Centers of Excellence May Deliver High Quality Care, But Could Impede Access to Care Without Safeguards

Centers of Excellence May Deliver High Quality Care, But Could Impede Access to Care Without Safeguards

Centers of Excellence (COEs) are specialized programs in health care institutions that have a high concentration of expertise on a particular medical area. Within their area of expertise, COEs typically provide comprehensive care through an interdisciplinary approach. These centers have been previously used for bariatric surgery, stoke care, cancer treatment, among others. However, there is no set definition or certifying body for defining COEs. Many employers view COEs as a desirable health care structure because of they are perceived to offer an enhanced quality of care that improves patient outcomes and efficiency. In addition, there is some evidence that these centers reduce provider error that results in unnecessary procedures.

The COE model has attracted attention from employers who are looking for lower-cost and potentially higher quality care for their employees. Walmart has been in the spotlight for their recently expanded COE model for their employees. This model expanded from six to fifteen COEs across the country and span in treatment specializations like oncology, knee and hip replacement, heart, spine, and transplant surgeries. Walmart now requires that their employees with health insurance use these COEs but also ensure that employees do not have to pay any cost-sharing when they get care from a COE and cover all of the travel expenses of the employee and a caretaker.

COEs have some distinct limitations by virtue of their structure. For example, these centers are difficult to replicate in many locations so patients will often need to travel long distances to them. This has several implications. Those who need the services from a COE have to take time off work and be away from their families and obligations, not only for the time needed to receive health care services but also for travel back and forth. In some cases, parents and other caretakers will also have to take time off work to travel and provide care for their loved ones receiving care at a COE. In addition, where a single parent or both parents must travel to the COE, the family may need to arrange for childcare. Finally, since many COEs are associated with University Hospitals and Medical Schools that are located in urban centers, these policies could exacerbate access barriers and health disparities for those who live in rural regions.

Recently, state Medicaid programs and Medicaid MCOs have experimented with steering beneficiaries toward, or even limiting them to, receiving certain specialty services only from designated COEs. While these policies may advance a goal of ensuring that low-income people on Medicaid get high-quality and cost-effective care, these policies can also harm beneficiaries by restricting their choice, and forcing people who have low-incomes to travel longer distances to receive care and incur financial costs they cannot afford.  Advocates should ensure that Medicaid programs offer appropriate alternatives to beneficiaries who are not able to travel to COEs, including the use of telemedicine when appropriate, or coordinating care with local providers.

At the same time, advocates should support policies that facilitate access to COEs, particularly when they are used to provide care for individuals with highly specialized needs and complex conditions. Medicaid programs that include COEs as network providers must provide access to comprehensive transportation assistance for beneficiaries who travel to COEs, including lodging costs as needed, and childcare assistance where appropriate. While COEs offer necessary expertise for many health care consumers, Medicaid programs that use COEs to deliver specialty services to beneficiaries must not do so at the expense of beneficiary access to care.

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