Myths Preventing You from Providing Better Employee Health Care

NOTE:  Group Health is now Kaiser Permanente. Group Health Cooperative (HMO) is now Kaiser Foundation Health Plan of Washington. And Group Health Options, Inc. (PPO) is now Kaiser Foundation Health Plan of Washington Options, Inc.

There’s been a lot said about HMOs in general and Group Health in particular over the years. Some of it is confusing, some misleading, some false. To set the record straight, here are some common misconceptions about Group Health that we frequently hear and what’s really true.

Myth #1: Group Health only sells HMO plans

Reality: Yes, Group Health is well known for its HMO plans. But we also offer employers our Access PPO with one of the broadest selection of doctors around. Our PPO plan is so well designed that it was ranked #2 in the 2015 Community Checkup from the Washington Health Alliance. The top-ranked plan? Our HMO. What’s more, our HMO was the highest-ranked health plan in the country in the 2016 eValue8 survey.* Both HMO and PPO plans feature several of Washington’s most respected hospitals and our own clinics staffed by Group Health Physicians, the highest-ranked medical group in the state.1

 

Group-Health-Number_One

 

Myth #2: HMOs don’t have as many doctor options

Reality: You’d be surprised at how many doctors we have in network—nearly 1,000 Group Health physicians in addition to those with whom we contract. In fact, some of the most respected doctors in the region are working at Group Health. From such renowned medical schools as Harvard, Stanford, Yale, and UCLA. Our doctors have spoken before the United Nations and chair national task forces on preventive medicine. We have world-class specialists and our physicians are consistently voted by their peers to be among the Top Docs in the area. 93 percent of our doctors are board-certified, compared to the national average of 87 percent.2 And we’re very picky about who we accept into our physicians group. For every Group Health Physician chosen for our family residency program, more than 150 don’t make the grade.

Myth #3: HMOs don’t have that many specialists

Reality: At Group Health we have nearly 600 specialists in almost whatever “ology” you can think of, from cardiology to neurology, oncology to rheumatology. Sixty specialties and subspecialties in all. We contract with some of the most respected hospitals in the region, including Harborview, Swedish, Overlake, Seattle Children’s, Mary Bridge Children’s, and more. Plus, we’re quick to diagnose issues and begin treatment. Which helps explain why we’ve consistently had some of the lowest average hospital stay and readmission rates in the area. Since 2011, we’ve been formally affiliated with Seattle Cancer Care Alliance, the leading cancer care organization in the northwest. Patients who receive cancer care from us have a survival rate that’s comparable or exceeds both national performance.  And we’re one of only three medical groups in the state that scored above the 90th percentile in both breast and cervical cancer screenings.

Group Health always puts the health of our patients first, providing whatever appropriate care is called for. We invest time with patients to discuss the medical evidence surrounding their issue and proper steps to take. What we don’t do is order unnecessary—and sometimes unnecessarily risky—tests or procedures in order to generate revenue as fee-for-service providers do. We emphasize preventive care to help keep your employees from getting sick in the first place. And turn to proven, evidence-based treatment when care is needed. In fact, in the 2016 eValue8 report, our HMO was the top-performing health plan in the country for helping members manage chronic conditions. Regarding prescriptions, instead of expensive brand name drugs, we look to prescribe generic versions that are just as effective. Our goal is to keep our patients as healthy as possible, while being mindful of the cost of care.

Myth #4: In HMOs, doctors don’t make the decisions, finance types do

Reality:  Group Health is one of the only health carriers with its own care delivery system, meaning care and coverage truly work together. Our physicians heavily influence our plan offerings, from helping define which medications are carried to what procedures should be covered. What’s more, the doctors that serve on our coverage committees are practicing physicians as well as medical administrators. So they know what issues patients are facing and are current with medical advancements. A Group Health doctor reviews any appeal to make sure the patient’s rights are protected.

 

1. 2015 Community Checkup, Washington Health Alliance 

2. Source: Is your doctor Board Certified? Does it matter?; Consumers’ Checkbook; www.checkbook.org/boardcert

3. Hospital Readmissions and Outpatient Care, Washington Health Alliance, January 2015.

4. Group Health Research Institute based on lung, colon / rectum, ovarian, prostate, and female breast cancer.

5. 2015 Community Checkup, Washington Health Alliance; cervical cancer screenings based on Medicaid population served; breast cancer screenings based on commercially insured population served.

 

* Group Health Cooperative’s commercial HMO rated the top health plan in the United States in the 2016 eValue8™ survey. Managed by the National Business Coalition on Health, eValue8™ is an evidence-based resource created by business coalitions and employers like Marriott and General Motors to measure and evaluate health plan performance.

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©2018 Kaiser Foundation Health Plan of Washington

All plans offered and underwritten by Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.