When your health is complicated, you need more than a doctor—you need a healthcare team.
When your health is complicated, you may feel like you need a medical degree to understand your medications, blood tests, X-rays, MRIs, and other healthcare services. You may feel the same if someone you love is experiencing a serious illness—for example, if your spouse has heart disease or your mother suffered a stroke.
Either way, consider how valuable it would be to have a healthcare team who works with you—and talks to each other. A team that guides you in creating health goals and taking steps to reach them. Advises you when to see a specialist. Reminds you when you forget a screening. These are all elements of high-quality care—the kind you get at a patient-centered medical home (PCMH). Blue Cross & Blue Shield of Rhode Island (BCBSRI) is already working with primary care practices in Rhode Island to help deliver this kind of care to our members with complex health concerns.
What a patient-centered medical home is
The Newport and Portsmouth practices of Aquidneck Medical Associates are the first PCMHs of about 10 across Rhode Island to open this year with the support of BCBSRI. When you walk into Aquidneck Medical Associates, it looks like any other doctor's office. There's someone behind a desk to greet you. There's a waiting area with issues of Newsweek® to read and examining rooms with cushion-top tables and neatly folded johnnies. However, there's more personalized and collaborative care provided here than you've probably ever experienced before.
In this setting, you really get to know your doctor. He or she leads a team of healthcare professionals—including a nurse care manager and, in some cases, a nutritionist, behavioral health provider, and/or other specialists—in helping you improve your health. Your team considers everything going on in your life affecting your health: your living situation, emotional well-being, and medical history.
When you have a healthcare team overseeing your care, you receive the time and attention you need to make positive changes in your health. Your nurse care manager may help you schedule tests (and then keep track of the results for you) or set up appointments with specialists. He or she may also help you set goals for improving your health, such as changing your diet, and then arrange for you to see a nutritionist for advice on doing it.
How a PCMH benefits you
The PCMH setting puts you in the center of the healthcare system and offers care across multiple levels.
Your primary doctor keeps an eye on the big picture.
Your care is led mainly by your primary care physician with support from your healthcare team. "Behind the scenes, in between patient visits, we provide care even when the patient isn't physically here," David Gorelick, M.D., says. He's been leading Aquidneck Medical Associates' transformation to a PCMH. "For patients who have diabetes, we'll look at aspects of their care to see if they're coming in for visits as they should, that they're seeing their eye doctors and getting blood tests, and if they're taking their medications. If they're missing anything, we proactively reach out to them." Any visits to other doctors are carefully coordinated to help ensure that nothing slips by.
Your nurse care manager works with you one-on-one.
Working with you to create a personalized care plan, your nurse care manager helps you set health goals and then take the steps to reach them (helping you stay motivated along the way). You and your nurse care manager also discuss any instructions from your doctor, go over your medicines, and review other aspects of your care. "Medical visits can be overwhelming for some people, especially when they're experiencing various illnesses," says Dr. Gorelick. "Patients may feel intimidated to call the doctor and say 'I don't understand what you told me.' So it's helpful to have another healthcare professional to be available to sit down with our patients and explain things."
Evidence-based medicine and electronic health records help ensure your health and safety.
With electronic health records, your healthcare team has access to data about the best treatments based on evidence-based medicine, where appropriate, for your condition. They can see what medicines you're taking and whether you've missed any screenings or exams they'll need to remind you about.
All of these advantages help you stay out of the hospital and may reduce your need for medications, procedures, and other services later on. Since these items cost money, you save when you don't need them. Having a PCMH also removes some of the hassles of coordinating your own care. Best of all, it helps you live a healthier life. And that helps you continue doing the things you enjoy.
See an example of how a PCMH works.
What BCBSRI is doing
We're working hard to help our primary care physicians set up PCMHs across the state. To help improve quality of care, we've also developed a new pay-for-performance system that will include primary care physicians in BCBSRI-sponsored PCMHs.
By the end of 2010, we are striving to have about 8,500 of our members with complicated health concerns in a PCMH setting. We hope that down the road all of our members will be involved in a PCMH practice.
Read more about how BCBSRI is helping change healthcare.
