It's time to rethink centers of excellence

Health care costs are projected to rise 8% in 2025, and in this challenging financial landscape employers are looking for creative ways to provide employees with access to high quality care without breaking the bank.   

Imagine needing a knee replacement and knowing a friend recently had an excellent outcome and experience with the same procedure. Would you ask WHERE they had their surgery or WHO performed it? Intuitively, we all know the surgeon matters most, and the evidence is clear that we're right.  

Historically, employers have relied on a traditional center of excellence (COE) model to reduce costs and improve outcomes for their employees. Today, 85% of large employers have some form of a center of excellence offering for at least one condition, according to Business Group on Health. But this traditional model hasn't been able to combat increasing costs or meaningfully improve outcomes, as it often results in low utilization rates due to limited steerage, lack of incentives, limitations in treatment types available, or travel barriers. 

Read more:  Trump's new policies are raising layoff concerns. Here's how benefits leaders can prepare

Rather than taking the top-down approach with a facility-only mindset, we should be building networks from the bottom-up, focusing on excellent providers first. The greatest enemy of quality is variation, and physicians' outcomes vary significantly, even within the best facilities. There's no guarantee — or dedicated external vetting — of individual providers' outcomes, clinical skills, or adherence to best practices in the traditional model.   

Many of the best physicians operate in non-hospital settings, including ambulatory surgery centers, where they deliver high-quality care and achieve enviable outcomes. It's well established that many surgeries have better outcomes and fewer complications when performed outside of the hospital setting — for a fraction of the cost. Identifying these quality providers — through a thorough vetting of clinical and cost metrics — allows care platforms to construct cross-country networks of high-quality care that are dramatically more cost-effective and typically, more convenient for the patient.  

Read more:  To reduce healthcare costs, address chronic conditions

While well-known facilities associated with the traditional COE approach are appropriate for rare and complex cases, these are the exceptions. And while the outcomes may be great at an excellent teaching hospital in New York City, this doesn't help you much if you live in Utah. In addition to often being more expensive and less convenient, traditional centers of excellence don't necessarily deliver better outcomes for many common surgeries. Rather, wide-reaching networks of excellence can identify excellent care closer to home, allowing patients to forgo the stress, travel time, cost, and caregiver coordination burdens that arise from directing people to faraway facilities.  

Recognizing the benefits of prioritizing a provider-focused model over the traditional, the next question is: How do you build a network of excellence?  

It starts with provider training and specialization. In establishing a network of excellence, the emphasis is truly on, well, excellence — identifying and selecting providers with a clear focus on their training, qualifications, and pedigree of quality outcomes.   

Case volumes must also be a high priority in evaluating providers for the network. Patients value experience in their physicians, and research demonstrates they're right to do so. In one study, more experienced surgeons achieved readmission rates between 37-51% lower than their less experienced, lower-volume counterparts. Directing patients to high-volume surgeons leverages this experience and leads to happier patients with better results.  

Read more:  Financial incentives won't make your weight loss benefits successful 

Optimizing site of care delivery is another key element of a network of excellence. Ambulatory care centers can offer improved quality and safety for some procedures, like joint replacements. For treatments like infusions, at-home or outpatient care can deliver comparable or better outcomes at thousands less per course. When appropriate, a diverse network of excellent providers allows patients to receive care at the most optimal site, leading to better outcomes, better patient experience, and lower overall costs. 

The final piece of a network of excellence is largely self-explanatory: identifying providers with a track record of delivering the best outcomes, the fewest complications, and the best patient experience. Dedicated external vetting — into outcomes, care optimization, and more — ensures patients are being served by the provider who is the best fit for them and can provide them with the best chance at the best outcomes.  

Navigating the healthcare system is complex, particularly for a layperson. By providing employees with access to a network of rigorously vetted providers, they can trust that they're receiving high-quality care from a high-quality provider — without having to search for or travel a great distance to that care themselves.