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August 18, 2019Cart

Business

by Fairfield County Business Journal
by FCBJ

CT comptroller seeks to rein in health care costs with ‘Centers of Excellence’ network

With health care costs continuing to rise, Connecticut State Comptroller Kevin Lembo announced he is working with providers across the state to establish a network of “Centers of Excellence,” a regional network of hospitals and providers that offer the cheapest medical procedures for approximately 200,000 working and retired patients on the state’s health plan.

Lembo

“There are health care providers in the industry that charge tens of thousands of dollars more for a procedure than a competitor that performs the same procedure better for less,” Lembo said. “In what kind of backwards world would we accept that kind of consumer service and dynamic? Nowhere – and we certainly should not when our lives, and that of our families, is concerned. Connecticut is going to demand the best health care at the best price.”

The comptroller has issued a request for proposals (RFP) to build the regional network for certain complex planned medical procedures. The Centers of Excellence will be hospitals and other providers that have demonstrated a sustained commitment to excellence and can demonstrate the best patient outcomes.

Through the RFP, Lembo is seeking to contract with a third-party administrator to assist state health plan participants in getting their services at a Centers of Excellence facility, and oversee financial reward incentives for patients willing to make smart health care decisions. When costs for the same procedure in some cases vary by thousands of dollars, Lembo said, small financial incentives to direct patients to the best provider will save significant immediate and long-term costs.

The Centers of Excellence model will build on the state’s existing SmartShopper program that provides monetary incentives for participants to utilize high-quality lower cost locations.

Rather than simply connect patients with the best providers, Lembo said his office will work with the selected vendors to identify the best performing hospitals in the region for a multitude of procedures and work with the vendors to contract with the top performing hospitals and other providers in order to get the best available rates for services covered under the Centers of Excellence program.

The awarded vendor will provide staff and services necessary to assist consumers in getting covered services from hospitals and other providers identified as Centers of Excellence, those with the highest quality lower cost procedures, elective surgeries or screenings. Services and care included in the Centers of Excellence program would include, but not be limited to:

  • Joint replacement
  • Women’s health and maternity
  • Certain cancer surgeries or treatments
  • Cardiac treatments
  • Bariatric surgery

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

The selected vendor partner, working in collaboration with the state through Lembo’s office, would be expected to directly contract with facilities and providers within Connecticut and surrounding states to build a comprehensive and credible network of Centers of Excellence that meet high-quality standards.