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 and if members actually use it. 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? As a warning, this answer might be harder to determine on your own than you might think. Part of the reason is that there’s no consistent definition of what an episode of care includes.

“If a benefits leader sends us their list of CPT codes, we can define their true spend on surgery,” says Ben Sanders, SVP, Strategy and Emerging Products at Lantern.

Where is your population currently consuming healthcare?

Do you live in a major metro area with several big health systems or are your people in a healthcare 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? Do your employees or members struggle to afford care?

Next, when you’re ready to start evaluating your COE options, consider breaking down the discussion into a few different buckets: quality, network, utilization drivers, member experience and savings.

COE Quality Questions

There’s no standard definition of quality for COE solutions. Questions related to quality get at how the COE builds its network.

• What qualifications do surgeons have to participate in your COE and do you individually vet all specialists and facilities? How often are they vetted?
• Do you have the same rigorous quality standards for every facility and specialist in your network for equitable access and best outcomes?
• If your COE covers multiple specialty care categories, how do you measure quality standards across your network for different procedure types and conditions?
• What is the complication rate for procedures performed by your network providers?
• How do you actually measure clinical appropriateness to ensure providers are avoiding unnecessary procedures?
• How do you communicate quality to members?

COE Network Questions

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 Lantern, include more local options.

These questions can help your team understand the network structure and how often employees would have to travel to access care. It’s also important to understand whether the solution applies the level of quality standards to its network, regardless of the procedure someone needs.

• How many surgical facilities and how many surgeons are in your network?
• Where are your facilities and surgeons located in relation to where my employees live and how far will they need to travel for care? Can you provide a geo-analysis?
• Do you empower the surgeons in your network to operate at the most appropriate, qualified site for the patient, whether that be at a hospital or ASC?
• How do you thoughtfully and sustainably grow the surgeons or facilities in your network?
• Do you contract directly with all providers in your network?
• What procedures within each surgical category are covered and what is covered at each facility?

COE Utilization Questions

You’ll only see savings and better outcomes if members use your COE. Factors like network access, procedures covered, benefit awareness and incentives all play a significant role in utilization.

Of course, any vendor will tell you that people love to use their program. These questions can help you assess the accuracy of their claims and get a clearer picture of the utilization you can expect.

• How will you help me communicate to employees that this program is available?
• Is the communication personalized and targeted to members’ care needs?
• What are your plan design recommendations to encourage or require utilization?
• What are your utilization results for voluntary and mandatory plan designs? How do you drive utilization for voluntary plans?
• What integrations do you have in place with other vendors or point solutions to drive utilization?
• How many procedures per thousand enrolled employees do you provide annually?
• If an employee does need to travel for care, what assistance can be offered?

Member Experience Questions

Utilization also relies heavily on member satisfaction. When members are happy with the outcome and the quality of care, they tend to share their story with co-workers, which helps to increase engagement. Dig into the member experience with these questions:

• How big is your care team and do you have nurses to help answer member questions and concerns?
• What kind of clinical oversight does the member experience have?
• What are your in-house bilingual capabilities, both through humans and technology?
• Can you walk me through what a member care journey will look like with your solution?
• What is your member Net Promoter Score (NPS)?
• What does member satisfaction look like and can you provide testimonials or survey results?

Best COE Savings Questions

As benefits leaders continue to feel the pressure of healthcare costs, it’s important the COE solution you choose provides tangible financial value. Understand the scale of PEPM savings and how the solution lowers medical spend through hard-dollar savings. Don’t accept vague calculations from vendors. Instead, take a look at Lantern’s TrueRate savings methodology report and ask these questions:

• What percentage of savings versus carrier-allowed amounts can I expect to see?
• If the savings are lower, how can the plan sponsor justify waiving member cost share?
• If you offer different network models, are the savings different?
• How do you calculate savings?
•  What percent of your savings are hard-dollar?
• What are your average PEPM savings?