Becker's Spine Review

18 THOUGHT LEADERSHIP How Walmart, CVS Health will affect spine care: 4 surgeon insights By Alan Condon R etail giants such as Walmart and CVS Health are continuing their push into healthcare, offer- ing cost-friendly and convenient care close to patients' homes, and more providers are taking notice. Four surgeons reflect on these mar - ket disruptors and predict how they could influence spine care in the coming years. Editor's note: Responses were lightly edited for clarity and length. Question: How will retail giants like Walmart and CVS Health affect healthcare in the U.S.? Alexander Vaccaro, MD, PhD. Roth - man Orthopaedic Institute (Philadel- phia): The ability to provide access at an individual's convenience at an ap- propriate price point with high quality is key to remaining relevant in health- care. With Walmart and CVS Health further integrating into the market by providing direct patient care via their Center of Excellence collaboration models and hiring providers on staff of their own, this places increased pressure on traditional care providers to innovate or risk a reduction in their patient volumes. More specifically, they are changing the landscape of where and how care is provided, within the lens that people want, such as the place, time and af - fordable price point; including where they shop for everyday items and with- in the comforts of their home. CVS, for example, has applied for a patent in the metaverse for virtual shopping and remote care. Traditional care pro- viders should take notice of these mar- ket disruptors as they have the ability to impact supply and demand, which in turn can directly impact volume, pricing and reimbursement for care. As Walmart and CVS seek to reinvent patient expectations and experience, so must current healthcare providers. Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The Walmart Cen - ter of Excellence program has made a large impact on quality in spine and total joint care. The reality is that we have a lot of variability in spine care to- day. Indications for interventions and surgeries remain subjective, and the literature suggests that patients may get different treatment recommenda- tions based on the provider they see (physiatrist, pain specialist, surgeon). Center of Excellence programs re- quire the use of standardized care pathways and often mandate multi- disciplinary decision making. We pub- lished a paper in 2017 that showed that multidisciplinary decision making can actually reduce surgical utilization in favor of nonoperative strategies like physical therapy. Large employ- ers have the ability to mandate such care and therefore have the potential to lead the healthcare system in ways that will improve outcomes, cost and ultimately the value of care delivered. Brian Gantwerker, MD. The Craniospi - nal Center of Los Angeles: My predic- tion is that cost will go down. Inevitably [Walmart and CVS Health] will be able to deliver it much more cheaply. I do not think better quality will necessar- ily follow. Cookbook medicine will be practiced and things will get missed. Ultimately, patients will likely do worse but the spend will be less. Healthcare quality has always been — and always will be — you get what you pay for. The only way forward is not cheaper; it's better. We have spent 10 years under the threat of underperformance from various organizations under the um - brella of HHS. I would wager we have gotten better, and perhaps cheaper, but healthcare costs continue to go up. I am not sure when someone at that organization will decide to read the writing on the wall that allowing unchecked profi - teering by for-profit insurance, drug- stores or retail stores is not going to drive down costs until you stop let- ting them gouge patients. Physician fees continue to be less than 6 per- cent of the healthcare spend. The free market, which is the current "gold standard" for driving down costs, is farcical when it comes to healthcare as the deck is stacked against pa- tients and physicians. Christian Zimmerman, MD. St. Al- phonsus Medical Group and SAHS Neuroscience Institute (Boise, Ida- ho): The current state of healthcare delivery has been measurably shak- en and disaffected by recent events that the "disruptive innovation" of de novo corporate oversight may be a welcome play. Consumerism and ac- countability are factored entities to large and small businesses alike, and further awareness of these workings could be made more efficient. EMRs are diverse, and digital enhance- ments will only improve. The positives of employee health and maintaining that outlook outweigh the negatives of brand disruption. n "With Walmart and CVS Health further integrating into the market by providing direct patient care via their Center of Excellence collaboration models and hiring providers on staff of their own, this places increased pressure on traditional care providers to innovate or risk a reduction in their patient volumes." - Alexander Vaccaro, MD, PhD. Rothman Orthopaedic Institute

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