Walmart already has a telehealth program that allows employees to have a virtual visit with a physician, psychologist or psychiatrist for $4 per visit. A pilot program starting in January in Colorado, Minnesota and Wisconsin will allow employees to sign up with a personal online doctor and book appointments.

The largest U.S. private employer is also expanding a surgery program that sends employees to top hospitals it calls "centers for excellence." The hospitals specialize in treating certain illnesses, including cancer, transplants, heart disease, weight loss, hip and knee replacements, and spinal surgery.

Lisa Woods, Walmart's senior director of U.S. benefits strategy and design, has been adding hospitals to the program. "We started looking at our data in 2012 and saw a huge disparity in cost, treatment outcomes and protocols," she said.

The program started with the Mayo Clinic in Minnesota more than 20 years ago and has expanded to Memorial Hermann-Texas Medical Center in Houston, Northeast Baptist in San Antonio, Cleveland Clinic and Johns Hopkins Hospital in Baltimore and others. Employees don't have to travel for their care, but if they do, Walmart pays for 100% of the hospital bills and travel and lodging for the employee and a family member.

About 900 employees in Texas have used the center for excellence program since Walmart expanded it to the state in 2017. About half of them were treated for spine issues, Woods said in an interview earlier this year. Since then, about 250 employees have traveled to Texas hospitals for care from other states for hip and knee replacement and weight loss treatment.

The program also addresses the fact that Walmart has stores in rural markets that don't have hospitals that can accommodate many procedures.

Even if Walmart pays more for the initial surgery, Woods said, cost may not be the most important consideration. "If we get the right care initially, we see savings in the long term," she said.

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Walmart expands medical benefits with pilot program that picks doctors based on performance - The Dallas Morning News