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How Walmart Gets Vaccines Into Arms: AHIP Annual Meeting

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What You Need to Know

  • North Carolina has used new data on patient race and ethnicity to shape primary care bonus spending.
  • Walter Isaacson wondered what COVID-19 is doing to children and young adults.
  • Dr. Cheryl Pegus, a Walmart executive, says clinical care accounts for only about 20% of the determinants of health.

Walmart Inc. has joined with CVS, Walgreens and other retailers to help get Americans vaccinated against COVID-19.

A company like Walmart is in a great position to help the country deal with health equity issues, Dr. Cheryl Pegus, a cardiologist who serves as Walmart’s executive vice president of health and wellness, told health insurance company executives Tuesday.

“You think of Walmart,” Pegus said, during a session at the America’s Health Insurance Plans (AHIP) annual meeting, which started Tuesday, online, and is set to end Thursday. “We’ve got about 1.5 million associates. About 150 million people come through our doors every week; 4,000 of our stores are in HRSA [Health Resources & Services Administration] designated medically underserved areas.”

Most of the employees live in the medically underserved communities where the stores are located, Pegus said.

Studies have shown that the kind of clinical care a doctor provides determines only about 20% of an individual’s level of health, and that much of the rest of health depends on factors such as access to fresh food, vitamins and telecommunication services, she added.

Pegus said Walmart can combine its own pharmacists, food delivery people and care coordinators with community health workers, and help organize and support health improvement efforts.

Making sure that people with health problems have smart phones and internet access can also help, both by bringing goods and services to those people, and by giving telehealth providers a glimpse of those people’s lives, Pegus said.

“A lot of clinicians finally got to see how their patients live, and what that world looks like and what may be needed,” she said.

Walmart Vaccinations

For the COVID-19 effort, Pegus said, Walmart started by looking hard at store market data by ZIP code, to see what communities might need.

The company also held many teleconference meetings store personnel could use to communicate with one another, as well as with local sources of expertise, such as aldermen in Chicago.

When the aldermen from the South Side of Chicago said their constituents had no way to get to the vaccination centers, Walmart arranged to send mobile vaccination units to the area, Pegus said.

She talked about other community-tailored vaccination efforts, such as mass immunization events scheduled to fit with teachers’ schedules, and events designed to have extra pharmacists present to meet the needs of people with disabilities.

North Carolina Data

Another speaker, Dr. Mandy Cohen, secretary of the North Carolina Department of Health and Human Services, said her state lacked good, detailed vaccination data needed to improve health system fairness when she came into office.

“[We] have to collect data systematically on race and ethnicity if we’re actually going to map our time and our resources differently,” Cohen said. “When we launched a new system, we had the technology to make it a forcing function, that we collect race and ethnicity data at every step. You couldn’t log a vaccination in North Carolina unless you logged race or ethnicity data.”

Because of that approach, North Carolina lacks race and ethnicity data for only about 1% of the people vaccinated. However, in other states, officials lack race and ethnicity data for 44% of the people vaccinated, she said.

She said one criticism of the approach is that some patients would refuse to give race and ethnicity information.

“Almost no one did that,” Cohen said.

Cohen said North Carolina then used the data to give primary care practices scores indicating how frequently they treated patients from the highest-risk Census tracts.

The state then gave “equity bonus payments” to the providers who were treating the most patients from high-risk areas. Providers could spend the cash on community health programs, telehealth systems and other programs designed to improve care in underserved areas.

“We have 10 other examples like that, because it can’t just be one thing,” Cohen. “This has to run through every decision that you make, from how you market, to how you pay your providers, to what you hold them accountable for on quality scores.”

The Future

AHIP is one of the largest trade groups for health insurers. Its president, Matt Eyles, kicked off the meeting by noting that health insurers are now emerging from the COVID-19 pandemic — one of the most tumultuous times in America.

AHIP has filled a web page with information about member insurers’ efforts to support the COVID-19 vaccination effort.

“We thought more deeply about equity and a with sense of urgency for sustained action and improvements,” Eyles said.

During his speech, Eyles recalled that AHIP recently updated its logo and other branding. “The new AHIP reflects our commitment to innovative solutions and strategies that deliver real results,” he said.

In the past, it hosted carriers with a strong interest in agents, brokers and customers in the traditional and small group individual commercial major medical market.

This year, sessions focused heavily on efforts to manage cost and quality of care, and to make the delivery of care more fair.

The first keynote speaker was Walter Isaacson, the prolific author, Tulane University history professor and host of Amanpour & Company. He is also a past editor of TIME magazine and a past chairman of CNN.

Eyles told Isaacson that he has children who are 18 and 20. “How do you think that the trauma of what we’re coming out of will impact the current generation, and how will it impact future generations?” he asked.

Isaacson said he has watched very young children wearing masks as they walk down the streets of New Orleans.

“They’re 4 or 5 years old,” Isaacson said. “When we come out of this, they’re not going to have a memory of when we did not put on masks. I also look at my students at Tulane, who came back to campus, but a lot of the learning was done virtually.”

Isaacson said he thinks the pandemic will leave young people with an appreciation for in-person collaboration.

“Zoom meetings are good when you have an agenda, and you get to tick off the items on the agenda,” he said. “They’re not great for when you have to do things like brainstorm.”

Isaacson added that Zoom meetings are bad for bringing new people into an organization.

“That’s what we’re going to have to play a lot of catch up on,” he said. “Helping people who joined an organization a year ago, but who’ve never just sat around drinking coffee, or drinking beer, with the people they work with.”

Dr. Cheryl Pegus (Photo: Walmart)