What is the Role of a PCP in an HMO setting?

What is a Role of a PCP in a HMO?Healthcare is changing. Technology, government regulations and new insurance choices, have an impact on how we receive  medical care.  A doctor with a stethoscope and a prescription pad may no longer be the face of healthcare, but  the Primary Care Provider is still the focal point of patient care in an HMO setting.

What is the PCP’s role particularly when it comes to senior patients, and what should you look for when choosing a PCP?

Let us start with the first question.  The PCP should understand not only the patient’s medical condition, but also consider the patient’s family involvement, housing situation, lifestyle and even their culture.  A care coordinator willing to work with other providers and social services.  The PCP should also be the patient’s advocate using programs available through the HMO and Medical Group to create a comprehensive treatment plan.  An educator promoting right lifestyle choices and a charismatic friend who can motivate patients to change.

How do I find a good PCP? Is their specialty most important? It depends.  Traditionally, we think that Internal Medicine doctors, since they have couple extra years of education, are better prepared to treat elderly patients.

At the same time, some Family or General Practitioners have an additional specialty in Geriatric Medicine.  Others will simply send patients to the specialists to treat their Diabetes or Hypertension.

Specialty is important, but the doctor’s personality, bed side manner, and their communication skills might be equally or of more importance.  A good PCP should be willing to explain the complexity of the patient’s medical condition as well as available treatment options.

The quality of service the office staff offers and their willingness to partner with your Medicare Advantage plan should also be considered when choosing a PCP.  Some doctor’s offices are managed very well and run smoothly.  At others, patients may have long wait times to see the doctor, and referrals may not be processed in a timely manner.

Both doctors and support staff have their preferences and opinions.  Make sure when you chose a MAPD option, you also find a medical office that accepts your choice, understands requirements of that model of care and that is willing to work with it. The type of office is important as well.

Clinics may have longer hours, be open on weekends and have a variety of services available in the same location.  At a small private doctor’s office they may not offer all these services, but offer a more personalized compassionate care. All of these things may affect your overall experience.

Understand your needs, and choose wisely. An experienced broker can assist you enrollment into a MAPD plan and also help you find the right doctor that best suits your needs.