our difference: what sets Imagine Health® apart from the competition?
What sets Smart Employer Network apart?
Want to know what really gives a Smart Employer Network (Smart E Network®) the edge over a traditional high performance network? It’s that perfect foundation of selection, motivation, competition and savings, building better healthcare from the ground up.
Take a closer look…
Smart E Network healthcare providers:
- Qualify for inclusion based on high clinical performance ratings from independent organizations. A representative sample of complete patient charts for the physician’s entire patient panel provides a real snapshot employers and patients can trust.
- Perform regular self-audits validated by an independent third party which creates an environment of continual improvement.
- Become integral pieces of an inherently smaller, quality performance network. Patients are effectively incentivized and steered to the Smart E Network at a higher benefit level. Providers compete in a bid process to anchor the Smart E Network, reducing reimbursement in order to win the bid and acquire significantly increased patient volumes.
- Receive valuable patient referrals through the Employer Sponsor’s health center further motivating providers to submit a competitive bid to join the network.
- Enjoy effective steerage, giving providers patient volume that is often two to three times their prior volume. This increase translates to an Employer Sponsor savings of 20% in price per unit or about $1,200 per employee per year.
How does that compare to a traditional network?
Traditional high performance network healthcare providers:
- Qualify based on the cost of existing fee schedules and utilization patterns and clinical performance based on incomplete medical records of a small portion of the physician’s patient panel.
- Exist as a subset of the PPO network and have the same fee schedule.
- Receive no other designation than an asterisk in the directory, resulting in poor steerage and little or no impact on patient volumes or employer costs.
- Lack direct relationships with employer, leaving no motivation to manage the employer’s population
- Experience no rewards for quality improvement or cost-effective advancements
Smart E Networks provide a direct relationship between provider and employer, valuable patient referrals, sizable volume increase, incentives for better systems of care, and a core structure that makes everyone a winner: the patient, provider and employer. Isn’t it time you got Smart?
Why are Smart Employer Network Discounts Better?
Imagine a world where all car manufacturers routinely offered each car buyer the choice of any and all brands of tires—whether it be Michelin, Goodyear, Dunlop, etc. What if, in order to be competitive with other car manufacturers, Toyota had to offer each car buyer the individual brand of tire he or she prefers? What type of price could Toyota command from each separate tire manufacturer? What type of performance would Toyota expect from each tire?
In truth, Toyota buys all of its tires from limited tire manufacturer(s). What volume discount do you imagine Toyota commands from that limited group of tire manufacturers? Would Toyota be in a position to require a higher level of performance from a custom tire designed especially for Toyota?
Toyota buys tires the way a Smart E Network buys healthcare. In contrast, Blue Cross, United, Cigna and Aetna offer any and all of the healthcare "brands," putting themselves at a price and performance disadvantage to a Smart E Network.
Because a Smart E Network includes only the top performing 25% of providers, Smart E Network healthcare providers will double or triple their patient volume from the Employer Sponsor.
What is a Smart Employer Network?
In every industry sector, organizations are rewarded when they improve the value of the services they deliver or products they make. This is not the case in healthcare. In healthcare, for the most part, only the volume of transactions is rewarded, irrespective of the quality of care delivered. A Smart E Network is a quality performance network designed to recognize and select healthcare providers dedicated to improving clinical care and reducing the cost of care. We accomplish this by:
- Using standard clinical performance measures
- Using nationally recognized independent third-party organizations to measure the performance of healthcare providers
- Offering healthcare providers clearly defined benefits which help them determine the value of participating in a quality performance network
- Encouraging healthcare providers to adopt better systems of care, including health information technology, to systematically improve the delivery of care and patient outcomes
Smart E Networks are created expressly for Employer Sponsors with a large concentration of employees in a geographical area or areas. Smart E Networks often compliment employer-sponsored primary care centers.
After healthcare providers are recognized and selected, Imagine Health contracts with the healthcare providers who successfully compete to supply services for the Smart E Network. Healthcare providers discount their rates in exchange for the inherent and large increase in the Employer Sponsor's patient volume.
Smart Employer Network Development
Some healthcare providers think of money as a means to improve what they do. They invest some of their income to install electronic medical records or hire a nurse to monitor diabetic patients more closely.
On the other hand, some healthcare providers see their practice primarily as a profit center. They have their staff set up appointments because insurers don't pay for patient phone calls and they consider providing Botox injections for cash. They look for ways to increase their high-margin work and decrease their low-margin work.
In every community you will find a mixture of these views—you want healthcare providers who do not treat patients the way subprime-mortgage lenders treated home buyers. A Smart E Network gives the Employer Sponsor a way to evaluate a healthcare provider's proclivity to improve what they do.
To determine which hospital(s) will anchor the Smart E Network, Imagine Health acquires information to compare:
- Hospital Clinical Care
- Mortality and complication clinical outcomes
- Clinical quality indicators
- Core process indicators
- Patient safety performance
- Patient satisfaction scores
- Hospital Margins—hospital charges, Medicare reimbursement and cost report data to determine achievable discount levels
- Hospital Locations—hospital locations and the employer member population are compared using geo-mapping software to ensure appropriate member access
Hospitals compete with each other to anchor the Smart E Network.
Physicians who had a substantial impact on the quality performance of the victorious anchor hospital(s) become the starting point for the development of the physician component of the Smart E Network. In addition to their contribution to the anchor hospitals' performance, Imagine Health acquires information to assess:
- Physician Clinical Care
- Demonstrated ability to successfully track and improve patient compliance with evidence-based clinical guidelines
- Submission of patient charts to independent quality recognition organizations who will assess the physician's performance
- As claims data matures, assessment of the physician's incidence of potentially avoidable complications
- Physician Locations—the location of physicians by specialty and the employer sponsor's member locations are compared using geo-mapping software to ensure appropriate member access
Physicians compete within their specialties to be part of the Smart E Network physician team.
Smart Employer Network Feasibility
Healthcare providers are not unlike other service providers:
- Some healthcare providers have measurably better clinical quality and service level performance than others
- Some healthcare providers have lower volume and higher motivation for price concessions
- For concentrated volume, healthcare providers can break even at lower reimbursement than they are currently receiving for diluted volume
The Smart E Network return on investment is high—generally 75-80% of healthcare provider savings is retained by the Employer Sponsor. On average, Employer Sponsors save between $1,200 and $1,500 per employee per year. For a group of 5,000 employees, an Employer Sponsor could save between $6,000,000 and $7,500,000 each year.
Smart Employer Network Timeline
It takes 240 days for Imagine Health to build the Smart E Network.
We estimate an additional 60 days for open enrollment activities.