How Payers Can Leverage Centers of Excellence to Boost Quality

What are centers of excellence?

Identifying a COE presents some challenges. As of now, there is no established definition of a COE nor is there any certification process for this designation. However, that does not make this title meaningless or useless for payers.

“While there is no single definition or approach for a COE across the United States, there is one commonality; they are centers made up of highly skilled experts dedicated to specific therapeutic areas and who are often at the forefront of innovation in their field,” started an article published in the Journal of Clinical Pathways in March 2019.

The fact that there are no external certifications that designate COEs presents some problems for employers and payers in identifying organizations that truly uphold that name, as any organization could claim the title for themselves.

However, there are some overarching themes that indicate whether a health system or hospital is a COE.

These health systems offer specialized care for complex conditions. They often run research and participate in clinical trials for that complex condition.

While almost any healthcare entity could form a COE, they usually manifest as a result of stakeholder collaboration, including specialty care provider societies, public programs, or consumer advocates. Additionally, these centers bridge a gap in care for their area by offering the service that they do for the specific complex condition.

The authors of the article called for greater standardization in defining and identifying COEs.

A separate study, conducted in 2017, analyzed an organization that has bene operating 11 COEs since the 1980s: the Willis-Knighton Health System. US News currently ranks the health system as high performing in seven procedures or conditions, as of September 2020.

The second study identified six features that qualify a health system as a COE: organization design, servicescape design, personnel, medical care, marketing, and finance. The Willis-Knighton Health System also formed a Center of Excellence Establishment Protocol.

Some payers provide their own designation for COEs, such as the Blue Distinction Center and Blue Distinction Center+ programs by Blue Cross Blue Shield Association that identify high-performing health systems.

How do employers use centers of excellence?

Employers have increasingly been utilizing COEs in recent years as they become more involved in arranging employee healthcare benefits.

In 2016, about eight in ten employers were using COEs (79 percent), a National Business Group on Health survey stated. By 2018, however, experts were expecting that 2019 would see 88 percent of employers using COEs. At the time, employers leveraged these centers largely for organ transplants, bariatric surgeries, and orthopedics.

By the end of 2019, employer activists were bringing that expectation to fruition, so much so that Steve Wojcik, vice president of public policy at the Business Group on Health—formerly National Business Group on Health—included COEs in his definition of employer activism sent to HealthPayerIntelligence by email.

“Employer activists are employers who are engaging with physicians either directly or through their health plan administrator to improve health care delivery and affordability through accountable care organizations (ACOs), centers of excellence, high-performance networks, or similar arrangements,” Wojcik explained.

How can payers partner with centers of excellence to improve quality of care?

However, employers are not the only ones that can use these systems to great effect. Payers can boost their quality of care by working with a COE with particular specialty care providers.

For example, Premera Blue Cross recently expanded its own COE strategy in order to improve its quality of care for radiology. Previously, radiology was not part of Premera Blue Cross’s COE strategy, but the payer recognized the need for better quality of care around this service.

“Establishing COEs around the highest quality radiology practices ensures patients are on the most direct treatment path back to health and reduces the high costs associated with misdiagnoses, which are surprisingly common,” explained the press release.

At least a third of MRIs and CT scans produce erroneous diagnoses, the release stated.

Working in tandem with a clinical analytics vendor, the payer will connect members with health systems that demonstrate high performance in this area.

Specifically, Premera Blue Cross noted a couple of areas that would characterize its COE providers: these providers deliver positive patient outcomes, lower costs, raise member engagement, and have high rates of patient satisfaction.

“High-quality radiology is critical to putting our members on the right healthcare track across numerous medical specialties,” said Rick Abbott, vice president of product and market solutions for Premera.

While many assert that there is still a need to standardize this designation, payers can move forward in step with their employer partners to leverage COEs for better quality of care in specialty areas.