This is the fourth and final installment in Dr. Robert Pearl’s “medical myth” series. To review his past stories, visit Dr. Pearl’s Forbes.com profile page.
Buying a certain type of auto insurance doesn't alter your chances of getting in a car crash. And your choice in homeowners insurance doesn't change the likelihood of losing your home to flood or fire.
So, you'd be justified in thinking the health insurance plan you select shouldn't affect your chances of becoming sick or staying healthy.
But you’d be wrong. You might even be dead wrong.
Studies show your choice of health insurance coverage plays a major role in determining whether you'll experience a stroke, die of a heart attack or suffer another serious health condition.
Of course, it’s not the insurance plan itself that cures or kills you. But your health insurer decides which physicians to offer through their network. And studies show some doctors and medical groups pay more attention to preventive medicine, disease management and the coordination of care delivery.
Less than 3% of Medicare Advantage programs receive a 5 out of 5-star rating. (Image courtesy of... [+]
Selecting The Right Health Insurance Matters
As last week’s medical myth article revealed, the size of your provider network – meaning, the number of doctors and hospitals on an insurer’s roster – is a poor predictor of quality.
What’s most important is how that network organizes care delivery.
Specifically, patients can and should evaluate health plans based on (a) the level of collaboration among the primary care and specialty physicians, (b) the immediate availability of clinical information through a common electronic medical record (EMR) and (c) whether the physician culture relentlessly focuses on prevention, care coordination and seamless management of chronic conditions.
Looking at the published data on quality outcomes is the best way for knowledgeable consumers to separate the best from the rest.
The good news is that it is relatively easy to do.
Finding Publicly Available Data On Health Plans
The independent National Committee for Quality Assurance (NCQA) ranks hundreds of private health plans from the Healthcare Effectiveness Data and Information Set (HEDIS).
This report includes information on quality of care, access to care and overall patient experience. What you’ll find on the NCQA website is significant variation in performance among different plans within a certain state or region.
You may be surprised where your health care plan ranks.
These differences in ranking aren't random. In fact, they’re remarkably consistent year after year.
For anyone over 65, it’s important to check out published Medicare data. And for people enrolled in a Medicare Advantage plan, the Centers for Medicare and Medicaid Services (CMS) offers a five-star quality rating system to help consumers compare plans.
CMS assigns ratings to plans based on five categories: staying healthy, managing chronic conditions, member experience, member complaints and customer service.
What savvy shoppers will find is some pretty dramatic variation in performance among Medicare doctors and hospitals. The insurance programs that perform the best include providers that invest in 21st century technologies and coordinate care across specialties.
Today, less than 3 percent of all Medicare Advantage programs are five-star rated.
And similar to the NCQA rankings, the best Medicare Advantage plans rank highest year after year.
More and more throughout the U.S., people are basing their health insurance choices on these objective reports. In fact, the majority of newly enrolled Medicare Advantage members choose a four-star or five-star program.
Still, many Americans continue to ignore the data or don't know the data exist. Or worse, they fall victim to the myth that their health doesn't correlate with the health insurance program they select.
Either way, the result of not knowing or not caring is potentially avoidable morbidity, mortality and higher cost.
Why Debunking Medical Myths Matters
If there has been a consistent theme woven throughout this month’s series on medical myths, it’s that our false assumptions often lead to higher costs without higher quality of care.
In medical myth No. 1, we debunked the theory that more doctor visits, more testing and more procedures lead to better health outcomes. They don’t. In practice, they often increase the risk of complication and the cost of health care.
In medical myth No. 2, we explored a common debate among doctors as to whether medicine is an art or an applied science. Why should that matter? Doctors who view medicine as an art use that rationale to ignore established, evidence-based guidelines for diagnosing and treating patients. The result: Worse clinical outcomes and higher health care costs.
And last week, medical myth No. 3 taught us that it’s very difficult to know whether your doctor is good, bad or somewhere in between. Most people don't have the data or expertise to properly evaluate their physician. Instead, they rely on word of mouth or reputation, neither of which is effective.
Finally, it may seem as though our health and the quality of our medical care is unrelated to our choice of health insurance companies. But independent analyses demonstrate enrollees in some health plans achieve significantly better clinical outcomes than those in others. What’s more: price and coverage options are rarely major factors in that equation. The differences reflect the underlying delivery system and the coordination of care provided.
Today, individuals and families can maximize their chances of obtaining the best care by selecting health plans with the best publicly reported rankings and the highest consumer and patient satisfaction scores.
In doing so, they will find the best doctors who work together most effectively. In the process, their chances of receiving medical care consistent with the best available evidence will increase, and as a result, their chances of dying prematurely from a heart attack, stroke or cancer will plummet.
Certainly, debunking these four myths alone won’t solve our nation's health care crisis. But making savvy patients aware of these myths will go a long way in helping Americans find better solutions to the health care problems we face.
