How These Affect You

From Winter 2014 issue of For Your Benefit newsletter pdf format of Winter 2014 FYB

The GIC is moving the Massachusetts health care marketplace to new ways of getting and paying for care.  We are requiring our health plans to establish integrated systems of care called Centered Care.  The health plans receive financial incentives for achieving budget targets and adopting new payment systems, or penalties for not meeting these new benchmarks.

Centered Care has 10 key elements, and over the next few issues of For Your Benefit we will highlight these features and how they affect members.  The first two are described in this month’s guest editorial by Dr. Paul Kasuba, Chief Medical Officer of Tufts Health Plan. 

  1. PCP designation: Your plan keeps track of who your primary care provider (PCP) is and lets the provider know that you are their patient and that you have selected him or her to coordinate your care.  Primary Care Providers include physicians with specialties in internal medicine, family practice, and pediatrics, nurse practitioners, and physician assistants.
  2. PCP engagement: Your PCP helps coordinate your care.

A third element of Centered Care is data sharing, where your primary care provider team has electronic health records so that they have ready secure access to your health history, prescriptions, lab results, and appointments, enabling them to keep track of your medical needs and make sure they are met.  In 2009, a federal stimulus bill included $19 billion to help medical practices adopt electronic health records.  As a result, the adoption of electronic health records has skyrocketed between 2008 and 2012 according to the Centers for Disease Control: from 17 percent to 50 percent in physician offices.  Electronic health records help medical practices:

  • Send reminders to their patients about needed tests and checkup reminders; 
  • Simplify tracking on whether patients have actually completed these tests and come in for their visits;
  • Access medical records from other providers, including hospital discharge instructions, to better coordinate and manage care;
  • Avoid unwelcome drug interactions and monitor changes in prescription medications;
  • Coordinate appointments with multiple specialists; and
  • Provide feedback on areas of quality improvement for the practice.

Centered Care assists your providers in providing the best care for you.  You also have a role in improving your own care by following your PCP’s instructions, taking medications and tests as prescribed, not smoking, eating right, and exercising.  Together, the GIC, our health plans, the provider community, and you, our members, can enjoy better health care under the Centered Care Initiative.

This information provided by the Group Insurance Commission.