How to make sure your health plan has the best doctors

Today’s health care costs are increasing the burden on employers and patients, and many employers want to know what they’re getting for their money.

“When you spend your health care dollar, you want to spend it with the confidence that you are going to get the best outcomes you can have for that health care dollar — not only today, but in the long run,” says Dr. Aaron Smith, assistant medical director of external affairs and organizational effectiveness for Ohio Permanente Medical Group (OPMG), the physician group that contracts with Kaiser Permanente to care exclusively for Kaiser Permanente patients.

“Knowing your health care partner’s staff of physicians has excellent technical, personal and leadership skills is integral to that value proposition.”

Smart Business spoke with Smith about how to make sure your health plan is recruiting the best and brightest doctors.

When evaluating a physician, specialist or medical professional, what should an employer or employee pay the most attention to?

From the perspective of an employer or a group considering whom to partner with, you need to have confidence in the quality of the physicians you are going to have.

At OPMG, as an integrated medical system, we have a couple key attributes we look for in our doctors. The first factor is the quality of the physicians. I’ve had the pleasure in the past six months of interviewing and bringing on board physicians who trained at the Mayo Clinic, Brown, Yale, the top training schools in the country. And we’ve had the great pleasure of getting some physicians from some of our top local institutions as well.

We want to make sure coming in that the technical quality and training of the physician is there. For those physicians who don’t have the level of expertise, their applications go no further. That’s the first step. Second, you want doctors who can function within an integrated group. The doctor is the leader of the team. The doctor has to coordinate the care, must be able to work not only from a technical perspective but have the interpersonal and leadership skills in order to deliver the medicine of the 21st century.

We look for doctors who have the ability to make personal connections with patients, to communicate effectively and to lead the health care teams we build. In this day and age, the concept of the solo doctor being able to deliver the quality of care that is necessary is something that can’t be accomplished.

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool managed by the National Committee for Quality Assurance that is used by health plans to measure performance on important dimensions of care and service. For us to achieve the high quality outcomes we have in our HEDIS scores, in our diabetes management and breast cancer screening measures, the doctor cannot do it alone. He or she has to work with a team of nurses, pharmacists and other health care personnel to bring that care to the patient.