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5 strategies for spine providers to appeal to cost-conscious employers

By Madeline VogelNahiyan Khan

October 10, 2022

    Patient steerage, including via Center of Excellence (COE) programs, has become appealing to employers due to their promise of lower costs and improved quality of care. In spine care, the idea is that employers partner with COEs that are committed to avoiding unnecessary surgery, thereby lowering employer costs.

    Additionally, by only reimbursing employee spine care if they receive care from a COE, employers steer their employees to them. This partnership, in turn, can lowers employers’ care costs through unnecessary surgery avoidance. Meanwhile, COE providers expect a guaranteed stream of volumes from their relationship with employers.

    In a 2020 survey of 165 U.S. employers, 75% said that they are currently utilizing or considering utilizing some form of patient steerage in the next 24 months—including narrow networks, national COE programs, and regional COE programs. Providers may need to gain COE designation or find ways to appeal to cost-conscious employers to prevent losing spine business.

    To help spine providers achieve these goals, we audited the websites of Walmart’s 10 designated spine Centers of Excellence to identify some of what those providers have done to gain inclusion in Walmart’s spine COE network. Given that Walmart likely serves as a model for other employers (as they were an early mover in spine steerage and their presence spans the entire country), their designated spine COEs can offer up strategies other providers can replicate to appeal to cost-conscious employers in their markets.

    Here are five strategies from Walmart’s spine COEs that providers can implement:

    1. Highlight spine care reputation and a personalized care experience

    The majority of Walmart’s COEs’ selling points include personalized care experiences and a reputation as the most advanced spine provider in the area, or, in some cases, the world. Many also marketed positive quality metrics, and access and convenience. For example, Mayo Clinic highlights it’s ranking among the best hospitals for neurology and neurosurgery, and it’s evidence-based, individualized, and comprehensive care.

    Next step for providers: Identify your value proposition to patients and highlight it on your website. One way to do this is through conducting patient surveys to learn why your organization was chosen.

    2. Ensure physicians are taking a multidisciplinary, team-approach to care

    Most of the designated providers state their commitment to bringing together staff from various operative and non-operative specialties. They believe that using a team-approach to care is essential in managing a patient’s spine care, as it involves a range of expertise to make a highly informed decision. For example, Memorial Hermann Texas Medical Center’s spine program markets an “expert” multidisciplinary team of board-certified neurosurgeons, neurologists, pain specialists, and therapists that take a team-approach to patient care.

    Next step for providers: Ensure your physicians across various spine specialties are not working in siloes and create forums for collaboration and data sharing. Read about how Penn Medicine took a multidisciplinary, team-approach to spine care in this case study.

    3. Offer wide-ranging, comprehensive spine services

    The spine offerings on most of the COE websites we audited are comprehensive, typically ranging from physical therapy to pain management injections to surgery, both minimally invasive and complex. For example, the Oschner Back and Spine Center markets a wide range of care options from physical therapy to advanced surgery, as well as a dedicated back rehabilitation program. Another example is Mayo Clinic’s emphasis on minimally invasive, technologically advanced procedures as well as post-treatment remote monitoring capabilities.

    Next step for providers: Ensure your spine program offers more than just surgery and has a comprehensive range of operative and non-operative services available to patients.

    4. Guarantee the most clinically appropriate care

    Many COE provider websites explicitly state that most spine conditions can/will be treated with conservative options (e.g., physical therapy, pain management) and that surgery will only be performed if necessary and after careful evaluation. For example, Carolina Neurosurgery & Spine Associates Comprehensive Spine Center’s website indicates that over 50% of their evaluated patients can use non-surgical treatments and avoid surgery altogether.

    Next step for providers: Have protocols in place to comprehensively evaluate patients and ensure they are getting the most clinically appropriate care recommendations through multidisciplinary input.

    5. Provide patients with visibility into the spine care pathway

    Some COE providers offer a more detailed explanation of the spine care pathway on their websites. Virginia Mason Medical Center explicitly describes what a patient’s first visit to their spine clinic might look like. They are first thoroughly evaluated by a physical therapist, and then discuss their issues with a physiatrist as well as the physical therapist. If physical therapy is determined to be the best treatment, “the first session will begin right then.” This transparency helps patients (and employers) better understand the spine care process.

    Next step for providers: Offer visibility into your spine care pathway on your website, in patient handbooks, and in journey-to-surgery guides.

    As employer COE networks increase in size and scope, employers are looking to work with organizations who can deliver lower costs, higher quality, and an excellent patient experience for their employees, among other things.

    While it’ll continue to be a key way to preserve volumes, not all providers are well-positioned to be spine COEs and/or adopt all the strategies mentioned above. Leaders need to carefully weigh the costs required to compete for and deliver on employer contracts with the value a given partnership will deliver.

    Is your spine program ready for employer steerage?


    Large employers are increasingly steering workers to high-quality providers for spine care, but their focus on surgery avoidance makes competing for steerage contracts challenging for most programs.

    Download this checklist to determine whether your spine program meets the three prerequisites for partnering with large employers.

    Download now

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