Guiding employees to the right health care providers 

Employee-sponsored health plans can be part of the solution to helping patients make the best decisions about their health.

American patients have very particular considerations when selecting their physicians, according to Harris Poll, a market research company that tracks the sentiments, behaviors & motivations of American consumers. According to the poll, the top results are: 

  1. How long it takes to have an appointment—47% 
  2. Hospital affiliation—49% 
  3. Office location—69% 
  4. Whether physician covered by health insurance plan—72%

These rationales all hold validity, but what comes as a shock is the lack of precautionary factors, such as medical training and prior facility-based incidents (lawsuits, board penalties, etc.). As a physician, my opinions contrast from those observed in this study. 

When I and others in the medical field ask for recommendations for ourselves or our families, we seek out health professionals with competence. In this case, “competence” refers to doctors using the best practices in diagnosis and treatment that have typically been proven through scientific research. 

Examples of competence include: 

  1. A primary care doctor who adds a second blood pressure medication when a patient’s hypertension is still not controlled on just one pill. (Effective hypertension treatment requires two or more medications the majority of the time.) 
  2. A cardiologist who does NOT order a stress test on a patient just because they are older or someone in their family has had a heart attack. (Stress tests should only be ordered if a patient is having cardiac symptoms.) 

Aligning health insurance plan design

The primary factor listed for care selection focuses on the percentage of costs one’s insurance plan will cover under a facility or physician. In this case, coverage is viewed as a proxy for out-of-pocket payments. 

An ideal suggestion for employer-sponsored health plans would be for companies to align their plan design with physician competence, specifically by arranging the costs that would be out-of-pocket for plan members.

Through this efficient approach, health plans sponsored by employers are able to prioritize plan members’ top concern (personal expenses) while advocating for the quality that doctors consider most important (staff/facility competence). 

Overcoming location bias

The second most-cited factor behind physician choice carries an interesting assumption. It insinuates that examiner’s offices are similar to leisure facilities, in that consumers will flock to whichever location is nearest and most convenient for them. 

Despite this mindset’s popularity, it is very possible for unfavorable outcomes to occur. A poor choice regarding the type of care received can result in a missed diagnosis, mistreatment, and/or unwarranted out-of-pocket costs. 

Not every hospital or office is equipped for every situation. It is possible that the short-term convenience of a nearby office will result in long-term negative consequences. The focus should be on finding the right hospital and the right specialty. 

So, what’s the solution? 

A recurring theme presents itself in these poll results: what’s important (competence) isn’t being prioritized over what’s easy (convenience). This is caused in part by members misunderstanding their insurance plans. In fact, only 9% of people understand the basic elements of their own health coverage. 

A plausible recommendation would be that employers use the reason listed as more important than facility location—out-of-pocket costs—to direct employees to physicians deemed competent in areas that match their needs. An effective plan design can incentivize behaviors that are more beneficial in the long-term over those that are inferior, but more appealing in the short-term. 

Patients should have the autonomy to make the best decisions about their health, including their choice of physician. Well-coordinated, employee-sponsored health plans can be part of the solution to achieving this goal.

Dr. Eric Bricker is the medical director at Simplepay Health.