Spine Centers of Excellence are designed to deliver high-quality, cost-effective healthcare by providing specialized and comprehensive multidisciplinary care and have become an attractive option to insurers and providers in recent years.
Hospitals, in particular, are increasingly considering Centers of Excellence. If they don't refine spine care protocols, they could lose even more access to patients as payers continue to push patients to the outpatient facilities that perform more efficient care at lower costs. ASC growth in orthopedics has also provided a new opportunity for the evolution of spine surgery Centers of Excellence.
Ten hospitals and health systems across the country — including Rochester, Minn.-based Mayo Clinic, Emory University Hospital in Atlanta and Virginia Mason Medical Center in Seattle — have partnered with Walmart in the retailer's spine Centers of Excellence program, which has been shown to reduce hospital stays, decrease readmissions and accelerate the recovery of patients, among other benefits.
Catalyst for Payment Reform conducted a study of the Centers of Excellence program Walmart launched in partnership with the Purchaser Business Group on Health in 2013, which began with hip and knee replacements and expanded to offer spine procedures.
Here are five recommendations for employers seeking to implement a spine Center of Excellence program:
1. Choose your provider partner carefully: When Walmart launched its Centers of Excellence program in 2013, it was difficult to find data to identify the right healthcare partners. Today, there is much more price, quality and outcomes data available. Walmart encourages employers to carefully analyze data and interview providers on-site to see their care processes firsthand.
2. Develop the right clinical model: Clinical advisers are key in the design and implementation of a Center of Excellence program. The employer has in-depth knowledge of benefit design and their employees' needs, but clinical expertise is needed for program-specific contracting.
3. Clinical evaluations encourage program adherence: Virginia Mason Medical Center championed the importance of a multidisciplinary evaluation process, comprising much more than a "yes" or "no" for surgery. Patients who receive a "no" leave with a care plan to help them manage their condition or pain. This extra step helps patients adhere to the Center of Excellence's recommendations and discourages them from seeking surgery elsewhere.
4. Effective care coordination across stakeholders is key: From the use of prospective bundled payments to direct contracting and going beyond traditional care management, the design of the program requires true partnerships with providers and a significant amount of management by health plans. Ensuring smooth transitions and wraparound services is crucial for the patient experience.
5. Comprehensive care navigation support is critical to success: Care navigators assist traveling patients with program logistics such as travel, lodging and booking appointments and help make them feel comfortable throughout the care process.