Employers consider Centers of Excellence (COEs) their best option for controlling healthcare costs. As many of the 92% of employers with a COE know, however, simply having something in place doesn’t necessarily drive the cost and quality improvements employers need.
We talked with Brittany McIntosh, Director, Employee Benefits, at NextEra Energy; Suzanne Dezember Usaj, Sr. Director, Total Rewards, at The Wonderful Company; and Wendy Smith, DsC, National Practice Leader – Delivery System Transformation at Aon Health Solutions about how employers can find a solution that truly delivers on engagement, quality and cost savings. Evelyne Giguere, SVP, Consultant Relations at Employer Direct Healthcare (EDH), moderated the conversation.
A few key takeaways:
- Employers are turning to COEs because they want predictability in both costs and outcomes—and cost does not equal quality in healthcare.
- Network access is critical. Fewer employers are interested in solutions that require employees to fly and be away from their families for days at a time. EDH mentioned that 98% of members are able to drive to their care.
- Aon, the Wonderful Company and Nextera Energy shared the positive experiences employees have had with EDH/SurgeryPlus and the savings they’ve seen, including MSK no longer being a top-five cost area.
Start with the Data
Evelyne opened the conversation by asking panelists what problems they were looking to solve by bringing on a COE solution.
Suzanne Usaj of The Wonderful Company shared that they were seeing prices rising dramatically for both inpatient and outpatient care. “It was pretty clear that not all of those costs were valid, in terms of appropriateness of care,” she said. “We also noticed that many people were having trouble getting to the right type of care and understanding what they were getting into when they made decisions about surgeries.”
The Wonderful Company wanted to find a solution that both lowered costs and guided employees to providers they could trust to help them make the right decisions for their care. “Cost and quality do not align in healthcare,” she said. “And so you can lower costs while increasing quality.”
NextEra saw similar cost spikes in their data, especially for musculoskeletal pain, which was one of their top five spend categories. “At the time, our analytics team dug a little deeper into the data, and there we saw some indications that were potential gaps in access quality and also appropriateness,” said Brittany. “Of course, we were looking to reduce our surgical spend, but we ultimately viewed that as secondary because we truly believed if folks are getting to the right care with the right doctor at the right time, then cost containment is going to come into play.”
For companies looking for similar insights, Wendy of Aon touched on the types of reports she encourages clients to ask their carriers for when looking to get a deeper understanding of their healthcare spending. “Clinical reports can always be requested at a deeper level from your carrier,” Wendy said. “I think a lot of times those are underutilized reports, so I always recommend our clients pull those forward.”
Network Considerations
When assessing solutions to those challenges, taking a close look at a solution’s network is one of the first pieces of the puzzle, panelists shared.
At EDH, we see that proximity to a provider plays a significant role in whether a member will receive care. Wendy agreed that fewer employers than in the past are interested in COE solutions that require employees to fly.
To that end, employers are looking for solutions that include high-quality options close to home. For The Wonderful Company, with many employees living in a healthcare desert, that also meant working with a solution that could be flexible and grow with them to expand local options for their employees.
“A lot of our employees are based in rural communities and many COEs are at minimum two and a half hour-plus hour drive or even further,” said Suzanne. “We needed the flexibility to grow and so that partner needed to understand that that was really important to us and be able to say, ‘Tell us who that partner is and we will go help you with that.’”
NextEra has employees around the U.S., so they needed a solution with a nationwide footprint. Brittany emphasized that while proximity was important to them, they wanted to make sure to find a partner that prioritized quality first.
“Quality is also of utmost importance to us,” she said. “Finding a solution partner that keeps that at the forefront and is aligned with our needs and our goals is really part of our minimum criteria when looking and thinking about networks.”
One challenge with evaluating COE solutions is that the definition of quality varies. Wendy shared her perspective on how EDH vets the SurgeryPlus network at the surgeon level. “Transparency of cost, that’s different than quality. But then what SurgeryPlus does in order to evaluate who gets to participate is also important,” she said. “The rigor around looking at the credentialing, the board certification, malpractice cases, and several other components really narrows down the number of people that are even looked at to be talked with about a contract.”
Member Experience
Being able to find options close to home is one part of the member experience. But healthcare is complex, and getting to appointments is just one part of it. Both The Wonderful Company and NextEra wanted to find a solution that helped their employees easily understand their options, costs and any other questions as they navigated their care.
“That partner needed to be able to help weed through options and navigate that already complex system,” said Suzanne.
For The Wonderful Company, finding a solution that offered that level of support in Spanish was also a high priority.
The NextEra benefits team also wanted to find a partner that would offer employees concierge support—specifically, they looked for a partner that would treat their employees the same way they treat them and their customers. “Our culture is very important to us, and we always look for our vendors to really understand who we are and the work that we do,” said Brittany.
Promising Results
Brittany said that through SurgeryPlus, they were able to reduce the same costs that inspired them to look for a COE program in the first place.
“We had 119 completed surgeries and 19 avoided surgeries in 2023,” Brittany said. “So 19 people who contacted SurgeryPlus, went through the program and were evaluated and it was determined that they did not, in fact, need a procedure. So we love to hear that. And then we are also seeing meaningful savings. MSK is no longer in our top five spend categories.”
Part of the success of the program has come through word-of-mouth recommendations as employees have a positive experience with their Care Advocates and surgeons, Brittany said.
The Wonderful Company launched in January 2024, but the program is off to a positive start. Suzanne also shared that seeing employees avoid procedures is one early indicator that the program is delivering on quality.
“Our biggest fan so far actually ended up as a avoided procedure after traveling across the state, and it was not only, you know, savings as a result, but also so happy that we would invest in her,” she said.
Watch the full webinar on demand.
If you want to learn more about improving care access and reducing costs at your company, reach out to learnmore@edhc.com.
