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October 17, 2019Cart

Business

by Fairfield County Business Journal
by FCBJ

Connecticut’s ‘Centers of Excellence’ health care moves forward

The “Centers of Excellence,” a regional network of hospitals and providers designed to offer the cheapest medical procedures for state employees, retirees and ultimately the general public, is moving closer to becoming a reality.

State Comptroller Kevin Lembo, who announced the initiative in July, said that two contractors have been selected to help implement the network. Remedy and Health Advocate will work with Lembo’s office to establish the state centers, expected to launch next year, for certain complex planned medical procedures, while Carrum Health will provide access to a national network of Centers of Excellence.

The latter’s team will assist consumers in getting covered services from hospitals and other providers identified as Centers of Excellence. Services and care included in the program would include but not be limited to:

  • Joint replacement
  • Comprehensive Spine (a program that seeks alternatives to spine surgery for individuals suffering from back pain)
  • Women’s health and maternity
  • Certain cancer surgeries or treatments
  • Cardiac treatments
  • Bariatric surgery
  • Chronic condition management

The program will also include incentives to encourage plan members to participate in clinical programs that may reduce unnecessary surgeries and interventions, and covered services will expand over time, Lembo said.

Hospitals and provider groups that receive the designation of a Center of Excellence are those that have demonstrated a sustained commitment to excellence and can demonstrate the best patient outcomes.

The comptroller’s aim is to ensure that the approximately 210,000 working and retired families on the state health plan – and ultimately every Connecticut resident – will have the tools necessary to make the most informed possible health care decisions.

“Patients have been forced to make important decisions about where to receive treatment or have major surgical procedures with little to no information about which facilities have the best outcomes,” Lembo said. “This is unacceptable.

“Instead of leaving patients in the dark,” he said, “the state will work with its partners to identify those facilities that are true Centers of Excellence. Patients will, for the first time, be able to see who performs best for each procedure or service and make informed decisions about where to receive care.”

The comptroller said the initiative is a double win: “When patients are treated by the highest quality providers, it not only results in the best health care outcomes for patients, but it provides the best financial outcome for the state – because low-quality care and poor outcomes, including hospital readmissions or unnecessary prolonged treatment that results from poorly done procedures is bad for patients and compromises the overall operation of the state health plan.”

The Centers of Excellence model builds off of a provision of the SEBAC 2017 agreement, which allows the state to provide incentives to plan participants in exchange for using high-quality health care facilities.

“This innovation is designed to inspire changes in practice patterns across the entire state and region – supporting a culture of continuous improvement across all hospitals and provider groups in the state,” Lembo said. “The Northeast is home to some of the best health care providers in the country, which means no patient should settle for anything less than the best.”