Some things to contemplate during open enrollment

By Dr. Michael Brant-Zawadzki

Categories: Featured News
Ever have a "special" day, like when your kitchen wall is caved in by an errant truck?

That's when you really find out how good your home insurance is. Traditional home policies do not cover maintenance, but are bought to protect against uncommon and often expensive episodes without thought as to who will fix things.

Health insurance is different. Health insurance is more like a subscription for important "maintenance" services provided by highly trained clinicians, including those needed in the occasional "special" crisis.

Health insurance changes during the "enrollment period." Premiums typically increase, even renewing the same policy. Not only does the premium change, but also the actual facilities and providers one can access may change.

When one's house wall caves in, a contractor chooses needed craftsmen. With health insurance the focus should also be on the specific providers.

We should look for quality facilities and experienced specialists. Instead, like with home maintenance, some of us are "do it yourselfers," using minute clinics or "urgi-centers" for vaccinations or the occasional antibiotic.

It is when a grave or acute illness strikes that access to "special" expert care becomes crucial. Yet we may not get the best, based on our choice of insurance.

The safety, quality and expertise of healthcare providers are increasingly scored by true outcomes, standard quality metrics and patient satisfaction. Those who are younger are interested in easy access and low cost of premiums.

The more senior population seeks superior expertise for conditions that come with aging, such as heart disease, cancer, stroke and memory problems.

But even younger folks experience trauma, or brain tumors, for which special care is needed.

Buying a health plan can limit access to certain facilities, and certain physicians, depending on whether they are in the "network" being offered. Though one may have access to their favorite hospital through the plan, a preferred specialist may not be part of the package.

Some plans allow access to a hospital, but not its affiliated outpatient facilities, such as its ambulatory surgery centers or imaging centers. Thus, the patient may be exposed to one level of quality in the hospital, but a different level in a facility required through the plan. Seamless communication of patient data among such non-integrated sites of care is limited.

That is why it's so important to pay close attention to your options. Choosing a world-class hospital and a multidisciplinary team of experts focusing on significant specific health conditions, teams that are measured by rigorous standards, including safety, health outcomes and patient satisfaction is critical to the confidence in the health insurance plan one selects.

Look for a hospital with low-complication rates and a dedication to comprehensive, multidisciplinary treatment. You want evidence-based treatment regimens and world-class programs that offer cutting edge technology and access to clinical research.

Thus, when considering your choice of health plans, look for one that provides a health system not just with affordable and easy access to maintenance needs, but also one that integrates the best in coordinated, specialized care focusing on a particular patient condition: A plan where all of the systems, facilities and expert physicians are accessible. Choose a plan providing a health system that measures its successes and constantly strives to improve.

So on that special day when your house wall caves in, you may look for a contractor simply trusting his "subs" capabilities. Think of your health system as a contractor, and make sure that its "subs" are not only a great maintenance crew, but contain integrated specialists and facilities focusing on the types of conditions you may need now or in the future.

During open enrollment, make sure that your choice of health plan is right, and your trusted contractor with proven subs is included, because any given day can become "special."

Dr. Michael Brant-Zawadzki is a senior physician executive at Hoag Hospital.