Assessing HMO centers of excellence programs: one employer's experience

HMOs have sought to enhance the provision of organ and tissue transplantation services for their members through centers of excellence (COE) programs. Such programs initially assess and subsequently monitor the medical centers offered as part of such programs on the basis of procedure volumes and outcomes, as well as the experience of the transplantation surgeons. Purchasers rely on the presence of COE programs to assure their beneficiaries of access to appropriate care in the event that a need for transplantation arises, but little comparative literature exists on these HMO programs. One purchaser assessed the COE programs offered by 89 HMOs serving its beneficiaries, based on the criteria developed on its behalf by the medical directors of six different health systems and reviewed by HMO and academic medical center personnel. 57 (75 percent) met these criteria, and the implications for HMOs, medical centers, beneficiaries, and other purchasers are explored.