You want the best health care possible for yourself and your family. If you're like most of us, the search starts by talking to a trusted medical professional, such as a personal doctor. While this is a good place to start, it’s in your best interest to dig a little deeper.
However, many of us don’t venture far when it comes to choosing the right doctor or facility. In fact, people spend more time researching a job change or a new car External Site than they devote to learning about their specialist or surgeon.
Choosing the right doctor, surgeon, outpatient facility or hospital is incredibly important. That’s because quality can vary among doctors and hospitals, based on the number of procedures they've done, complication rate, and other factors. But, where do you start?
What is "quality" health care?
Sure, we all want quality health care, but what does that mean, exactly? According to the National Committee for Quality Assurance (NCQA) External Site, health care quality means getting the right care, in the right amount, at the right time. This means having timely access to care, as well as the ability to get the right treatment and preventive care. Quality also means providing the care the patient needs when the patient needs it, in an affordable, safe and effective manner.
Three ways to find quality care
When you log in or register for myWellmark® Opens New Window, our secure member website, you will have access to a variety of resources you can use to guide your decision. Select “Find Care” to compare the quality of in-network doctors, facilities, and hospitals.
Compare hospitals and doctors
Search for doctors and facilities and find information about the quality of their care
Check quality scores. Your health plan monitors how well doctors care for their patients across a number of different measures and then combines them into a single score for you. The higher the number, the better the quality score. At this time, quality scores are included only for primary care providers (not for specialists).
- Consider doctor ratings. This tool is used to find out how other members rate their overall experiences with each doctor on a scale of 1 to 5 stars, or you can submit a review of your own. The ratings are included in your results when you search for providers from the myWellmark home page.
Look for recognitions. When you search for providers in myWellmark, you'll find various designations and achievements for which they've been recognized. These include awards, certifications and similar designations from accredited, independent third parties. You can find more information about these recognitions during your search.
Find top centers for specialty care
When you or someone in your family needs specialized care, like surgery or a transplant, choosing where to receive it is particularly important. That’s why we offer Blue Distinction® Centers (BDCs) Opens New Window, facilities that have a proven history of delivering exceptional care and results, at a lower price. BDCs have expertise in 11 areas of specialty care Opens New Window, To receive a Blue Distinction Center designation, doctors, hospitals and facilities must meet or exceed predetermined standards for patient care. Overall, patients who use BDCs experience fewer complications, lower re-admission rates and higher survival rates. This means getting back to your normal daily life sooner.
There may be BDC requirements specific to your plan, so talk to your doctor, review your coverage manual, and check your plan details by logging in to myWellmark Opens New Window. You can also call the customer service number on your ID card to know before you go.
Call BeWell 24/7SM
Wellmark Blue Cross and Blue Shield's free health information hotline, BeWell 24/7 Opens New Window (844-84-BEWELL), is available anytime for advice based on your symptoms and recommendations on where to go for care. If you have a specific condition and need to see several specialists, BeWell 24/7 can schedule appointments and tests for you. The people at BeWell 24/7 can even coordinate care for services like medical equipment and prescription drug delivery.
Check your benefits first
You want quality care, but you don't want to break the bank. While health care costs can be difficult to find, Wellmark makes it easier. Log in or register for myWellmark, and find the Cost Estimator in the "Find Care" section. The Cost Estimator will help you research cost estimates for hundreds of common medical conditions, hospital costs, physician costs, prescription drug costs and other related costs.
When it comes to quality, you play a key role
Quality health care is a two-way street. You play a key role. This means being engaged in the process, asking questions and following through on treatment. It means staying on top of the preventive care you need and seeking the care you need when you need it. You'll get better care when you are a smart health care consumer.
At Wellmark, we are committed to quality. Learn more about Wellmark's Commitment to Quality Opens New Window and how we work with providers to keep you healthy. Also, get information about Wellmark's NCQA accreditation status and other quality measures.