Harnessing Centers of Excellence for Healthier Outcomes and Lower Costs

In an era where healthcare costs continue to soar, self-funded employers need to be proactive in deploying strategies that guide members to quality care. In healthcare, quality costs less, not more, because of the reduction of misdiagnosis, unnecessary care, and complications. Centers of Excellence (CoE) — specialized facilities that stand out for their exceptional care in specific medical areas — are a key component of healthcare quality.

Key Advantages

Could your member population benefit from a CoE specializing in cardiac care, musculoskeletal (MSK) disorders, or cancer treatment? Analyzing your health plan data will help you pinpoint the right CoE for your members.

Identify High-Cost Areas

One of the first steps is to examine spend across your employee population. This analysis can help you pinpoint specific conditions, treatments, or procedures that are driving up costs.

Estimate Impact

How many relevant procedures did your population receive last year? Use the CoE code list. Remove roughly half of the codes which are low value and lower frequency. Then estimate conversion rate to a CoE (without navigation, 5% is a good assumption). Finally, estimate savings — net savings of 30–40% is a good assumption.

What Can I Do to Increase My CoE Utilization Rate?

Despite its many benefits to employees and employers, utilization rates can be stubbornly low. Our experience points to two key levers to enhance participation.

• Timely Identification
  Members do not read their benefit manual with an expectation they are going to need a CoE — after all, there is a <2% chance they will need one. However, they are much more receptive when it's increasingly clear they may be in the 2%. Using your employer claim data, you can use predictive analytics to identify members that are likely candidates for a CoE.
• Quality Outreach
  Make sure your members get the message. Too often, it is assumed that someone in the vendor system is "taking care of it." Understanding "who's on first" and providing them with the candidate list helps ensure your members get timely information. And if members aren't getting the information, it's time to reassess your approach to outreach.

Example

Whether it's a high volume of orthopedic surgeries or an increasing need for cancer care, your data can identify which plan members could benefit most, and lead to more sustainable healthcare spend.