How employers and employees benefit from making the right choices during open enrollment Featured

9:01pm EDT July 31, 2011
How employers and employees benefit from making the right choices during open enrollment

How long do people spend choosing a hospital, doctor and health plan during open enrollment? The average is just 16 minutes. By minimizing time spent making selections, people hope to make the process less painful. But the opposite may happen. Without careful selection, they may end up lacking the choices they will need later on.

Open enrollment is like putting together a complex puzzle. The more employees try to make sense of the options offered, the more they end up confused in the process.

As open enrollment season approaches for numerous businesses, Smart Business turned to Barry Arbuckle, Ph.D., president and CEO of MemorialCare Health System, to learn more.

Why is open enrollment so important?

During this period — typically about 30 days — employees select benefits for themselves and their families. Choices determine the cost, access and quality of their health care for the following year. Whether adding dependents, enrolling in a new plan, selecting a different primary care physician, increasing or decreasing out-of-pocket expenses or other options, consumers should know the facts before making decisions.

What many don’t realize is that when they select a doctor, they determine the entire course of their health care. This includes the hospital they’ll go to for inpatient and outpatient care.

What’s the best approach?

Shop for health care benefits like you would for other major purchases. A wrong decision can be costly in terms of health and financial results. Don’t just sign up for the same plan. Instead, examine benefit options to match your current and future needs.

With HMOs, the doctor (or network) selection determines the specialists one can see. That’s why it’s important to have a big-picture perspective before signing on with a health plan. Are you satisfied with your medical, dental, vision and drug plans? And 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.

Where do I start?

Ensure your chosen hospital is part of a larger system of care like the MemorialCare Health System. A health system with multiple locations and thousands of physicians and employees offers more comprehensive care for all family members. Selecting the best hospital for your care when you are healthy makes good sense. A health system has more access to advanced equipment and procedures. Most hospital admissions involve people who never expected to get sick. By planning ahead, you’ll have access to services that you consider important — and in a facility that meets your standards, if needed. Inquire about a hospital’s clinical outcomes, reputation and patient care philosophy before making a decision.

How are physicians selected?

By selecting a first-rate hospital, you’ll have access to physician experts who work with the hospital to achieve 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. Large, highly regarded health systems like MemorialCare are associated with many high-quality medical groups and have websites describing backgrounds, specialties and services offered by their doctors.

What are the next steps?

After selecting a hospital and physician, check the details. Do you understand the benefits covered by your health plan? Are you comfortable with the medical group your physician belongs to? Can you continue to see your favorite specialists? Don’t just select the plan with the best price. Examine your medical needs. Do you need regular prescriptions or doctor visits? Do you have contacts or glasses? This factors into how much coverage is adequate without paying too much. And price out the unpredictable — medical emergencies occur and payment varies from plan to plan.

How can employers improve open enrollment?

Ensure your plans are competitive. The selection of health plans and medical groups to include in your offerings is critical to recruitment and retention of your work force. Employers can work with their brokers or health plans to ensure the networks that are offered provide the best care possible while maintaining affordability.

Improve the process with comprehensive communications, benefit plan meetings and other activities to ensure employees fully understand their options and ramifications of their choices. Explain basic insurance terms, the differences between co-payment and co-insurance, impact of deductibles on premiums and out-of-pocket expenses and costs of out-of-network care.

Orange Coast Memorial in Fountain Valley, Saddleback Memorial in Laguna Hills and San Clemente and MemorialCare HealthExpress centers at Albertsons in Huntington Beach, Irvine and Mission Viejo all offer employers many services. These include benefits and health fairs, wellness programs, executive physicals and information on how to select the best plan, lower benefit costs and access high-quality care.

Barry Arbuckle, Ph.D., is the president and CEO of MemorialCare Health System. The not-for-profit MemorialCare Health System includes Long Beach Memorial Medical Center, Miller Children’s Hospital Long Beach, Community Hospital Long Beach, Orange Coast Memorial Medical Center in Fountain Valley and Saddleback Memorial Medical Center in Laguna Hills and San Clemente. For additional information on excellence in health care, please visit memorialcare.org.