If you Google ACO and Centers of Excellence, you get mixed results which might also be the outcome of combining these approaches to improve healthcare quality and cost efficiency. First, a definition:  Centers of Excellence are generally hyper-focused on the treatment of a particular disease or condition. Examples include bariatric surgery, stroke care and breast cancer care. For these three conditions, there are external organizations that grant formal COE accreditation. But in most cases, a Center of Excellence is a self-dubbed designation used by a hospital or health system to promote a specific service line and team of specialists.

Even so, Centers of Excellence have had a place for quite some time in reimbursement reform. The linkage goes back at least as far as the Medicare Participating COE Demonstration of the late 1990s. Focused on bundled payments for defined episodes of care, it came well before the current Medicare Bundled Payments for Care Initiative (BPCI) and its predecessor, the Medicare Acute Care Episode (ACE) Demonstration.

So why revisit the topic? Because providers and private payers are promoting Centers of Excellence as part of their accountable care positioning. A specific example on the provider side is Atlantic ACO in Northern New Jersey, which identifies six specific COEs for its accountable care organization, ranging from diabetes, to cardiac and respiratory conditions to oncology and behavioral health. Atlantic ACO includes Atlantic Health System and Valley Health System, and covers all of their accountable care contracts (commercial and Medicare). Atlantic is a minority owner of Optimus Healthcare Partners, which is also using a COE model for a pulmonary Center of Excellence.

On the payer side, UnitedHealthcare is touting Centers of Excellence as part of its Accountable Care Platform/Accountability Continuum, aligning a COE model with bundled payments. Ranked lower are its P4P programs and higher its ACOs, based on the degree of provider integration, accountability and risk involved.

Done right, a Centers of Excellence approach weans specialists into accountable care introducing risk for targeted conditions and smaller populations.

They may be on to something. UnitedHealthcare's continuum is essentially a provider contracting strategy that recognizes not all providers are as ready or willing to bear medical risk. The approach starts smaller, with quality goals for primary-care physicians, and builds to specialists, adding cost control to the mix but keeping things targeted by focusing on specific episodes of care. Of course, United is also taking considerable heat for big cuts to its Medicare Advantage provider networks, adding a not-at-all-surprising dimension to accountable care.

Back on the provider side, Cleveland-based University Hospitals is taking a similar approach: deploying a COE model to develop evidence-based protocols specifically for its employee ACO a population over which it has tighter control. UH's other ACOs include a state Medicaid model, the Medicare Shared Savings Program and  you guessed it  UnitedHealthcare.

In both the United and UH examples, specialty care is weaned into reimbursement reform, with specialists having opportunities to adjust to bundled payments and more tightly controlled patient populations before being pulled into a downside risk ACO. Combining the COE approach with accountable care is a logical move as ACOs mature. As with so many care trends, where UnitedHealth goes, others often follow.

Follow Laura Beerman on Twitter at @LauraBeermanDRG

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