As in all endeavors, the provision of healthcare services falls on a quality bell curve. In developing SmartCare networks, we seek to include those care providers who have demonstrated performance at the high end of that bell curve. We generally target just the top quartile performers.
We base our assessment on a number of criteria relating to clinical performance, efficiency, safety, technology use and patient satisfaction. "Clinical performance" refers to how well these care providers meet certain recognized measures of clinical care. We use clinical guidelines established by leading medical associations that are considered part of standard clinical practice and backed by medical evidence-based guidelines.
Hospitals and other care facilities are measured in 39 clinical categories based on their performance in mortality and complication rates, AHRQ inpatient quality indicators, TJC core process measures, AHRQ patient safety performance, readmission rates and CMS patient satisfaction achievement.
Physicians are targeted based on their affiliation with SmartCare hospitals if the physicians specialty is in a clinical category for which the hospital is recognized for high quality. We also look at board and other third-party certifications, use of electronic medical record technology and willingness to participate in clinical quality initiatives with the hospitals that monitor care efficiency.
It is important to emphasize that the SmartCare network is intended to be only one option for a member when choosing a physician. There are many ways to evaluate healthcare providers. We recommend that members seek referrals from other trusted sources, review physician credentials, training and experience and consult with the physician to assess communication skills and personal comfort with practice style.
Selection in the SmartCare network is not a guarantee as to the quality of the service a member receives or the outcome of any treatment by that physician. Likewise, if a physician is currently not selected for the SmartCare network, this does not mean the physician does not provide quality services.