Can your hospital stand toe-to-toe with the Cleveland Clinic? Can it match Intermountain Healthcare's quality metrics? Do you offer the same value as Scott & White Healthcare or Virginia Mason Medical Center?

Do you think that just because you're not located in Northeast Ohio or Seattle or Utah it doesn't matter? Think again. These high-profile, highly regarded institutions are entering your market, and doing so without erecting million-dollar edifices. More accurately, employers — those that help turn your balance sheets, stained with red ink from Medicare and Medicaid, black — are turning to these high-reliability organizations as their providers of choice, especially for high-margin procedures. And they are willing to pony up for an all-expense paid trip to one of these destinations.

In 2012, Wal-Mart, with 1.1 million covered lives, identified six centers of excellence for heart, spine and transplant care, including the Cleveland Clinic, Scott & White and Virginia Mason. The arrangements aren't just about sending employees elsewhere for surgery; they are also about avoiding surgery.

"The reason we developed these arrangements is for the hospitals to evaluate the appropriateness of care," Sally Wellborn, vice president of benefits for Wal-Mart, said during a session at last month's Health Forum–AHA Leadership Summit.

If that means a less invasive option is recommended, the care team at the center of excellence calls patients' local providers to coach them in the next steps. Imagine that conversation.

Other national employers have been following suit, and the trend shows no sign of abating, according to a Fitch Ratings report issued in May. The report, "Seeking Value: Direct Contracting Strategies," notes that providers that demonstrate "superior clinical outcomes and cost savings" will benefit the most from direct contracting. The report offers a note of caution, though, stating that it will take some time to assess long-term implications of these national contracts.

Momentum also is picking up at the local level as employers pursue narrow networks and other benefit plan redesigns. In this month's InBox, staff writer Marty Stempniak examines an accountable care arrangement among Boeing Co., the University of Washington Medicine and Providence-Swedish Health Alliance [Page 18]. Boeing employees who opt into the ACO will find some consumer-friendly perks: same- or next-day appointments, Web access to test results and a concierge service.

Providence-Swedish CEO Joe Gifford, M.D., told Stempniak that the ACO allows the health system to move closer toward a refined customer experience.

Interestingly, a Boeing spokesperson told Stempniak that the deal isn't just about lowering costs; it's also about getting employees more engaged in their care. Barbara Wachsman, Disney senior executive of employee health benefits, echoed those sentiments at the Leadership Summit. Disney is introducing more narrow networks this fall. Doing so will "disrupt" the lives of employees, Wachsman said.

"We need to figure out a way to communicate this to employees," she said. "We have to have them walk away and see value in this network; that it is high-quality and high-efficiency."

Does your hospital fit the bill?

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