How to Make the Best Decisions During Open Enrollment to Fit Your Needs

Appeared in:
Smart Business Orange County

As fall approaches, millions of Americans are facing one of the most important decisions for themselves and for their families. The annual ritual called open enrollment is often the only time each year that businesses allow their work force to make changes to their health benefits plans. Smart Business Magazine spoke to Barry Arbuckle, Ph.D., president and CEO of the nationally recognized MemorialCare and also the past chairman of the California Hospital Association, about how employers and employees can learn to make smarter choices about their health.

Why is open enrollment so important?

The choices that employees make during open enrollment will help determine the cost, the access and quality of their health care for the following year. Whether it is adding dependents, enrolling in a new plan, selecting a different primary care physician, increasing or decreasing one’s out-of-pocket expenses or other options, consumers should know the facts before making such decisions. Selecting a doctor, for example, can determine the entire course of one’s health care — including the hospital you’ll go to for both inpatient and outpatient care. That’s why it is so important to shop for health care just as you would for any other major purchase you make. Selection of a health plan should be determined by more than just price. It’s important to examine your medical needs and those of your family. Do you or your family require regular prescriptions or doctor visits? This and some issues factor into how much coverage will be adequate for your needs. And you need to price out the unpredictable because medical emergencies do occur and payment for those varies from plan to plan.

How are physicians selected?

When it comes to choosing a physician during open enrollment, take the time to understand the benefits that are covered under each plan offered. Determine if you are comfortable with the medical group that your physician belongs to. Will you be able to continue to see your favorite specialists? Is your preferred hospital of choice contracted with your new health plan? Large, highly regarded health systems such as MemorialCare are associated with many high-quality medical groups in Los Angeles and Orange counties. Consider the hospital or hospitals that are covered in your plan. Are they part of an integrated health system that provides patients with more access to sophisticated technology and advanced treatments and procedures? Receiving care from a health system also helps to ensure the clinicians treating you — whether they are in a primary care physician’s office, a specialist’s office, or a hospital — have shared access through electronic medical records to the latest information about your diagnosis, allergies, tests and other critical medical information. This helps streamline care, better manage any chronic conditions and avoid the unnecessary duplication of tests.

What are other considerations?

By planning ahead, you will have access to services that you consider important — and in the facility that meets your standards, when needed. Also take the time to inquire about a hospital’s quality, safety, its clinical outcomes, reputation and its patient care philosophy before making any decisions. Ensure you’ll have access to the hospital that demonstrates the best possible results for their patients — a hospital that employs a ‘best-practice’ approach to patient care where multidisciplinary teams continually study and implement cutting-edge treatments and techniques in a variety of specialties. We are proud that MemorialCare hospitals — innovators and pioneers in best practice, evidence based medicine — have received many honors and awards from national, regional and statewide organizations for their quality, safety, clinical care and employees. For example, MemorialCare is again one of only 27 businesses globally to receive the Gallup Great Workplace Award for having the world’s most engaged employees, which, according to Gallup, are safer and more productive, customer-centric and successful. Another example is the recent accolades of MemorialCare Medical Group and of Greater Newport Physicians. Both physician organizations are continually honored by California Association of Physician Groups with the Elite Status rating of four stars, the highest rating possible for medical groups in California. The program measures ways that physician organizations improve patient quality, safety, affordability, access, communications, continuity of care, health information technology, public accountability, cultural sensitivies and their responsiveness.

How can employers improve open enrollment?

Businesses should continually evaluate their health plans to ensure they remain competitive. Work with brokers and health plans to ensure networks that are offered provide the best care possible while maintaining affordability. Improve the process with comprehensive staff communications, benefit plan meetings and other activities to ensure employees fully understand all of 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 their premiums, out-of-pocket expenses and the costs of out-of-network care. All of the MemorialCare medical centers, MemorialCare Medical Group and Greater Newport Physicians offer employers many programs and services both onsite at the workplace and in the community. These include benefits and health fairs, wellness programs, executive physicals and information on how to select the best plan, lower your benefit costs and access high-quality care.

Barry Arbuckle, Ph.D., is the president and CEO of MemorialCare.