CASE $6\mathrm{.}1$

Why limit the center of excellence to American $($continued$)$ providers? Excellent providers are available in other countries for much lower prices. For example, American private insurers paid an average of $$32,500$ for hospital and physician services for hip replacement. Australian insurers paid an average of $$20,900,$ and Swiss insurers paid an average of $$15,600($International Federation of Health Plans $2019).$ Hip replacement costs about $$12,500$ in Mexico $($CMQ Hospital $2021).$

One alternative to a center of excellence is a high$-$performance network, which identifies high$-$quality, cost$-$effective providers. No explicit contract may be required. In $2021,$ less than one$-$fifth of employers offered high$-$performance networks. This number is expected to grow significantly. Currently, centers of excellence are much more common, but it is difficult to distinguish marketing hype from reality.

Discussion Questions

Why do prices vary so much?

Why does clinical quality vary so much?

Why do patient experiences vary so much?

$-$What employers are participating in centers of excellence?

What services do centers of excellence typically offer?

Why might low$-$quality care be more expensive than high$-$quality care?

Have you or has someone you know used a center of excellence? What was your$/$their experience?

Why would risks for providers be higher for a center of excellence?

If you ran an ACO, would you choose a center of excellence or reference pricing?

Have centers of excellence grown as expected? Have highperformance networks?

Would you be willing to go to a center of excellence if you needed spine surgery?

Would you be willing to go to Cancun if you needed a hip replacement? Zurich?

What are the alternatives to a center of excellence program?