Many employers have implemented a Centers of Excellence (COE) model in an effort to improve the quality of care for employees and reduce procedures caused by misdiagnoses and unnecessary treatment. COEs have been designated as world class centers around the country, each specializing in particular procedures and diagnoses of distinct medical branches.
Bringing attention to employer healthcare data, Edison Healthcare pointed out that six to eight percent of group plan members have been spending 80 percent of plan dollars. Generally, these members had complex health problems and comorbidities, meaning more than one condition. Patients were seeing three or more specialists who did not collaborate or communicate with each other regarding treatment and diagnoses.
In juxtaposition, COEs have been defined as programs that feature an exceptional concentration of expertise and resources focused on a specific medical specialty while employing comprehensive interdisciplinary practices to achieve the best outcomes for patients. COE physicians have ensured proper treatment and diagnoses by collaborating and communicating cross-specialty.
Medical issues are often misdiagnosed.
According to researchers, the approach taken by traditional healthcare models to pay doctors and hospitals per visit and procedure has encouraged unnecessary treatment. In a 2017 national survey published in PLOS ONE, a Johns Hopkins research team found that an interpolated median of 20.6 percent of medical care was reported by physicians as unnecessary. Itemized, the data showed 22.0 percent of prescription medications, 24.9 percent of tests, and 11.1 percent of procedures were unnecessary.
Edison Healthcare reported on research that showed 20 percent of employees had been misdiagnosed, including 30 percent of cancer diagnoses, 55 percent of spine surgeries, and 60 percent of bypass surgeries. 40 percent had been recommended the wrong treatment plan. Meanwhile, COEs had 25-35 percent fewer readmissions thanks to precise treatment plans and accurate diagnoses.
What are Centers of Excellence?
COEs have been known to be the best at what they do, whether it is cardiac care, joint replacements, diagnostics, or another medical practice. Offering the complete continuum of care for conditions like breast cancer and diabetes, COEs have committed to provide diagnoses, treatment, and rehabilitation at lower costs when compared to less specialized institutions.
One of the markers that have made COEs successful has been that their physicians are paid on salary instead of a fee for service.
Center of Excellence teams have approached diagnostics and treatment by relying on current data from evidence-based science. Their teams have performed complex procedures with high quality outcomes and recommended non-surgical treatments when it was the best course of action. Their physicians have had a lower number of patients at once, less procedures, and better outcomes.
According to the 10th Annual Health and Well-being at Work Study from 2018, 78 percent of employers used a COE strategy (up from 45 percent in 2016).
What does an employer-sponsored Center of Excellence benefit look like?
Typically, the COE benefit has $0 member cost to go to the designated center for diagnoses, recommendations, and treatment, including surgery if needed. The health plans cover travel and lodging for both the member and a companion, removing all barriers for the employees. In addition, the designated COE teams coordinate local care for when the employees return home.
Employer success story
Walmart has grown their COE program since they partnered with Mayo Clinic 20 years ago. The partnership began for the purpose of providing elite expertise for their associates in need of transplants. Since then, their COE program expanded to include spine surgeries, hip and knee replacements, weight loss surgeries, and cancer treatment focusing on breast, lung, and colorectal cancer.
During Walmart’s 2018 general session, Lisa Woods, Senior Director for Health Benefits, announced “there is 30 percent waste in the [healthcare] system.” She pressed on reporting Walmart’s data showed that COEs had lower hospital readmissions within 30 days by 95 percent. Employees were returning to work three weeks sooner with COE care.
In stark contrast, Walmart had learned that with the fee-for-service model, over 30 percent of prescribed care had been unnecessary.
Furthermore, over 50 percent of associates who were told they needed spinal surgery by their local physicians were told by a COE that surgery was not necessary. Likewise, 55 percent of cancer patients who visited Mayo Clinic were given a new or adjusted treatment plan, and ten percent received a new diagnosis, including some who found they did not have cancer. In addition, associates who underwent weight loss surgeries were found to have reduced drug costs by 70 percent after nine months.
Employers across the country have discovered the improved performance of their workforce by concentrating on providing quality and accessible healthcare. COE popularity has increased due to their demonstrated ability to provide better outcomes for patients with greater efficacy at lower, more reasonable costs.
Annual Health and Well-being at Work Study. (2019). Optum. Retrieved from https://www.optum.com/content/dam/optum3/optum/en/resources/ebooks/wiw10-ebook_2019.pdf
Centers of Excellence. (n.d.). Walmart. Retrieved from https://one.walmart.com/content/usone/en_us/me/health/health-programs/centers-of-excellence.html
The Edison Healthcare Difference. (n.d.). Edison Healthcare. Retrieved from https://edisonhealthcarecorporate.com/the-edison-healthcare-difference
Elrod, J. K., & Fortenberry, J. L. (2017, July 11). BMC Health Services Research. Centers of excellence in healthcare institutions: what they are and how to assemble them. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5516836/pdf/12913_2017_Article_2340.pdf
HLTH. (2018, June 4). General Session: Lisa Woods and Marcus Osborne, Walmart. Youtube. Retrieved from https://www.youtube.com/watch?v=n87g_mb_kuk
Lyu, H., Xu, T., Brotman, D., Mayer-Blackwell, B., Cooper, M., Daniel, M., … Makary, M. A. (2017, September 6). Overtreatment in the United States. PLOS. Retrieved from https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0181970&type=printable