A South Florida senior is rushed to the emergency room because she mixed medications that are contra-indicated. Another bounced around from specialist to specialist, undergoing duplicate tests and procedures.
These situations are more common than you think — and current medical data suggests they could be avoided with better health care coordination.
More than 100 national studies document the critical role primary care physicians (PCPs) play in patient care. PCPs can be many things for a patient — their cheerleader, advocate and even their medical interpreter — but most importantly, the studies prove that having a strong relationship with a PCP leads to better quality of life, more productive longevity, and lower costs as a result of reduced hospitalization, improved prevention and better coordination of chronic disease care.AvMed Health Plans, one of the oldest Medicare providers in South Florida, prides itself on personalized service and consistently scores above its statewide competitors in customer satisfaction. Embracing a more PCP-coordinated approach to healthcare through CenteredCare seemed a natural progression. CenteredCare puts the PCP at the center of every member’s care.
“We have physician advisory groups and it was in these forums that comments about more coordinated care began to surface,” said Susan Pinnas, Senior Vice President of Provider and Service Operations at AvMed. “Our primary concern is the safety and health of our members and the physicians are critical partners in this regard. We listened to our physicians and partnered with them to improve care for our members.”
Comprehensive, Coordinated Care
According to Michael Sheehan, M.D., Medical Director for Medicare Affairs at AvMed, this coordinated approach to health care will lead to better outcomes for patients.
“Some 15-20% of Medicare hospital admissions are due to medication complications,” said Dr. Sheehan. “By developing a strong relationship with your PCP, patients can avoid this.”
A key component of CenteredCare is the Rational Med program, which offers an ongoing review of each member’s prescriptions to help identify potential risks before complications occur. AvMed looks at prescription fulfillment patterns and alerts primary care physicians if members aren’t filling prescriptions. If there is a problem with cost, AvMed helps identify programs that can help. If there is a problem with side effects, the member’s PCP can prescribe something else.
Next spring, AvMed is launching a Physician-to-Physician Referral to further coordinate patient care. This is different from other referral systems on the market because it does not require involvement or authorization from AvMed. It’s simply a transaction between physicians designed to keep primary care physicians in the loop about their patient’s care and to ensure health care coordination.
“We don’t want to get in the middle of the patient-physician relationship,” said Dr. Sheehan. “We are not going to limit access to specialists. But with all of the available technologies and the specialization of medicine, it is now more important than ever to have someone coordinate and serve as the ‘quarterback’ of the medical team.”
Louise Schendel, a senior from Margate who visits her PCP every three months, admits she would be lost without the lasting relationship she has built with her PCP over the years.
“When I have a problem, I call him and he tells me exactly where to go and what to do. I feel like I have someone out there rooting for me,” said Schendel, an AvMed Medicare Advantage plan member for two years. “Without my PCP I wouldn’t have the confidence on where to go and what specialists to visit.”
Better Outcomes for Patients
Physicians across the country – and here in South Florida – have started to embrace the PCP-centric approach to health care. Through CenteredCare, AvMed is educating its Medicare members on how to establish a strong relationship with their PCP and recommends members visit their PCP once a quarter – even when they are well.
William Pena, M.D., a primary care physician who practices in Hollywood, said patients rely on their PCP to navigate the health care system.
“Patients want us to explain procedures,” he said. “The best way to get better results is when a patient understands clearly what they have and how to interpret tests. They need to understand their options for treatment and they rely on their PCP to help.”
