Health Plans Take A New Approach To Centers Of Excellence – OPEN MINDS Releases New Guide To COEs For The Complex Consumer Market

Gettysburg, Pa. (September 16, 2018) – A new report from OPEN MINDS analyzes the changing role of the Center of Excellence (COE) model of care for the complex consumer market. According to OPEN MINDS new analysis, most of COE initiatives among the largest health plans are focused on medical procedures related to complex physical health treatment such as bariatric surgery and transplants. Most health and human services related COEs are found at the local Medicaid plan level, or are through behavioral health organizations (BHO). Both Optum and Beacon Health Options, two of the largest BHOs, offer programs focused on clinical excellence for behavioral health provider organizations. These findings were released by OPEN MINDS in their recent reference guide, States & Insurers With Health & Human Services Center Of Excellence Programs.

Traditionally, a “center of excellence” has been defined as a research center focused on promoting best practices related to a certain health care condition or topic. Medicaid plans use COEs in either the traditional sense, or to designate organizations as providing high quality care. But health plans are taking a slightly different approach to the term COE. Generally, most health plan managers now define a COE as a health care provider with special expertise that can reduce costs and improve outcomes.

“COEs are part of the changing definition of value in the complex consumer market. And for provider organizations, there are some clear benefits of COE recognition. Often it means enhanced rates, additional referrals, special status in the provider directory, or additional consultative help from the health plan,” said Athena Mandros, Market Intelligence Director, OPEN MINDS. “Our new analysis gives executive teams an overview of the COE market and highlighted how both Medicaid plans and the largest health insurers are defining COEs and utilizing them in practice with complex consumers.”

A free summary of the report can be found at: What Does ‘Center Of Excellence’ Mean Now?. The report, States & Insurers With Health & Human Services Center Of Excellence Programs, is available at no charge to Premium and Elite members of The OPEN MINDS Circle and can be purchased in the OPEN MINDS shop for $295. The report includes information on state Medicaid programs with health and human services centers of excellence, and health insurers offering programs that reward clinical excellence through a COE-like facility designation.