Getting care – it’s all about who you know.

Getting care – it’s all about who you know.

When you hear the phrase Primary Care Physician, do you know who that is? Let me introduce you.

I grew up in a small town. Our town was lucky enough to have our own doctor. Our town’s doctor was Dr. Sanders, and he was my doctor. In fact, he took care of everyone in my family. We went to him for sports and school physicals every year, and saw him when we had a stomach ache or a cold. When I fell and took out the corner of the coffee table with my chin, Dr. Sanders stitched me up. He took care of all that, times hundreds, every day. He was our town doctor for decades, until he retired at age 70.

We also called Dr. Sanders our “family doctor.” Today, he would be called a primary care physician, or PCP. A PCP may practice  family medicine, general medicine, pediatrics, women’s health or geriatrics.

While medicine has changed a lot over the years, the role of the primary care physician hasn’t changed much. He or she is still e the one  who takes care of you through all of the ups and downs of your health. And it is who you would call first when you have  a health problem. If you said “I need to call the doctor,” this is “the doctor” you would mean.

The Pew Research Center has a study that showed that 1 out of 3 adult Americans in our modern day “cough and click culture” – meaning they go to the web first for health information. While the web is a good place for health information, it isn’t the best place to go if you have symptoms and want to know what the real problem is. It can’t take the place of a health care expert who can run tests, talk through your symptoms and make sure you see a specialist if needed. For example, the fatigue and joint pain you are having may lead you to worry that you have Lupus, a chronic and devastating disease. A doctor  may quickly rule out Lupus and may instead trace your problems to lack of sleep, stress, certain meds or other root causes that can be an easy fix.

If you have “your” doctor, or PCP, you are already on your way to better health. Having your own personal doctor is one of the most important thing you can do for your health. It means you’ll have someone in your corner making sure you get the care you need.

  • Having a PCP means you can focus more on staying healthy, instead of only seeking help when you are sick or hurt. Your doctor becomes your health coach, to make sure you have the support to stay healthy and live longer.
  • Your PCP will already know your health history, what meds you take, and what health problems you have. This means you have someone who  is making informed decisions about your care.
  • Your PCP will handle your routine health care needs, and be there when you need care right away, such as with colds and the flu.
  • Early diagnosis and care can keep many common health problems from getting worse. Your PCP can identify problems before they become serious or lead to other major illnesses. For example, identifying diabetes early and getting it under control could prevent you from having other diabetes related illnesses later on.
  • Your PCP can guide you and follow your care each step of the way if you need to be seen by a specialist or go to a hospital. This keeps your care on track and helps you avoid unnecessary expenses.

Do You Have an HMO Plan?
That doctor-patient relationship is at the center of an HMO plan.  An HMO, or Health Maintenance Organization, relies on the PCP to manage your health in order to control your costs and keep your health on track.  

Your HMO, Your PCP and You   
To make the most of your relationship with your PCP and get the most out of your HMO, keep these tips in mind:

  • If you are new to an HMO or are choosing a new doctor as your PCP, make your first appointment as soon as possible. Having a relationship with your PCP will help you avoid delays when you’re sick or hurt, or need to get a referral to see a specialist.   
  • Each person on your plan can pick their own PCP. If you later decide your PCP isn’t right for you, you can change to another one.
  • Always call or go to your PCP first when you need care, unless it is an emergency. It’s important you get all your care from providers in your HMO network, and call your PCP before you see any other doctors, have tests run or go to the hospital. Your PCP will coordinate with other providers to make sure they are in your network, that your care is authorized and that the other providers have information about your health care needs.

So, What's the Difference Between a PCP and an HCP?

According to UC Berkely, a Health Care Practitioner (HCP) is a person who has been trained in a specific kind of medicine to help target health issues. These can be doctors, nurses or specialists.

Most often a doctor (MD), a primary care provider (PCP) is a health care practitioner who manages a patient’s health over a long period of time. This is a care provider who sees people that have common medical concerns or are seeing preventive care. A PCP can also be a physician assistant or a nurse practitioner.

Both will file claims with your insurance provider. Long story short, a PCP is a type of HCP, but an HCP might not be a PCP. It is always a good idea to talk to your doctor—by that we mean your PCP-- about any other treatments that you receive from a specialist or other provider or HCP. Make sense?

To get information about your health plan or need to find a PCP, log on to Blue Access for Members and use our  Provider Finder, a search tool that lists the providers who are part of your HMO plan’s provider network.