Company leaders are reclaiming control of one of their top expense categories, healthcare, through innovative changes to plan design that bypasses traditional insurance options by directly contracting with providers. The vanguards of this movement are forward-thinking companies like Walmart, which spends over a billion dollars annually in healthcare as the nation’s largest employer. Walmart’s jump-start in direct contracting with specialized care focused on procedures with a high variation in cost and clinical outcomes, like orthopedic surgeries. Sophisticated employers are meeting this cost trend challenge by replacing low-value care with high-value care that is low cost and higher quality.
Tom Emerick was one of the leaders of this movement for Walmart as the VP of Global Benefit Design. The Walmart health plan was designed to pursue direct contracts with Centers of Excellence (COE) for procedures and conditions in major expense categories. These COEs focused on the accurate diagnosis and appropriate treatment of a patient, thus providing more precise care which resulted in a reduction of the overall cost of a patient encounter. Since the inception of this model with Walmart, Tom has since founded Edison Healthcare, which furthers the Centers of Excellence pursuit to provide best-in-class care for employers who aren’t as big as Walmart.