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What is a Smart Employer Network?
A Smart Employer Network (Smart E Network®) is a quality performance network designed to recognize and select hospitals and professional providers dedicated to improving clinical care and reducing the cost of care.
When developing a Smart E Network, Imagine Health® first reviews regional hospitals to identify areas of proven clinical performance excellence. Hospitals with qualifying performance measures are invited to bid to participate in the network. Bid proposals include proposed reimbursement rates and assert quality service initiatives. Bids are based on the assumption that the selected hospital will receive a high percentage of the Employer's patient care, and that they will be recognized as the performance facility selected to anchor the network.
Performance facilities are measured on the following:
- Low mortality and complication rates
- Impressive inpatient quality indicators
- Solid core process measures
- Successful patient safety performance
- Excellent patient satisfaction achievement
Physicians who admit to the performance facility are invited to submit a bid to participate in the Smart E Network. Similar to the hospital bid process, physician bid proposals include proposed reimbursement rates and illustration of the quality of patient customer service initiatives. Physician bids also reflect the assumption that the physician’s practice will receive an increased percentage of the Employer's patient care as well as community recognition as a quality performance network provider.
Each physician is evaluated predominately on:
- Compliance with evidence-based best practices
- Customer service quality
- Proposed reimbursement rates
Physicians are also asked to participate in a self-audit of their current performance by demonstrating achievement or recognition from nationally recognized, independent third-party organizations that measure the performance of healthcare providers. This commitment creates a true road map for change and is a key component to community recognition as a member of a local employer's quality performance network.
Why Accept an Invitation to Bid for Participation?
Employer Sponsored Networks provide lower costs and better medical outcomes — well above typical open access provider networks. This is accomplished by significant patient steerage to the quality performance network providers, with high benefit direction and less out-of-pocket collection requirements.
Current quality performance networks demonstrate proven bottom line results for hospitals and providers;
Current Employer Sponsored Network Case Study #1;
For the second quarter of 2009, 92% of inpatient hospital expense and 70% of physician expense occurred within the Smart E Network. Prior to implementation of the Network, the same network hospital and network providers treated 20% of inpatient hospital expense and 31% of physician expense.
Current Employer Sponsored Network Case Study #2;
In 2008 and 2009, an average of 63% of hospital and professional services were treated within the Employer Sponsored network in a large metropolitan market that typically yields 35% of the market share to the same hospital and professional providers.
Employer Sponsored Networks benefit employers, providers and patients! Higher quality lowers costs due to such factors as lower complication rates, fewer unnecessary services and less absenteeism. Provider participation increases your opportunity to treat these patients and enjoy a healthy return on investment.
Baptist Health System in San Antonio was pleased to be selected as the premier hospital delivery system for the Innovative Health Network (an Employer Sponsored Network for Toyota Motor Manufacturing Texas).
When we were contacted by Imagine Health to submit our bid for participation, Toyota was in the process of opening its new manufacturing plant in the San Antonio area. San Antonio is a highly competitive healthcare market, and Baptist saw an opportunity to work increase market share by working closely with employers to offer them an exclusive healthcare solution that best serves their patient population.
As a result, Baptist has benefited from treating over 65% of their inpatient and outpatient needs, in a market that typically yields 35% of the volume in our community.
Imagine Health has developed a unique product that enables a health system to highlight its quality outcomes which sets them apart from the competition, and truly directs patient care in a manner that results in a positive return on investment for the participating hospital system.
~Tom Shock, CFO
VP of Managed Care
