Choose wisely Featured

8:00pm EDT July 26, 2009

This fall, 160 million workers in America will spend an average of just 16 minutes selecting a health plan. This annual ritual is called the open enrollment period, when employees choose from plans available to them. By minimizing time spent in these crucial decisions, people hope to make the process less painful. But without careful selection, they may lack choices needed later on, especially when U.S. businesses are shifting a greater portion of their $550 billion health care expenses onto their workers. Open enrollment is like putting together a complex puzzle. The more employees try to make sense of the insurance options offered, the more they may end up confused.

As open enrollment season approaches, Smart Business spoke to Barry Arbuckle, Ph.D., the president and chief executive officer of MemorialCare Medical Centers and immediate past chair of California Hospital Association, to learn more.

Why is this period so crucial?

With deep economic challenges facing our country, it is critical individuals spend substantial time looking after their current and future health care needs. Most employers continue to increase co-pays and out-of-pocket costs for their employees. During open enrollment, employees select benefits for themselves and their families. These choices determine cost, access and quality of their health care for the following year. Whether it’s adding dependents, enrolling in a new plan, increasing or decreasing the out-of-pocket expenses, or changing any other options, consumers should know the facts before making decisions. Many don’t realize that by selecting a doctor they determine the entire course of their health care, including the hospital they’ll go to for inpatient and outpatient care.

Where should consumers start?

Shop for health benefits just as you would for any major purchase. A wrong decision can be costly in terms of health and financial results. Instead of signing up for the same plan, examine benefit options for current needs, watch for hidden costs and surcharges and determine whether there are additional incentives for healthy behavior.

With HMOs, the physician (or network) selection determines specialists one can see. Have a big picture perspective before signing on with a health plan. Are you satisfied with your medical, dental, vision and drug plans? Are you comfortable with your current primary care physicians acting as your gatekeeper or do you want increased flexibility? Review these and other issues before making a change.

Does hospital choice matter?

Absolutely. Ensure your chosen hospital is part of a larger system of care. A health system like MemorialCare with multiple locations and thousands of experienced clinicians provides more comprehensive care for everyone in the family. A health system more likely offers the latest in equipment and procedures. By planning ahead, you’ll have access to the health care services you consider important and hospitalization in a facility that meets your standards. Inquire about the hospital’s clinical outcomes, reputation and patient care philosophy before making a decision.

By selecting a first-rate hospital, you’ll have access to physician experts who work with the hospital. Does the hospital employ a ‘best practice’ approach where multidisciplinary teams continually study and implement cutting-edge treatments and techniques in a number of specialties? Highly regarded health systems, like MemorialCare Medical Centers, are associated with many excellent medical groups and will offer physician referral centers and Web sites describing the backgrounds and specialties of their doctors and the services they provide.

What’s the next step?

After you’ve selected your hospital and doctor, check the details. Do you understand the health plan benefits? Are you comfortable with the medical group to which your doctor belongs? Can you continue to see your favorite specialists? It’s not just about the best price. Examine your medical needs. Do you require regular prescriptions or physician visits? Questions help to determine how much coverage is adequate without paying too much. Price out the unpredictable, since emergencies do occur, and payments vary among plans.

How can employers improve the process?

Selection of competitive health plans and medical groups is critical to work force recruitment and retention. MetLife’s Open Enrollment Survey suggests some ways to enhance the open enrollment experience for the increasingly engaged employee. These include asking employees which benefits and tools they prefer, adding voluntary benefit offerings to round out existing coverage, designing communications strategies and benefit plan options around your employee demographics, and providing education and off-cycle enrollment of a new benefit to boost participation. Benefit experts from MemorialCare Medical Centers can help employers through the open enrollment maze by offering on-site health fairs as well as data and education on how to select the best plan, lower plan costs and access the best health care possible.

BARRY ARBUCKLE, Ph.D., is president and CEO of MemorialCare Medical Centers (www.memorialcare.org) and past chair of the California Hospital Association. Reach him at arbuckle@memorialcare.org or (562) 933-9708. MemorialCare Medical Centers include Saddleback Memorial Medical Center in Laguna Hills, Orange Coast Medical Center in Fountain Valley, Long Beach Memorial Medical Center, Miller Children’s Hospital in Long Beach and Saddleback Memorial Medical Center in San Clemente.