December 14, 2018

Employee Back Pain? Why Centers of Excellence + Personalized Advocacy = HR's Best Friend

By Peggy Fischer

Back pain costs your employees and the business.

📷Chronic back pain - it's a scourge in the workplace, taking a toll on employee well-being and productivity, and the company's bottom line, too. Eighty-five percent of people will experience back pain at some point in their lives, and the aggregated cost to employers is staggering. Direct annual healthcare spending related to lower back pain is estimated between $50 billion and $91 billion annually in the US. Add in the cost of lost employee productivity and the amount skyrockets to $635 billion.¹


What's the answer? For many organizations, it's a Centers of Excellence (CoE) Strategy.

Physical therapy, lumbar support pillows, standing desks and ibuprofen - your employees have likely tried all sorts of strategies in the quest for pain relief. As a last resort, some of them decide to brave spine surgery. It's a good thing your team has just put in place a CoE benefit precisely for this need.

A CoE promises high quality care at a bundled rate, with no co-pay for employees. Nearly 50% of large employers already use CoEs for managing complex orthopedic procedures (knee, hip, and spine), and another 25% are considering adopting the strategy in 2020-2021.² Employer use of CoEs for a variety of complex and costly services - orthopedic surgery, transplants, bariatric surgery, fertility, and other procedures as well - will increase to nearly 90% in 2019.³ What could be better than the promise of better outcomes at lower cost?

But your CoE strategy might fall short.

Unfortunately, to make your CoE strategy live up to its promise, you will need to overcome some challenges, including:

  • Making employees aware of the CoE program - How do you identify employees that can benefit from a CoE experience? How do you ensure employees become aware of the benefit before utilizing traditional care elsewhere? It's likely the member services representative of your health plan won't know to - or be incented to - direct your employee to an out-of-network CoE program.
  • Convincing employees to utilize the program - “Why would I travel for surgery when I can have it done locally?” It's going to take some work to help your employees understand why and how they can personally benefit from traveling to a CoE for a procedure. And you will need to support the employee in achieving eligibility for the service when health plans don't have a mechanism for doing so.
  • Coordinating care throughout the process - Delivering optimal health outcomes demands insight about the patient's broader life context, continuity of care across settings, and support to help the patient comply with care plans before, during and after CoE procedures.
  • Ensuring quality care - On top of all of that, not all programs are created equal. Health systems and hospitals independently define standards for their Centers of Excellence, and most have accreditations standards only for their facilities, not their doctors. One potential consequence is having your employees undergo unnecessary surgery, which can cause distress as well as undue financial burden.

Personalized advocacy addresses these challenges head on.


Accolade personalized advocacy optimizes the effectiveness of a CoE strategy. With a people plus technology approach, Accolade personalized advocacy addresses the gaps that HR teams and CoE programs alone can't easily fill. Personalized advocacy:

  • Identifies CoE candidates early and engages them before they have made a care decision.
  • Educates employees and families about the benefits of CoEs, helping influence them to take advantage of the program.
  • Works with individuals to understand psychosocial factors, e.g., work-family imbalance, that could be contributing to issues such as lower back pain.
  • Supports candidates in achieving eligibility for procedures.
  • Prepares patients to ask the right questions of their providers, and coordinates with providers across care settings to optimize quality, patient compliance and outcomes.
  • Builds a long-term, trusted relationship to support the patient before, during and after the procedure with any question or need, including behavioral health needs that often coexist with medical conditions.

📷The result? Better experiences and outcomes, and cost savings for both employees and employers. Learn more about how personalized advocacy works and improves health and financial outcomes: read the whitepaper.

And now we're taking personalized advocacy and CoE integration to the next level.

As recently announced, Accolade and Health Design Plus (HDP) are working together to combine their respective personalized advocacy and Centers of Excellence solutions - bringing even greater value in patient outcomes, satisfaction and employer and member cost savings. HDP works in partnership with the Pacific Business Group on Health (PBGH) to offer the Employers Centers of Excellence Network (ECEN) - a CoE program that features elite medical centers and surgeons from across the country in the areas of oncology and surgery - for joint replacement, bariatric, spine and cardiac conditions. Read about some of our shared employer results in Harvard Business Review.


¹Haiou Yang, PhD, Scott Haldeman, DC, MD, PhD, FRCPC, Ming-Lun Lu, PhD,c and Dean Baker, MD, MPH, (2016 Aug 25), Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey.

² Large Employers' 2019 Health Care Strategy and Plan Design Survey, NBGH,

³ Ibid.