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Analysis

Walmart, Doctor on Demand Join Forces in Primary Care Telemedicine Deal

By Christopher Cheney  
   November 06, 2019

Walmart employees and their dependents in three states will have access to primary care and behavioral health visits with just a $4 copay.

A new telemedicine partnership between retail giant Walmart and Doctor On Demand features a primary care model with integrated behavioral health services.

Telemedicine is one of the hottest growth areas in U.S. healthcare. The U.S. telemedicine market is expected to reach $64.0 billion by 2025, according to MarketWatch. In 2018, the web- and mobile-based telemedicine segment held a telehealth revenue share of $11.8 billion, and the telehospital segment accounted for $12.7 billion, MarketWatch says.

From 2010 to 2017, there was steady growth of telehealth services at the country's hospitals, according to the American Hospital Association. In 2010, 35% of hospitals offered telehealth services to their patients. In 2017, that figure more than doubled to 76%.

The new partnership between Walmart and Doctor On Demand features an innovative approach to primary care through telemedicine, says Hill Ferguson, MBA, CEO of the San Francisco–based telehealth services provider.

"This partnership involves not only having a primary care physician assigned to employees but also having a care team that works behind the physician of nurses, pharmacists, coaches, and nutritionists that can help engage patients, many of whom have chronic conditions. We can help patients manage chronic conditions from the comfort of their home, keep them out of the emergency room, and make sure that if they need in-person care that we can route them to the right place where they will optimize for quality and cost," he says.

The partnership has transformative potential, Lisa Woods, Walmart’s senior director of U.S. benefits, said in a prepared statement. "If we get this right, we can raise the tide for all healthcare."

Deal details

The new partnership provides primary care and behavioral health services via video-based telemedicine to Walmart employees and their dependents in Colorado, Minnesota, and Wisconsin.

Walmart is the second large organization to reach a deal with Doctor On Demand since the telehealth services provider launched its Synapse virtual primary care platform earlier this year. Humana was the first to adopt the platform.

Walmart is self-insured, and the financing of visits is fully integrated into Walmart's and Humana's insurance carrier networks, so Doctor On Demand is reimbursed through those payers, Ferguson says.

"The way it works financially is we have a component of cost that is assessed on a per-employee-per-month basis and a component of cost that is assessed on each patient visit. Depending on the type of visit, the price may vary—it may be an urgent care visit, or an initial psychiatry visit, or a follow-up psychology visit. They will all have different visit fees," he says.

Walmart is paying for the bulk of the telemedicine services. "Walmart contracts directly with Doctor On Demand, and they pay us for the services that we provide. Then they offer our services to their employees for the $4 copay. In effect, they are subsidizing almost all of the cost for the delivery of the care that we are providing," Ferguson says.

Doctor on Demand's primary care model

Doctor On Demand features video telemedicine visits available on mobile devices and home computers. The telehealth service provider's physicians are employed by the company.

"These are fully employed physicians who have joined our medical practice. We have several specialties—family medicine, internal medicine, pediatrics, psychiatry, and psychology. We have built an integrated model where it's virtual primary care with integrated behavioral health. That model has formed the foundation for our future direction and for deals like the one with Walmart. We can do so much more than simply talk on the phone to a patient and determine whether they need an antibiotic," Ferguson says.

In the Walmart deal, Doctor On Demand will be auto-registering populations of employees and their dependents in Colorado, Minnesota, and Wisconsin. Initially, the only requirement for employees is to create a password on the Doctor on Demand website or the company's mobile application.

"Employees will be able to see the virtual primary care physician we have assigned to them—you can read about their background, you can see what they look like, you can see where they went to medical school, and you can see what languages they speak. If employees decide to have different providers, they can search our directories and pick a new provider," Ferguson says.

The Doctor on Demand primary care model mirrors the services provided in brick-and-mortar practices, he says.

"We encourage employees to have an initial visit to establish a baseline with their provider. In some cases, there may be a preventative care visit. If a patient has a chronic disease, the provider may create a care plan that involves a number of virtual interactions with our care team through text messaging, or phone calls, or video visits. We may order a lab test for patients; for example, if you are 45 years old and you have no idea about your cholesterol levels."

Sometimes, patients receive referrals for in-person care, Ferguson says.

"We resolve about 92% of our cases virtually. The rest of the cases are referred to brick-and-mortar facilities. Sometimes, it will be for lab tests. Sometimes, it will be for an MRI. A referral could be for a specialist consultation such as an endocrinologist for an advanced form of diabetes. For specialist referrals, Doctor on Demand works with Walmart and finds a high-quality provider in their network," he says.

Improving access

Telemedicine partnerships like the Walmart and Doctor On Demand deal have the potential to grow exponentially and help address healthcare access problems and physician shortages nationwide, Ferguson says.

"We believe the largest impact we can have on healthcare is expanding access to primary care beyond routine conditions such as colds, flu, and pink eye. We're talking about real primary care, where a patient engages with a physician over a long period of time, and that physician treats most of the patient's conditions, then helps the patient make smart decisions on where to get in-person care. We think we are part of the solution for our broken healthcare system. It's just not practical to think that everyone can go in person every time they need to see a doctor," he says.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


KEY TAKEAWAYS

The primary care model that Doctor on Demand, a telehealth services company, has developed for large employers focuses on preventive care, behavioral health, and management of chronic illnesses.

There has been steady growth of telehealth services at the country's hospitals, according to the American Hospital Association. In 2010, 35% of hospitals offered telehealth services to their patients. In 2017, that figure more than doubled to 76%.


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