MSK COE Program Design
MSK COE programs direct employees who need joint replacement, spine surgery, or other high-cost MSK procedures to designated COE facilities. COE facilities are selected based on quality metrics — complication rates, readmission rates, patient satisfaction, and volume. Members who use COE facilities pay little or no cost-sharing; members who use non-COE facilities pay standard cost-sharing.
COE Program ROI
COE programs for MSK procedures consistently demonstrate significant cost savings. A joint replacement at a COE facility typically costs $15,000–$30,000 less than the same procedure at an average community hospital — and delivers better outcomes. For a plan with 20 joint replacements per year, a COE program can save $300,000–$600,000 annually.
Second Opinion Programs
IQ Insight
Second opinion programs for elective MSK surgery consistently find that 20–30% of recommended surgeries are unnecessary or can be treated more conservatively. Walmart's COE program found that 30% of recommended spine surgeries were unnecessary when evaluated by COE physicians. A second opinion program that prevents 5 unnecessary spine surgeries per year at $75,000 each saves $375,000 — far more than the cost of the program.