As a major part of the GIC’s initiative to provide more coordinated care for our members in today’s complex medical world, all of the GIC’s Employee/Non-Medicare health plans are making a concentrated effort to identify which provider is serving as a member’s primary care provider (PCP). In addition to a general practitioner primary care physician, a PCP can also be a nurse practitioner, physician assistant, internist, family practice physician or pediatrician. PCPs are critical to the success of the GIC’s Integrated Risk Bearing Organization (IRBO) model that is rolling out over the next five years. IRBOs emphasize team-based systems that accept full or partial risk for the quality and cost of patient care. Central to the IRBO approach is that a PCP will be responsible for coordinating the care of each patient by providing reminders about needed tests, helping patients find appropriate specialists, keeping track of prescriptions and lab tests and results, and helping patients navigate the medical world.
The GIC’s HMOs have always required their members to select a PCP and this practice will continue, although Fallon Health Plan Direct Care and Select Care, Harvard Pilgrim Primary Choice Plan, Health New England, and Neighborhood Health Plan use slightly different methods for determining a member’s PCP. Health New England assigns a PCP based on the first claim received for a member from a PCP. Members can also call the plan or use the HNE Direct Member Portal to list their PCP. Neighborhood Health Plan assigns a PCP for new members. NHP’s customer service team also verifies PCP information with every member call. Fallon uses both new member letters and welcome calls to let members know that PCP identification is required. The Harvard Primary Choice Plan asks members to call them with their PCP the month before their coverage begins; if a member does not call, a PCP is assigned and the member can subsequently change this designation by calling the plan.
In a new initiative, the GIC’s EPO, PPOs and Indemnity Plan/Basic will now begin to ascertain members’ PCPs. Tufts Health Plan has actively been encouraging members of Navigator and Spirit to identify a PCP, and their Annual Enrollment communications included messages encouraging members to call Tufts or to use the secure member portal, mytuftshealthplan.com, to list PCP information. The Tufts Health Plan customer service center is also actively encouraging members to identify their PCP. Harvard Pilgrim Health Care and UniCare are currently working on their roll-out of PCP identification for the Independence and UniCare Indemnity plans.
Look for more information from your health plan, or call them for additional details
This information provided by the Group Insurance Commission.
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