title: Finding the Value in 'Value' Designation: Evidence and Opportunity in the United States.
abstract: Centers of Excellence (COE) designations have been used to distinguish high-quality facilities. Originally based on quality metrics alone, published evidence failed to consistently show improvements in measurable quality markers. COE development has since shifted to a value-based framework incorporating cost of care, providing greater transparency. This study evaluated the patient outcomes of such value-designated facilities certified under one of the larger U.S. commercial provider networks.
  
  
  
  Retrospective, observational study using 2009-2013 commercial administrative claims data.
  
  
  
  Analysis included 33,827 adults (≥18 years) who received spine surgery at value-designated (n=6,141, 22%) vs. other facilities (n=27,686, 78%). Multivariate regression models were used to compare 90-day episodic costs and quality outcomes, adjusted for patient characteristics and comorbidities.
  
  
  
  Adjusted episodic cost per surgery was lower in value-designated facilities by $3,157 (16%) for lumbar discectomy/decompression, $6,784 (19%) for cervical simple fusion, and $11,134 (18%) for lumbar simple fusion (all P<.05). Adjusted complication rate was lower (1.5% vs. 2.0%; P<.05) at value-designated facilities, while other quality measures were similar. Value-designated facilities tended to be large, in metropolitan areas, affiliated with medical schools, and performed more surgical procedures and provided more nursing hours.
  
  
  
  To our knowledge, this is the first large-scale study evaluating value-designated COE. Value-designated COE programs represent an advance over a cost- or quality-alone designation in the ability to identify facilities with lower costs and equal or better quality outcomes. Value designation offers patients transparency for selecting care providers. Future efforts should continue to refine quality criteria used in designations to distinguish patient outcomes.
authors.affiliation: HealthCore Inc., Wilmington, Del.
authors.forename: Sze-Jung
authors.initials: SJ
authors.lastname: Wu
authors.affiliation: HealthCore Inc., Wilmington, Del.
authors.forename: Qinli
authors.initials: Q
authors.lastname: Ma
authors.affiliation: Anthem Inc., Indianapolis, Ind.
authors.forename: Patricia
authors.initials: P
authors.lastname: Martin
authors.affiliation: HealthCore Inc., Wilmington, Del.
authors.forename: Andrea
authors.initials: A
authors.lastname: Devries
mesh_terms: D000328:Adult; D005260:Female; D006302:Health Services Research; D006742:Hospital Bed Capacity / Q000706:statistics & numerical data; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D006782:Hospitals, Special / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000601:surgery*; D014481:United States / Q000453:epidemiology