Prevention, integration and your new healthcare team

By Gus Manocchia, M.D.
Posted 3/3/16

The major changes in healthcare over the past few years can be summed up in a two words: prevention and integration. Across the healthcare system, from insurers to doctors and other care providers, …

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Prevention, integration and your new healthcare team

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The major changes in healthcare over the past few years can be summed up in a two words: prevention and integration. Across the healthcare system, from insurers to doctors and other care providers, we have seen a shift in emphasis from treating sickness to keeping people healthy.

The benefits of preventive care are so widely understood that for many of us, thinking about whether an insurance plan includes a benefit for gym membership has become routine. Doctors are having broader conversations with patients who suffer from chronic conditions, discussing diet and lifestyle choices as much as symptoms and treatments.

“Integration” can be a harder notion to understand, but when we think about making sure that healthcare providers have the most complete, up-to-date information, and that the many different parts of the healthcare system should work together to serve you, it starts to make sense.

Think of all the different healthcare provider entities that you touch as part of your healthcare experience. The present process can be fragmented and very chaotic – but that is changing. The result is that “systems of care” are forming to increase collaboration among all members of the healthcare team –including doctors, hospitals, nurse practitioners, technicians, pharmacists, dentists, therapists and others – and new health plan products incentivize teams to meet high quality metrics and achieve better outcomes for patients. Many primary care providers are stepping up to play a central role in this new model of care.

When all members of healthcare teams coordinate and share the same information, everyone understands the “big picture” of your health and needs.

You can improve your health and take full advantage of your healthcare benefits by speaking to more members of your healthcare team than just your primary care provider. A nurse care manager can support you in managing long-term issues and chronic conditions, or in making healthier lifestyle changes. A conversation with your pharmacist could lead to lower cost versions of the same drugs, more convenient mail order options, or even streamlining a complicated medication regimen.

No matter where you get your care, regular screenings and preventive care are essential for overall health. A strong relationship with your primary care provider, in which he or she gets to know you and your medical history, will help ensure that you get the preventative care you need now (like vaccinations) and that you get the screenings you need to keep an eye out for potential problems before they worsen.

Your healthcare team should meet three main criteria: high quality, manageable costs, and a great patient experience. Whether it’s consulting with your primary care team before seeing a specialist and making sure your doctors share information, or asking where a surgical procedure should be performed or if it needs to be performed at all.

Of course, you also want to be able to access care whenever you need it – even if that’s when an office is closed. You should always call your doctor first but also be sure to check to see if your insurance plan offers a 24/7 Nurse Care Lines, covers health clinics in retail stores or telemedicine programs to connect with doctors online.

There’s no one “best” plan – the right choice for you will depend on your personal health. What’s critical is finding a primary care provider you trust, so that you can be completely honest and give them a realistic understanding of your lifestyle and any other potential health issues. The most important step is using your coverage. Don’t wait until you “need” it – the best care team can’t keep you healthy if you don’t show up.

Gus Manocchia, M.D., is senior vice president and chief medical officer for Blue Cross & Blue Shield of Rhode Island.

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