From the GIC Fall 2009 Newsletter pdf format of fybfall2009.pdf

By Paul Mendis, M.D., Chief Medical Officer, Neighborhood Health Plan

Everyone is concerned about health care costs and quality. Part of controlling rising health care costs is making sure care is delivered in the least intensive setting possible. Your primary care provider's (PCP) medical practice, Community Health Centers, or an Urgent Care center should be the first stop for minor acute illnesses.

Cost, Convenience and Quality

A sore throat, rash, fever, nausea, diarrhea, headache, or knee pain usually represents the kind of minor acute ailment that should be assessed in your PCP's office, one of the least intensive health care settings available to you. The ER, on the other hand, is one of the most intensive health care settings and often more intense than is needed for any of these conditions.

Costs associated with an ER visit include your copayment, which is higher than you pay at your PCP's office. Also, the cost to your health plan is at least two or three times greater for an ER visit. These costs contribute to rising health care costs so only use the ER when it is truly necessary.

There are other benefits to seeing your PCP or Urgent Care center including convenience and quality. It is usually more convenient for you to be seen by your PCP since you can make an appointment for your care. And seeing someone who is familiar with you and your health care needs makes it easier for you to explain your concerns. Quality of care is rooted in the continuity of care. Your PCP will have your complete medical history. Therefore, tests aren't repeated unnecessarily and he or she will know what medications you take before prescribing anything new and can determine if the issue is linked to something in your medical history. This reduces chances of a medical error, which can cause injuries and create extra expense.

Better Access to Urgent Care

Some medical practices, like Community Health Centers, have expanded hours of operation, hire telephonic triage nurses, and extend normal hours for urgent care. The next time a minor acute illness arises, think about visiting your PCP's office or Urgent Care center first.

Paul Mendis, MD, has served as Chief Medical Officer for Neighborhood Health Plan since 2002. He is responsible for NHP's care management, disease management, behavioral health, pharmacy and special populations programs.


This information provided by the Group Insurance Commission .