Online Program

Aligning Cost and Quality to Achieve Excellence in Surgical Care

Monday, November 2, 2015

Olivia Ross, MPH, MBA, Pacific Business Group on Health, San Francisco, CA
Rachel Lee, Pay for Value, Pacific Business Group on Health, San Francisco, CA
In early 2015, Health and Human Services announced an ambitious goal of linking 50% of traditional, fee-for-service payments to alternative payment models by the end of 2018. Self-insured employers are echoing this movement towards value-based purchasing and using their market power to change care delivery for their employees. Together with several pioneering employers, the Pacific Business Group on Health, a not-for-profit coalition of healthcare purchasers, developed the Employers Centers of Excellence Network (ECEN), a travel surgery program that delivers high quality surgical care for a single competitive bundled payment rate.

Launched on 1/1/2014, the ECEN travels patients from four participating employers to one of five meticulously qualified and selected Centers of Excellence (CoEs) for total joint replacement and spine procedures. With over 500 completed joint replacements in the first year of the program, the ECEN is providing unparalleled access to high quality centers. The ECEN has created a new bar for center of excellence standards: with almost eighty provider groups considered for the network, few are able to meet both the center and surgeon-level requirements.

The episode-based bundled payment the ECEN negotiates with each participating center is all inclusive, meaning that all procedure-related services received during the 10-12 days patients spend in the CoE city are included. Early analysis indicates that ECEN cases cost up to 20% less than similar cases covered by health plan carriers. The ECEN is an exciting opportunity for employers and providers to show leadership in driving quality and advocating for value-based health care purchasing.

Learning Areas:

Administration, management, leadership
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe key clinical quality and patient experience criteria required by the Employers Centers of Excellence Network Differentiate the Employers Centers of Excellence Network from other Center of Excellence programs Formulate potential ways the Employers Centers of Excellence Network can influence purchaser, policymaker, and provider behavior

Keyword(s): Health Care Costs, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Associate Director of the Employers Centers of Excellence Network (ECEN). I regularly speak to purchasers, providers and other stakeholders about the ECEN and am responsible for the program's ongoing administration, strategic direction and growth.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.