The self-insured employer world has embraced “High-Performance” as way to describe their adoption of value-based care health coverage and care offerings.

Employers are driving concepts into the mainstream conversation that used to be thought of as impossible to proliferate to the critical mass in any significant way. These include the use of Centers of Excellence (COE) for procedures with a bundled payment, reference-based pricing (RBP) and narrow networks. But I question whether “quality” is getting lost in the pursuit of nominal dollar price shaving.

Although deploying a COE strategy as part of your health plan sounds like the ideal solution, a 2019 study published in JAMA appealed to the reader to question one of the leading “quality transparency” websites. The conclusion stated, “Surgical outcomes vary widely across hospitals affiliated with the US News & World Report Honor Roll hospitals. Public reporting mechanisms should provide patients with information on the quality of all network-affiliated hospitals. Networks should monitor variations in outcomes to characterize and improve the extent to which a uniform standard of care is being delivered.”[2]

A number of studies [3][4] cite no difference in COE complications versus all other systems. Pile on that the fact that your member/employee has to pick up and travel with “one” loved one, adding to the cost and patient disruption. The whole situation can get clunky for marginal savings and quality improvement (depending on the employee's location). The question becomes, “how do you really know what you are getting with a COE?” including the quality of these programs and indirect costs such as management of these programs, administration, burden on employees to travel, etc.

As employers frustrated with opacity in the industry race to cost transparency solutions, we think they need to take a closer look at quality. Quality was cited in nearly every article the Joint Commission studied, so why isn’t there more quality transparency in the industry? The answer lies in the fact that most providers don’t report quality measures and what they report, based on government regulation, does not contain value in a form that a consumer can digest, or a healthcare expert for that matter. Obviously, even US News & World Report gets it wrong.

Learn how you can solve this problem for your organization by downloading our Solving Healthcare's Black Box Referral Problem eBook

Read Part 2 of this blog post – Healthcare cannot be High Performance without Quality-based Physician-Patient Matching

[1] https://www.jointcommissionjournal.com/article/s1553-7250(16)30045-9/fulltext

[2] JAMA Surg. 2019;154(6):510-515. doi:10.1001/jamasurg.2019.0090, https://pubmed.ncbi.nlm.nih.gov/30865220/

[3] https://khn.org/news/center-of-excellence-designation-doesnt-mean-a-lack-of-bariatric-complications/

[4] https://www.jstor.org/stable/41714649?seq=1