A Center of Excellence (COE) is a health care facility or provider that meets Saint Mary’s Health Plans’ (SMHP) high standards for quality and value including demonstrated positive patient outcomes, cost-efficient health care delivery and compliance with rigorous quality control metrics. Additionally, SMHP has established relationships with COEs which work to assure a continuum of care throughout the patient’s treatment cycle.
The Centers of Excellence program was created to offer a continuum of care for patients with complex health care needs. Through a collaborative approach, the SMHP Medical Management team works with a Health Plan member’s provider to determine the most effective, safe and affordable care at a Center of Excellence for complex conditions.
Centers of Excellence medical categories include: Bariatric Surgery; Complex Cardiac Care; Complex Cancer; Complex Orthopedic Conditions; Complex Pediatric Conditions; and Organ or Tissue Transplants.
Not all complex or specialized procedures within the COE categories require the use of a COE. The use of a COE is directed through the Medical Management prior authorization process.
For more information about Saint Mary’s Health Plans’ Centers of Excellence Program, click here.
SMHP Centers of Excellence Program At-a-Glance
- Members are required to use Centers of Excellence facilities associated with specific medical conditions or surgical procedures, unless the use of a non-COE facility has been prior authorized by SMHP’s Medical Management department.
- Travel benefits of up to $3,000 per treatment may be available when using a COE facility.
- Use of a non-COE facility for designated conditions will result in benefits being paid at the out-of-network level and a much higher member expense, unless the use of a non-COE facility has been prior authorized by SMHP’s Medical Management department.
- Standard prior authorization requirements still apply.
