Centers of Excellence: Why you should evaluate beyond short-term costs

Many payers and employers evaluate Centers of Excellence (COEs) primarily through a financial lens, focusing on mitigating the risk of short-term, high-cost medical events. But complex conditions usually involve long-term care needs and ongoing monitoring that accrue additional costs and impact workforce productivity.

That means, in practical terms, return on investment (ROI) also depends on how effectively care strategies reduce long-term costs and sustain better outcomes for members. With this in mind, payers and employers need to carefully consider how to connect members to the innovative care they may need from COEs — and drive measurable value over time.

Forward-thinking organizations can factor COEs into their benefits strategies to better support outcomes while managing total cost of care.

Why a long-term lens matters

Complex conditions rarely begin or end with a single medical event. Usually, a member first notices subtle symptoms that gradually worsen until they eventually seek a medical diagnosis. That tends to involve a series of tests and referrals before getting treatment, undergoing recovery, ongoing monitoring and any follow-up procedures.

Conditions like cancer, organ transplants, musculoskeletal disorder and fertility treatments have particularly complicated journeys. Outcomes depend on many factors, including severity of symptoms, accuracy of diagnosis, timeliness and effectiveness of intervention and post-recovery support. A single case may cycle through various scenarios and stages, each of which can shift a member’s care path while significantly influencing their well-being and the total cost of care.

The member’s best interests remain at the center, but costs accumulate throughout the journey. These often include sharp spikes for high-cost interventions and sometimes arise from redundancies or unnecessary procedures.

It’s crucial, therefore, to develop a coordinated benefits strategy that addresses the member’s clinical and lifestyle needs, while mitigating risk and accounting for current and future, predictable and unpredictable, financial implications. A well-designed COE benefits strategy accounts for potential journey shifts and builds in efficiencies, helping members receive the right care at the right time in the right setting.

Building an effective benefits strategy with COEs

An effective benefits plan strategy integrates COEs into a comprehensive framework that provides:

• Proven clinical structure to support consistent, quality care to deliver healthier members, better care experiences and more predictable costs and ROI. This includes:
  • Qualifying specialty networks, applying clinical standards and best practices in relationship management and staying ahead of advances in care and technology
  • Anticipating shifts in treatments and population needs, with case management, utilization management and data analytics driving better outcomes at lower cost
  • Establishing value-based incentives with clear, measurable expectations
• Deep industry and market expertise to connect members with evidence-based, whole-person care that enables better outcomes and promotes efficient use of healthcare resources
• Scale and scalable solutions that grow with organizational and population needs, efficiently managing and providing clinical and administrative resources
• An ability to evolve with changing industry needs, particularly in clinical innovation, defining relevant, measurable endpoints, and negotiating and implementing value-based contracting — all of which help ensure your organization can meet current member needs and anticipate new ones
• Access to enterprise-wide assets and resources to deliver scale and insights that optimize the benefits strategy, maximizing value and ROI

Together, these components help payers and employers improve members’ access to quality care while creating more predictable pathways, outcomes and total costs.

For example, cancer already costs an estimated $209 billion annually in the United States alone.¹ It’s a leading cause of death worldwide, and nearly 40% of men and women will receive a diagnosis in their lifetimes.¹ The cancer journey can last months to years, requiring coordinated care across screenings, treatments, ongoing management and end-of-life support.

Meanwhile, the number of cancer survivors is increasing. By 2030, there will be an estimated 22.2 million survivors.² This growing population highlights the need to help survivors maintain health, return to work, manage long-term side effects and monitor for recurrence.

By 2050, new cancer cases are expected to reach 33 million annually, with 18.2 million cancer-related deaths.¹ This underscores the critical need for payers and employers to address member needs while managing costs over time.

Feel supported with Optum

Optum offers proven care models, expert guidance, scale with scalable solutions and resources that evolve with your organization’s needs.

Learn more about Optum programs that work with COEs to improve outcomes for members, while lowering total cost of care and maximizing ROI.

References

1. National Cancer Institute. May 7, 2025. Cancer statistics.  https://www.cancer.gov/about-cancer/understanding/statistics.
2. American Cancer Society. 2019. Cancer treatment & survivorship facts & figures, 2019–2021. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/cancer-treatment-and-survivorship-facts-and-figures/cancer-treatment-and-survivorship-facts-and-figures-2019-2021.pdf