Centers of excellence (COEs) in health care aren't new developments; they have been around for several years. However, as health care becomes more complex and expensive and as patients demand better outcomes, trustees should take a new look at COEs. Not all COEs are equal. A trustee should determine if the COE increases value and outcomes for members while decreasing costs for both the trust and members. If so, then a COE and trust partnership may prove valuable — to the trustee, to the trust and to the members.
But what should a trustee look for when partnering with centers of excellence? Here are important things trustees need to know about COEs:
Quality of Care
As reported by National Center for Biotechnology Information (NCBI), trustees should ignore a COE's marketing slogans and focus on the quality of the care. For example, COEs are earned, not given, in that COEs are distinguished from others by providing expertise in certain medical treatments, such as cardiology, bariatric surgery and neurology. These COEs also deliver quality care through "the application of innovative tools, technologies and techniques which improve outcomes" while improving efficiencies of care. However, trustees can't only rely on marketing. They must confirm that the COE was earned.
Quite simply, do your homework and dig into the data at your disposal. Perform due diligence to determine how the hospital is performing on such designated procedures. Look at efficiency and quality. Have an expert third party in medical data analytics help you determine the COE's performance. In so few words: Don't simply decide on reputation alone.
When performing due diligence on COE's data, trustees should pay attention to outcomes, such as mortality, readmission and complication rates. These objective rates will give trustees insight to potential increased value and outcomes provided by the COE. For example, Anthem's COE — known as Blue Distinction — which began in 2006, focuses on six areas of specialty care: bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacement, spine surgery and transplants. In cardiac care, for example, Blue Distinction patients have experienced an 18 percent reduction in in-hospital mortality rates and a 29 percent reduction in inappropriate procedures rates. In spine surgery, patients have experienced a 24 percent to 38 percent reduction in readmission rates and a 47 percent reduction in reoperation rates.
In addition to quality of care and outcome analysis, cost savings is a critical indicator for trustees. Cost savings should be data driven, but such savings should run parallel with quality of care and outcome analysis. Trustees shouldn't choose cost savings at the expense of care, as low quality care can cause longer hospital stays and more medical care for members, eventually driving up cost. The data should line up on all three metrics: quality of care, outcomes and cost savings.
For example, in the two Blue Distinction programs mentioned above, the cost savings are significant, running parallel to the outcome percentages. For cardiac care, the cost savings are 23 percent. For spine surgery, the cost savings are 22 percent. Overall, the cost savings for the Blue Distinction programs are 19 percent more than other hospitals.
COEs provide high levels of efficient care to members. However, even with established criteria, trustees must complete their own due diligence to confirm their prudent partnership decision. Weighing the quality of care, objective outcomes and cost savings metrics along with the needs of the trust and members is necessary to not only make a reasonable business decision but to make the best decision for members. Although a full analysis takes additional time, the benefits far outweigh the work.