TL/DR –
The article discusses the rise of employer-sponsored health plans using Center of Excellence (COE) programs to provide specialized care for selected health services. In 2023, 34% of large firms reported sponsoring COE programs including behavioral health services, with a higher share (45%) among the largest firms. While COE programs can channel patients to specific providers, the article also highlights potential limitations such as difficulty with timely access to services and higher out-of-pocket costs for those who prefer providers not participating in COE programs.
Increasing use of Center of Excellence Programs in Employer-Sponsored Health Plans
Employer-sponsored health plans are increasingly leveraging Center of Excellence (COE) programs to deliver specialized care to their enrollees. These programs identify and select providers based on the quality, cost, and outcomes of their healthcare services, such as lower readmission rates or additional accreditations. The structure of COE programs varies; some plans restrict coverage to COE providers, while others offer lower cost-sharing for enrollees using COE providers. COE programs can focus on specific services such as behavioral health, which includes mental health and substance use disorder services.
COE Programs in Large Companies
In 2023, 34% of large firms (1,000 or more employees) adopted COE programs, with prevalence rising to 45% in the largest firms (5,000-plus employees). A significant portion of these large firms with COE programs reported having programs for behavioral health services – 29% of them provide such services. However, 13% of large firms with COE programs were uncertain whether their programs included services listed in KFF’s EHBS survey.
Expansion and Limitations of COE Programs
About 27% of large firms with a COE program added a new COE program in the last two years. Despite the uncertainty regarding whether these new services pertain to mental health or substance use treatment, COE programs are moving beyond high-cost specialized surgeries. They are now addressing mental health and substance use disorders, including programs for autism, eating disorders, and residential addiction services. However, limiting in-network coverage to a few providers may pose challenges for enrollees, such as delayed access to services and higher out-of-pocket costs for non-COE providers.
Impact of Federal Regulations on COE Programs
A recent Congress report on implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA) highlighted increased enforcement on illegal exclusions of coverage for certain treatments. The scrutiny of behavioral health provider network composition may have encouraged employers to include these services in their benefits packages. Employers may see COE programs as a means to control costs and guide patients to specific behavioral health providers and residential treatment centers.
—
Read More Health & Wellness News ; US News