Anatoli Berezovsky, MD’s Post

Walmart is closing all of its 51 healthcare clinics - a U-turn after it recently announced in March its plans to open 21 more clinics by the end of the year. What led to this shift? Apart from the usual culprits being static reimbursement levels and rising operational costs, as mentioned in their official announcement, deep-diving further unearths a few other problems - 🩺 Leadership Turnover: Frequent leadership changes affecting the stability and continuity of the initiative. The initial leader, Sean Slovenski, departed only a year after the launch, citing the challenges of navigating Walmart’s bureaucratic environment. His successor, Dr. Cheryl Pegus, brought a promising vision but left after just eight months for a new opportunity at JPMorgan Chase. This revolving door of executives created inconsistencies in leadership and commitment, undermining the initiative's success. 💵 Financial Missteps: Initially designed to offer affordable, cash-based medical services to those without quality health insurance, the clinics struggled to attract enough patients willing to pay in cash. This miscalculation was evident in locations like Chicago, where many residents were on Medicaid, not aligning with the cash-payment model. What's next? 🔮 Future Outlook: Retailers may pivot towards employer-focused healthcare solutions, leveraging their extensive employee bases to drive down costs and improve care coordination. This approach aligns with efforts by companies like Amazon, which is exploring employer-focused healthcare solutions. Even Walmart's tie-up with Included Health has proven success of employer-focused healthcare solutions (Read - https://lnkd.in/dxEs9buF) Can retail giants succeed in healthcare, or are the challenges too great? Eager to hear any thoughts below!

The Kaiser Family Foundation report linked below examines the extent of physician networks in the Affordable Care Act (ACA) Marketplaces and how the breadth of these networks impacts enrollee costs. The study analyzes the share of doctors participating in the provider networks of Qualified Health Plans offered in the individual market in 2021 while focusing on the challenges enrollees face when selecting plans with little information on network breadth. #PrivateInsurance #AffordableCareAct #Healthcare

Been seeing a lot of news articles about Walmart taking a step back from the health sector. Pretty big change in trajectory after being on track to have a primary care presence in eight different states by the end of 2024. Since I did college in Northwest Arkansas at the University of Arkansas and have a lot of Walmart or Walmart-affiliated connections, would be curious to hear what people are thinking? Drop me a comment below! As we seek to understand, Walmart cites a few things as reasons why they are taking a step back and feel this may not be the right time and/or industry for their company. A spokesperson for the company shared two primary things leading them to this decision: 1) “a challenging reimbursement environment” 2) “escalating operating costs” Based on Walmart Health’s mission and clinic site locations, a third driving factor almost undoubtedly was: 3) the complexity of delivering high-quality primary care, especially in underserved communities Walmart came in as one of several big, for-profit, non-traditional disrupters to shake things up in healthcare over the past couple of years. They sought to adapt to the industry through savy for-profit methodology and resources to optimize reimbursements from insurance companies and subsequently profits, but it appears the complexity of our broken U.S. healthcare system was too much for their appetite right now. The broken system is significantly contributed to by the wildly complicated insurance-reimbursement system, which requires significant administrative staff time to navigate well. They likely also found underserved patient populations to be too sick and complex for their band-width. Walmart often cites that 90% of the U.S. population lives within 10 miles of a Walmart. When they sought to fill a hole in the community by addressing access to care needs in underserved communities, they came face-to-face with the outcomes of that disparity... very complex healthcare and social situations in their patients' lives. Patients that haven't seen a doctor or had an annual with a PCP in years to decades sometimes with a laundry list of issues needing to be addressed in 30 but more likely 15 minutes. In addition, a separate list of social determinants of health that are prohibitive to a patient's well-being. And the confluence of these two things results in high operating costs. It takes something special to put in the time, effort, and money to tackle these issues with this special patient population. While Walmart is special, looks like it wasn't the right kind of special for this tall order. See my article from last year where I discuss this from a 30,000 foot level: https://lnkd.in/gpD4vvEZ More to come soon! #Walmart #healthcare #forprofit #corporate #accesstocare #underserved #primarycare #socialdeterminantsofhealth #SDOH #clinic #disrupter

📢 𝗞𝗲𝘆 𝗨𝗽𝗱𝗮𝘁𝗲𝘀 𝗳𝗿𝗼𝗺 𝗖𝗠𝗦: 𝗡𝗲𝘄 𝗩𝗮𝗹𝘂𝗲-𝗕𝗮𝘀𝗲𝗱 𝗖𝗮𝗿𝗲 𝗠𝗼𝗱𝗲𝗹𝘀 𝗳𝗼𝗿 𝗗𝗲𝗺𝗲𝗻𝘁𝗶𝗮 𝗮𝗻𝗱 𝗣𝗿𝗶𝗺𝗮𝗿𝘆 𝗖𝗮𝗿𝗲 As of July 1, 2024, CMS has launched two significant initiatives aimed at enhancing value-based care. The GUIDE Model focuses on improving dementia care by providing comprehensive support to unpaid caregivers, including care coordination, caregiver education, and respite services. The Making Care Primary (MCP) Model targets small, independent primary care practices in eight states, aiming to improve health equity for Medicare and Medicaid beneficiaries through bundled payment plans and care management services. These initiatives represent a significant shift towards value-based care, with the potential to improve patient outcomes and support caregivers. 𝗟𝗲𝗮𝗿𝗻 𝗺𝗼𝗿𝗲 𝗱𝗲𝘁𝗮𝗶𝗹𝘀 𝗶𝗻 𝘁𝗵𝗲 𝗯𝗹𝗼𝗴 𝗯𝗲𝗹𝗼𝘄. ⬇️ #HealthcareNews #ValueBasedCare #CMSInitiatives #DementiaCare #PrimaryCare #HealthEquity #AlternativePaymentModels #CareManagement #HealthcareInnovation #PatientOutcomes #CaregiverSupport #HealthIT #HealthcareTransformation #Medicare #Medicaid #PopulationHealth #HealthcarePolicy #HealthcareUpdates

Study suggests employer-sponsored and private health plans pay more for hospital services in #Michigan. Why are employer-sponsored plans playing double of what Medicare pays? Learn more: https://lnkd.in/e28ahSxw #hospitalcosts #healthcarecosts #fairprice #healthbenefits

Is SDOH the next big market for GPOs? Healthcare is evolving, and Social Determinants of Health (SDOH) services are becoming essential. Traditionally, Group Purchasing Organizations (GPOs) focus on cost reduction. But what if they expanded into SDOH-focused services? Why now? Programs like Medicare Advantage (MA) are integrating SDOH into care plans, addressing: 🏡 Housing Security 🚍 Transportation Access 🍎 Food Assistance Zing Health recently secured $140 million to enhance special needs plans for seniors with chronic conditions. As one of the fastest-growing MA plans, they're taking a holistic approach to serve underserved populations. With only 2% of MA enrollees in chronic special needs plans, there's significant opportunity. Is your GPO ready to enter this emerging space? https://lnkd.in/g3ESJU9A #HealthcareInnovation #GPOs #SDOH #MedicareAdvantage

Improving the member care experience involves more than just connecting people to their physicians. Prioritizing health outcomes and providing convenient access to care require health plans to address health barriers, such as food insecurity. That’s why a majority of our Aetna, a CVS Health Company #MedicareAdvantage plans offer fresh healthy meals delivered to members’ homes after inpatient or skilled nursing facility stays at no cost. My colleague Terri Swanson shares with HealthPayerIntelligence how Medicare Advantage plans can help members break down affordability barriers and improve their overall health. https://cvs.co/3IbCpYP

#Newsflash Another blow to the Low-income communities- Walmart’s recent decision to close its 51 healthcare centers is a significant setback for local and low-income communities. These centers, located in underserved areas, provided essential services such as primary and urgent care, labs, X-rays, and dental work. They were a lifeline for patients without insurance or with high out-of-pocket costs. Of course, it was a paid service but at a marginal cost compared to the expensive clinics. Its time that we acknowledge the importance of initiatives like Walmart’s and continue to advocate for healthcare solutions that serve all communities. The closure reflects the harsh realities of the healthcare industry, including a challenging reimbursement environment and escalating operating costs. #HealthcareAccess #CommunityHealth #WalmartHealth https://lnkd.in/gSiivBaR

Despite its proven efficiency and higher quality outcomes, home health care, especially for Medicare Advantage members, faces many barriers. From labor shortages to reimbursement complexities, the journey to fully embracing home-based recovery is challenging. However, with collaborative efforts and advancements in technology and value-based reimbursement, we're paving the way towards a future where every patient receives the care they deserve, where they want it. tango CEO, Brian Lobley dives deeper into this topic for MedCity News here: https://lnkd.in/gmABTAr2