How to make the right decision when choosing a hospital, doctor and health plan
Appeared in Smart Business LA County | August 2012
How much time do people spend choosing their hospital, doctor and health plan during open enrollment? The average is just 16 minutes. By minimizing the amount of time spent making selections, people are hoping to make the process less painful. But without careful selection, they may later end up lacking the choices that they needed.
Smart Business turned to Diana Hendel, Pharma.D., CEO of Long Beach Memorial Community Hospital Long Beach and Miller Children’s Hospital Long Beach, for more.
Why is open enrollment so important?
The choices employees make during open enrollment help determine the cost, access and quality of their health care for the following year. Whether adding dependents, enrolling in a new plan, selecting different primary care physicians, increasing or decreasing out-of-pocket expenses or other options, consumers should know the facts before making decisions. Selecting a doctor, for instance, can determine the entire course of their health care — including the hospital they’ll go to for inpatient and outpatient care. That’s why it is important to shop for health care as any major purchase.
Selection of a health plan should be determined by more than just price. Examine your medical needs and those of your family. Are regular prescriptions or doctor visits required? These and other issues factor into how much coverage is adequate. And it’s important to estimate, or ‘price out,’ the unpredictable events. Medical emergencies occur and payment varies from plan to plan.
How are physicians selected?
When it comes to choosing a physician during open enrollment, take the time to fully understand the benefits covered by each plan that is offered. Are you comfortable with the medical group your physician belongs to? Is your preferred hospital of choice contracted with your new health plan? Large, highly regarded health systems such as MemorialCare are associated with several high-quality medical groups in both Los Angeles and Orange counties.
Consider the hospital or hospitals covered in your plan. Are they part of an integrated health system that provides you access to sophisticated technology and to advanced treatments and procedures? Do they offer the same specialized services for adults and for children? Receiving care from a health system helps ensure clinicians treating you — whether it is from a primary care physician’s office, specialist’s office, or hospital — have shared access through electronic medical records to have the latest information about your diagnosis, allergies, tests and other critical medical information. This helps to streamline care, better manage chronic conditions and avoid unnecessary duplication of tests.
What are other considerations?
By planning ahead, you’ll have access to services you consider important — and in a facility that meets your standards, when needed. Take time to inquire about a hospital’s quality, safety, clinical outcomes, reputation and its patient care philosophy before making any decisions. Ensure that you’ll have access to the hospital that demonstrates the best possible results for its patients — one using a ‘best-practice’ approach to patient care in which multidisciplinary teams are continually studying and implementing cutting-edge treatments and techniques in a variety of specialties.
The MemorialCare hospitals — innovators and pioneers in best practice, evidence-based medicine — have received many honors and awards from national, regional and statewide organizations for quality, safety, clinical care and employees. MemorialCare Health System is again one of only 27 businesses globally to receive the Gallup Great Workplace Award recognizing the world’s most engaged employees, which, according to Gallup, are safer and more productive, and customer-centric and successful.
Another example is the recent accolades of the MemorialCare Medical Group, which later this year opens a new medical building in Los Altos MarketCenter with family physicians, internists and pediatricians, as well as laboratory and X-ray services and urgent care. MemorialCare Medical Group is continually honored by California Association for Physician Groups with four-star Elite Status, the highest rating that is possible. This program measures how physician organizations improve the affordability, cultural sensitivities, patient quality, safety, health information technology, communications, access, the continuity of care provided, public accountability and their responsiveness.
How can employers improve open enrollment?
To do this, businesses should continually evaluate their health plans to ensure that they remain competitive. They could work with brokers and health plans to ensure networks that are offered provide the best care possible while still maintaining affordability.
Improve the process with comprehensive communications, meetings on benefit plans and other activities to ensure employees fully understand their options and the ramifications of their choices. Explain basic insurance terms, the differences between co-payment and co-insurance, the impact of deductibles on premiums, out-of-pocket expenses and the costs of out-of-network care.
MemorialCare hospitals and MemorialCare Medical Group offer employers many programs and services both onsite at the workplace and in the community. These include benefits and health fairs, physicals for executives, wellness and prevention programs, screenings and information about how to select the best benefit plan, lower benefit costs and access high-quality care.
DIANA HENDEL is CEO of Long Beach Memorial, Community Hospital Long Beach and Miller Children’s Hospital Long Beach. The hospitals are part of the not-for-profit MemorialCare Health System which also includes Orange Coast Memorial Medical Center in Fountain Valley and Saddleback Memorial Medical Center in Laguna Hills and San Clemente. For more information on excellence in health care, visit memorialcare.org.