Optum has designated several specialties and service lines at Rochester, Minn.-based Mayo Clinic as Centers of Excellence, a bundled program for UnitedHealthcare customers and employers.
Mayo has participated in Optum's COE program for transplants for 11 years. Under the new agreement, the health system's locations in Arizona, Florida and Minnesota will participate as COEs for cancer, bariatric surgery and heart failure.
Mayo's providers in Rochester will also participate as a COE for congenital heart disease and infertility services.
When members and employers participate in the COE program, they pay negotiated, bundled rates for most services. Overall reimbursement is often capped at $10,000, according to the Star Tribune. Eden Prairie, Minn.-based Optum vets providers to choose high-quality hospitals and care teams that ultimately contribute to fewer unnecessary procedures and post-surgical complications.
How does Optum define "excellence"? It has more than 100 clinical experts who develop evaluation criteria, participants are evaluated annually. The experts examine procedure success and survival rates, the number of patients treated at a hospital for a specific condition, patient satisfaction and the hospital's involvement in clinical research, among other factors. COE criteria varies for different types of procedure.
Optum says its COEs yield tangible results. For example, the average length of stay for the transplant COE and clinical management program was 21 percent lower than the national benchmark in 2013.