News From Kevin Lembo

FOR IMMEDIATE RELEASE                                                                                                                          WEDNESDAY, JULY 17, 2019

Contact: Tara Downes
860-702-3308
Tara.Downes@ct.gov 

LEMBO ANNOUNCES INITIATIVE TO ESTABLISH HEALTH CARE "CENTERS OF EXCELLENCE" IN CT

State Comptroller Kevin Lembo announced today that, through the negotiating power and leverage of his office, he is working with health care providers across Connecticut to establish a network of “Centers of Excellence” – a system of hospitals and other providers that verifiably provide the best possible health care outcomes at the most fair price.

This will allow Lembo to ensure that the approximately 200,000 Connecticut working and retired families on the state health plan are equipped to make the smartest possible health care decisions.

“There are health care providers in the industry that charge tens of thousands of dollars more for a procedure than a competitor that performs the same procedure better for less,” Lembo said. “In what kind of backwards world would we accept that kind of consumer service and dynamic? Nowhere – and we certainly should not when our lives, and that of our families, is concerned. Connecticut is going to demand the best health care at the best price.

“Connecticut is home to some of the best health care providers in the country, which means no patient should settle for anything less than the best.”

Here’s how Lembo plans to establish health care Centers of Excellence, and save the state money in the process:

Lembo has issued a request for proposals (RFP) to build a regional network of Centers of Excellence for certain complex planned medical procedures. The Centers of Excellence will be hospitals and other providers that have demonstrated a sustained commitment to excellence and can demonstrate the best patient outcomes.

Through the RFP, Lembo is seeking to contract with a third-party administrator to assist state health plan participants in getting their services at a Center of Excellence, and oversee financial reward incentives for patients willing to make smart health care decisions. When costs for the same procedure vary by thousands of dollars, in some cases, small financial incentives to direct patients to the best provider will save significant immediate and long-term costs.

The Centers of Excellence model will build on the state’s existing SmartShopper program that currently provides monetary incentives for participants to utilize high-quality lower cost locations, however, the Centers of Excellence program will go much further, Lembo said.

Rather than simply connect patients with the best providers, Lembo said his office will work with the selected vendor to identify the best performing hospitals in the region for a multitude of procedures and work with the vendor to contract with the top performing hospitals and other providers in order to get the best available rates for services covered under the Centers of Excellence program. This will allow the state to negotiate a win-win that results in deeper savings for better patient outcomes.

The awarded vendor will provide staff and services necessary to assist consumers in getting covered services from hospitals and other providers identified as Centers of Excellence, those with the highest quality lower cost procedures, elective surgeries or screenings. Services and care included in the Centers of Excellence program would include – but not be limited to:

  • Joint replacement
  • Women’s health and maternity
  • Certain cancer surgeries or treatments
  • Cardiac treatments
  • Bariatric surgery

The program will also include incentives to encourage plan members to participate in clinical programs that may reduce unnecessary surgeries and interventions, Lembo said.

The selected vendor partner, working in collaboration with the state through Lembo’s office, would be expected to directly contract with facilities and providers within Connecticut and surrounding states to build a comprehensive and credible network of Centers of Excellence that meet high-quality standards.

“The program will reduce the costs paid by the state health plan for certain high-cost procedures, while improving patient outcomes,” Lembo said. “Ultimately, patients have the power to pick and choose where they go – but we’re going to make sure that they have as much information as possible to make their choice.”

  

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