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High-Performance Networks/Centers of Excellence

Why Employers Care

The idea of high-performance networks (HPN) including centers of excellence (COE) is not new. However, documented significant variations in price and quality for the same procedures keep HPN and COE high on the list of employer strategies to improve health plan value.

Thirty-eight percent of employers use COEs for procedures other than transplants; 18% of employers offer an HPN/narrow network, and 13% differentiate cost sharing to incent employees to access these care options.1

COEs have shifted from a focus on low frequency, high cost events such as transplants, to addressing moderate frequency, moderate to high cost conditions including knee replacement, back surgery, CABG and metabolic surgery. At the same time, it has become clear that a single COE or preferred facility is unlikely to be a high performer on all procedures within a category such as orthopedic, cancer or cardiac care.

Direct contracting with specific facilities or narrow networks is being tried by a small number of employers working with consulting firms or other third parties. Considerations for employers interested in this approach include potential savings, quality criteria, TPA capabilities, and benefit design elements such as eligibility, coverage differential, allowable price per market, notification requirements, additional incentives/penalties, employee communications and performance evaluations.

What Can Employers Do?

Employers can take several actions to optimize the value of HPN and COE:

  • Require patient safety criteria for COE status;
  • Encourage employees to use high quality providers by differentiating cost sharing;
  • Incent the use of treatment decision-support resources such as second opinion services and shared decision-making tools;
  • Cross-train vendors to refer employees into HPN or COEs;
  • Offer price and quality transparency tools; and
  • Carefully explore the option of direct contracting.

Relevant Tools and Resources Include:

Page last updated: July 28, 2015

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