Health plan enrollment Featured

8:00pm EDT July 26, 2008

How long do people typically spend choosing a health plan, hospital and doctor during their company’s open enrollment period? Two hours? A day?

The average is just 16 minutes. By minimizing time spent making selections, people hope to make the process less painful. But without careful selection, they may lack the choices they need later on.

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.

With open enrollment season approaching for many Southern California businesses, Smart Business spoke to Barry Arbuckle, Ph.D., president and CEO of MemorialCare Medical Centers and chair of the California Hospital Association, 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 cost, access and quality of their health care for the following year. Whether adding dependents, enrolling in a new plan, increasing or decreasing out-of-pocket expenses or changing other options, consumers should know the facts before making decisions.

What many don’t realize is that by selecting 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 for your current needs.

With HMOs, doctor (or network) selection determines the specialists one can see. For these reasons, 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? 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?

Start by ensuring your chosen hospital is part of a larger system of care. A health care system with multiple locations and thousands of physicians and employees offers more comprehensive care for everyone in the family. Also, a health care system is more likely to have access to the latest 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, when needed. Inquire about a facility’s clinical outcomes, its reputation and patient care philosophy before making a decision.

Why does the choice of hospital matter?

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 many specialties? Large, highly regarded health systems, like MemorialCare Medical Centers, are associated with scores of medical groups and have physician referral call centers and Web sites describing the backgrounds, specialties and services offered by their doctors.

What’s the next step?

After you’ve selected your 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? These questions play a part in 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 their open enrollment programs?

Ensure your plans are competitive. Selection of health plans and medical groups to include in your offerings is critical to recruitment and retention.

Next, improve the process. The MetLife 2008 Open Enrollment Survey offers suggestions to enhance the open enrollment experience for the increasingly engaged employee. Improvements include designing benefit plan options and communications strategies around employee demographics, surveying employees about which benefits and tools they’d prefer most, considering additional voluntary benefit offerings to round out existing coverage, providing educational tools and considering off-cycle enrollment of a new benefit to help boost participation.

Ask local hospitals and physician groups for help. MemorialCare Medical Centers, for example, offer employers assistance through benefits, health fairs and information, 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 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 and San Clemente, Orange Coast Memorial Medical Center in Fountain Valley, Anaheim Memorial Medical Center, Long Beach Memorial Medical Center and Miller Children’s Hospital in Long Beach.