Centers of Excellence (COE)

The Centers of Excellence (COE) Program offers knee and hip replacement surgery and spine care for low to no cost to qualifying Uniform Medical Plan (UMP) Classic and UMP CDHP members.

Premera Blue Cross administers the COE Program for UMP. For more information about the COE Program, call Premera at 1-855-784-4563  (TRS: 711).

Learn more about this benefit.

Visit Premera's COE page

Why create the COE Program?

The Health Care Authority (HCA) works to provide high-quality health care at the lowest possible cost to our members. The COE Program is part of HCA’s continued efforts to pay for value instead of volume and supports HCA’s Healthier Washington initiative.

Through the COE Program, HCA contracts with providers who excel in treating certain medical conditions. These providers are selected to be a part of the COE Program because they have proven their ability to provide excellent service with successful results for patients with those conditions.

Virginia Mason is the UMP COE for knee and hip replacement surgery. HCA selected Capital Medical Center and Virginia Mason as the COEs for spine care, beginning January 1, 2019. Premera Blue Cross administers the COE Program.

UMP Classic and UMP CDHP members who meet medical and other criteria described below can receive their treatment, including pre- and post-surgical care, at low to no cost. The Program also includes a travel and lodging benefit for eligible expenses.

  • The COEs use evidence-based best practices as recommended by the Bree Collaborative.
  • The COEs assume financial risk for preventable surgical complications and infections.
  • The COEs' clinical teams – including physicians, hospitals, and others involved in coordinating patient care – keep the member involved in every step of the decision-making about their care choices.
  • HCA reimburses in what is called a “bundled payment,” one sum for the entire episode of care, including diagnosis, surgery and rehabilitation.
  • HCA reviews the quality of care given to its members by the COEs.

COE results

HCA began offering the COE Program for single knee and single hip replacement to qualified UMP Classic and UMP CDHP members on January 1, 2017 (HCA will offer spine care starting January 1, 2019). HCA's success with the COE Program is highlighted on the New England Journal of Medicine’s blog, Catalyst.

First year results for knee and hip replacement COE 

  • 95 joint replacement surgeries performed
  • Residence of participating members:
    • Eastern Washington: 24 percent
    • Western Washington: 56 percent
  • No participating members experienced complications, readmissions or surgery revisions
  • Average out-of-pocket expense amount saved by participating members: $988.46
  • Participating member satisfaction with COE (scale of 1-10):

My case manager was courteous and helpful

9.8

I felt ready for my surgery

9.5

The travel arrangement met my needs

9.1

My recovery went well

9.1

If I have another joint replacement, I would choose to use this program

9.7

I would recommend this program to family and friends

9.7

Overall satisfaction with your total experience

9.5

Am I eligible?

The COE Program is open to UMP Classic and UMP CDHP members who:

  • Are 18 years or older.
  • Are not enrolled in Medicare as their primary coverage.

The COEs must determine if the surgery is the appropriate treatment for your condition. Their decision will be based on established medical guidelines for knee and hip replacement and spine care.

Note: The COE Program is not available to members enrolled in Medicare as their primary coverage or UMP Plus members. Medicare and UMP Plus members still have access to covered services related to joint replacement and spine care outside of the COE Program. These services may be paid at the standard rate.

How much does this benefit cost?

For UMP Classic members, treatment under the COE Program is covered in full. For UMP CDHP members, treatment is covered in full after they meet their annual medical deductible.

To learn about your cost share for this benefit, read the "Joint replacement surgery" or “Spine care” section in your UMP Classic or UMP CDHP certificate of coverage.

If you live more than 60 driving miles from the COE location, you may qualify for assistance with travel and lodging expenses. To be covered, all travel arrangements must be made through Premera.

If you choose to drive, mileage reimbursements are determined by the IRS rates for medical mileage. If you choose to fly, you must travel to and from one of the airports listed on Premera's travel benefit page.

How do I get started?

Note: The spine care benefit will be offered to qualified UMP Classic and UMP CDHP members starting January 1, 2019.

If you are interested in participating in the COE Program, you may refer yourself, or your regular provider may refer you, by calling Premera at 1-855-784-4563  (TRS: 711).

Once referred, Premera will assist you in gathering your records so that the clinical teams at the COEs can make a determination if the COE Program is right for you. You may be required to follow a plan of care the COE gives you as a condition of approval for treatment.

Visit Premera's COE page for more information about the program's clinical review requirements.

Contact

Premera Customer Service
Phone: 1-855-784-4563 (TRS: 711)
Business hours: 7 a.m. to 5 p.m. Monday - Friday