Both health plans and employers are increasingly developing Center of Excellence networks that steer patients to specialty providers that meet their criteria for high-value care. Criteria for COE inclusion varies by entity, but often includes metrics like outcomes, procedural volumes, episodic cost, appropriate utilization, and access. By being a part of a purchaser’s COE network, service lines could have access to patients otherwise inaccessible to them.
In particular, employers are increasingly looking to this model as they try to curb unsustainable cost growth—especially in the financial wake of the pandemic. An October 2020 survey found overwhelming buy-in from large employers that COEs can reduce costs and improve quality.
As opposed to employer COE models of the past, which focused primarily on the quality and cost of a procedure itself, emerging models look more holistically at the total employee care pathway. This means a provider’s ability to manage episodic utilization, cost, and quality. For example, Walmart has expanded its COE model to include steering employees to a shortlist of high-quality imaging centers. The goal here is to enable more accurate diagnosis upstream to reduce the need to even send a patient to a surgical COE.
A program does not have to brand itself as a self-designated COE or even get accreditation from an external body to develop these direct-to-employer relationships. However, they will need to understand the specific needs and criteria of local or national employers they look to partner with. Developing these models, particularly with large employers outside your area, requires a significant investment in administrative infrastructure to manage these contracts and tightly coordinate this subset of patients. Providers will want to ensure they can capture enough new patient volume to cover these investments.