Employers use Center of Excellence programs as a pathway to behavioral health services

A growing number of employer-sponsored health plans are using Center of Excellence (COE) programs as a way to provide enrollees with specialized care for select health services. COE programs designate providers or facilities based on the cost and quality of care they provide. Providers participating in COE programs often specialize in selected services and may provide additional case management and other patient support services. Participating providers may be selected based on the results they achieve, such as lower readmission rates, or because they have earned additional accreditations. Plans vary in how they structure their COE programs, with some plans limiting coverage to providers participating in the COE and others providing lower cost sharing for enrollees to use a provider within the program. KFF’s 2023 Employer Health Benefits Survey asked employers about the COE programs included in their largest plans, including those that focus on behavioral health services (these include mental health and substance use disorder services substances).

In 2023, 34% of large firms (firms with 1,000 or more employees) reported sponsoring COE programs, with a higher share (45%) reported among the largest firms (firms with 5,000 or more employees). Companies can sponsor different COE programs for different services. Many of these large firms (firms with 1,000 or more employees) with COE programs report offering behavioral health services programs. Among large firms with COE programs, 29% reported offering behavioral health services (this included 25% offering mental health services and 25% offering substance use services). In other words, one in ten large firms has a COE program that includes at least some behavioral health services (Figure 1). Of note, 13% of large firms with COE programs do not know if their programs include any of the services listed in KFF’s EHBS survey (bariatric surgery, mental health, substance use, back or spine surgery, or shift of joints).

Among large firms (firms with 1,000 or more employees) with a COE program, roughly a quarter (27%) reported adding a new COE program in the past two years. However, it is not known whether these newly added services address mental health or substance use treatment.

COE programs are often used for expensive specialty surgeries, such as transplant, spine, or bariatric surgery. In recent years, several insurers have established COE programs for mental health and substance use disorders, such as programs for autism, eating disorders, and residential addiction services. COE programs may limit network coverage for selected services to a smaller group of providers than participate in the provider network as a whole. While this may allow enrollees to access more providers who have additional specialized capacity or track records for specific services, enrollees may also face certain limitations. For example, with a limited number of providers, enrollees may have difficulty accessing services in a timely manner; and enrollees who prefer providers that do not participate in COE programs may face higher out-of-pocket costs.

A recent report to Congress on the enforcement of certain provisions of the Mental Health and Addiction Equity Act (MHPAEA) to Congress noted a new law enforcement focus on illegal exclusions from coverage for home treatment and specific autism treatments. This, along with increased scrutiny of the network composition of behavioral health providers, may have led employers to add these services to their benefit packages. Center of Excellence programs may be one way employers try to control costs and direct patients to specific behavioral health providers and home treatment centers.

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