January 4, 2021

Reducing Cost by Increasing the Quality of Employee Care

PBGH in partnership with eight large employers designed the Employers Centers of Excellence (ECEN) program to increase employees’ access to high-quality care for elective surgeries. ECEN began with hip and knee replacements and has since expanded to offer spine and bariatric procedures and certain oncology services.

Key program elements

  • Selected and monitored high-quality centers and surgeries.
  • Aligned incentives with providers through prospectively negotiated “bundles” and with patients via reduced or eliminated cost share.


Employers dramatically increased optimal patient outcomes and reduced variation in quality and cost. Results for Walmart:

  • Zero ECEN patients requiring postsurgical care in skilled nursing facility (compared with 5.2% non-ECEN facilities)
  • Three times lower hospital readmissions rates in ECEN joint replacement patients
  • 50% of ECEN spine surgery patients avoid surgery
  • $19.4 Million collective savings by Walmart, Lowe’s and McKesson in 2017