Employers turn to Centers of Excellence (COE) to tackle multiple challenges, from making sure employees in rural areas have access to high-quality care to taking on high hospital costs.
But a COE will only be successful if it fits the needs of your organization. Will your employees have options near them? Do you feel confident about the quality of care they will receive? Finding the right solution starts with clearly identifying the problems you’re trying to solve—and then asking the right questions.
Before you start conversations with COE networks, work with your team to understand your requirements and what questions you’ll place to lead the conversation.
These early discussion questions may look like:
- What are the most significant drivers of healthcare costs at your company? More than likely, you already know this one: musculoskeletal pain, orthopedics, bariatrics and cancer tend to be top of the list for most employers. But what about surgery spend as a whole? Most claims reports sort by CPT code or condition and make it easy to see a roll up of total surgery spend. Work with your benefit consultant to pull this together.
- Where is your population currently consuming health care? Do you live in a major metro area with several big health systems or are your people in a health care desert and driving 100 miles or more to see a specialist?
- Is health equity a problem with our population? In addition to access, what other social determinants of health issues serve as a barrier?
Next, when you’re ready to start evaluating your COE options, consider breaking down the discussion into a few different buckets: quality, network and utilization drivers.
Quality-related question examples
There isn’t one definition of quality or excellence across COE solutions. Questions related to quality get at how the COE builds its network.
- What qualifications do surgeons have to participate in your COE?
- How much relevant experience do the surgeons have, by condition area?
- What is the complication rate for your priority procedures?
- How often do your surgeons avoid unnecessary procedures?
Network-related question examples
Traditional COEs include only a few select facilities and require employees to travel. Solutions that build their network at the surgeon level, like we do at Employer Direct Healthcare, include more local options. These questions can help your team understand how often employees would have to travel to access care.
- Tell me about your network. How far will my employees need to travel for care?
- What travel assistance do you offer?
- Where can employees receive care?
- How is the COE’s network expanded when needed?
Utilization-related question examples
Travel is typically the most common barrier to COE utilization, but awareness and lack of incentives can lead to low usage, too. These questions explore how a COE drives employees to use it and options your company has for plan design.
- How do you help me communicate to employees that this program is available?
- What are your plan design recommendations to encourage or require utilization?
- What procedures does your COE cover?
- What integrations do you have in place with other vendors or point solutions to drive utilization?
Interested in hearing from other benefits leaders who recently went through a COE evaluation process? Join our webinar on March 27, 2024, to hear how 7-Eleven, The Wonderful Company and NextEra Energy assessed their options and found the right solution for their employees.
