Democratizing Access to Care: The Rise of Virtual Centers of Excellence

With continued rising costs and increased awareness of site-of-service cost disparities, employers are actively looking for unique ways to steer employees to more efficient care with the best outcomes and putting pressure on their health plan partners to deliver on their promises for cost management.

Virtual care models are a bright spot in this pressured environment, reshaping how medical services are delivered, accessed, and paid for. The promise of virtual-first care is in bridging the gap between traditional healthcare delivery and innovative care models built for accountability to both patients and purchasers. Yet not all virtual care models are created equal. 

A new model of virtual care is emerging that promises to better democratize healthcare access for millions of Americans and revamp our care delivery system with a focus on value and efficiency. Early entrants are demonstrating how to apply this model across the most expensive condition types and accelerate this promising future. 

Centers of Excellence

A traditional Center of Excellence (COE) in healthcare is more than just a facility — it’s a specialized care delivery organization within a healthcare institution that delivers clinical leadership and innovation within a category of care. It is designed to provide world-class expertise and resources for specific medical conditions. These centers are known for their medical breakthroughs and comprehensive, interdisciplinary approach to care, delivering superior patient outcomes and reduced total cost of care while setting industry standards for clinical excellence. 

Historically, COEs have been pivotal in bridging gaps in care across medical specialties and subspecialties by offering highly specialized care, research, and education that local hospitals and health systems may not provide. Their contributions to patient outcomes and pioneering care models are so significant that patients will travel from every state and internationally for treatment – often at great expense and disruption to their lives, families and employers.

The challenge is that access to these COEs is severely limited. Many operate at full capacity, constrained by tight funding, staffing challenges, and physical infrastructure. Most are structured for episodic care, which isn’t well-suited for managing complex, chronic conditions effectively. And not all employers opt in to cover COE treatment and the associated travel, which leaves many patients bearing substantial financial burdens.

Despite these challenges, the rising prevalence of chronic conditions and associated costs mean the case for scaling center-of-excellence level care to achieve more equitable healthcare outcomes nationwide is stronger than ever. 

Achieving virtual excellence: A new approach to COEs

The dawn of virtual-first care has untethered COE models from localized, brick-and-mortar settings with the advent of the virtual Center of Excellence (vCOE). By leveraging digital technologies, vCOEs take the core principles of the traditional COE to make continuous, high-quality specialty care more accessible and more convenient for patients anywhere. 

This model promises to revolutionize healthcare delivery and set new standards for excellence, access, and equity for entire populations by enabling:

• Convenient, patient-centric care that is easily accessible from home and offers flexible scheduling, timely interventions, and ongoing support for chronic conditions. 
• Improved access to clinical expertise by coordinating a multidisciplinary team of experts nationwide, overcoming geographic barriers, ensuring patients receive care from top-tier specialists regardless of location.
• Seamless coordination with the local care ecosystem for necessary in-person care, optimizing for site of service. 
• Value-based payment models with major insurers to make vCOE care more financially feasible for patients and to facilitate easier contracting with employers seeking comprehensive, national healthcare solutions. 
• Closing the evidence gap as vCOEs are able to swiftly implement emerging evidence and guidelines into practice, ensuring patients receive the most current and effective treatment available.

Of course, building a vCOE entails challenges, most notably, building a national multidisciplinary workforce of specialized clinicians – who go through a tedious state-by-state licensing process established when healthcare delivery was only local – and requires significant time and monetary investment. 

Achieving the level of quality foundational to COEs also requires meaningful dedication to incorporating the latest research and guidelines, training the clinical workforce, and building clinical protocols to support the application of evidence-based diagnosis and treatment across the multidisciplinary team. It also requires investing in clinical and actuarial evaluation to prove outcomes and savings in a rigorous way. 

Lastly, to address the affordability challenge, insurance coverage is crucial as vCOEs establish in-network contracting with every national and local payer, each requiring rigorous clinical review and network integration.

These requirements have dissuaded many digital health companies (and their investors) from this path in favor of easier, less rigorous options. However, as traditional COEs have demonstrated, the investment is worth it to transform the patient experience and to achieve the highest-caliber clinical and financial outcomes.  

The promise of virtual-first: Coordinated, collaborative care

The first and most common question posed to virtual Centers of Excellence is how to manage necessary in-person care and coordinate that care. For payers, this also manifests as a question of complementing their existing provider networks. 

The benefit of vCOEs is as significant to local in-person healthcare providers as it is to patients. The immediacy of vCOE appointment availability gives patients an alternative – and often a strong preference – over emergency department or urgent care utilization. Drawing from significant patient volume experience, vCOE specialist clinicians are uniquely suited to make a preliminary diagnosis, make recommendations that immediately start treating symptoms while ordering appropriate tests from high-quality labs and imaging centers.

vCOEs are purposefully structured and staffed to coordinate care within the network ecosystem, order appropriate tests, explain those test results, develop care plans, and provide support between visits – all with the intention to guide patients to empowered health. vCOE partnerships with high-quality specialist provider groups enjoy reciprocal benefits: Practice capacity is optimized for well reimbursed in-person visits and procedures, and patient care plan adherence and complementary care that local clinics often don’t provide is supported by virtual visits and messaging with multidisciplinary clinicians that are scarce locally.   

To fully achieve the promise of the vCOE approach, these six key tenets must be considered:

1. Clinical rigor: Adhering to the latest clinical guidelines and evidence-based practices, as well as conducting rigorous clinical evaluation to prove outcomes and savings.
2. Multidisciplinary collaboration: Bringing together experts from various fields to offer comprehensive, coordinated team-based care, including collaboration with community providers where clinically appropriate.
3. Patient-centered approach: Designing care models around the needs and preferences of patients, ensuring access and convenience.
4. Innovative payment models: Establishing payment mechanisms driven by accountability towards patient outcomes, supporting payers’ own strategic initiatives for value-based speciality care
5. Technology integration: Leveraging telehealth and other digital tools to enhance care delivery and patient engagement.
6. Continuous improvement: High case volume creates a platform for continuously evaluating outcomes and processes, advancing research initiatives within the space.

These transformative qualities position vCOEs at the forefront of healthcare innovation, promising a future where specialized care is more accessible, efficient, and effective for all. By integrating this type of model into the broader healthcare system, we can create a more equitable, efficient, and patient-centered approach to care.

Implications for the future of healthcare

The implications of vCOEs extend far beyond patient access and clinical outcomes. These models represent a pivotal advancement in healthcare delivery, poised to revolutionize patient care on multiple fronts. By eliminating geographical and cost barriers, vCOEs ensure that top-tier specialized care is accessible to a broader population, addressing disparities in healthcare access. 

And, this model can be adapted to various specialties or clinical acuities, demonstrating its flexibility and effectiveness. In the not so distant future, we believe vCOEs must exist for chronic conditions including gastrointestinal, diabetes, heart disease, and mental health, where ongoing management and multidisciplinary care are crucial.

Fully democratized access to virtual COEs’ cutting-edge care will still take time and work, but momentum is building. Health plan partners are leading the work of rigorous clinical screening, virtual COE contracting, and communicating the available care to members as a network benefit. 

A new American medical system is within view – one where patients can easily find vCOE care through their insurance plan, have access to the best specialized clinicians anywhere in the country, and achieve a quality of life and level of health that ultimately bends the curve on healthcare costs. 

Photo: Dilok Klaisataporn, Getty Images

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