How a Quality-Based Primary Care Provider Provides Comprehensive and Coordinated Care for Seniors on Medicare

Charlotte Miller

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How a Quality-Based Primary Care Provider Provides Comprehensive and Coordinated Care for Seniors on Medicare

Senior citizens frequently interact with the healthcare system and for good reasons. Seniors tend to face a variety of health conditions that needs addressing and often need care management. It’s no surprise that they would reach out to primary care for seniors or other specialists. However, this often results in them taking various medications and having numerous appointments.

In this article, we will explore how primary care providers can offer coordinated care for seniors on Medicare.

How Do You describe Coordinated Care?

Before we head over to the main subject, let’s familiarize ourselves with coordinated care first. Coordinated Care is best described as a community-based collaboration of health practitioners. The primary goal of coordinated care is to provide personalized healthcare of the highest quality to a patient.

Now, let’s use a scenario as an example. Let’s say that I am a senior citizen that has a lot of chronic health conditions. I’ll be heading over to a geriatrician near me. What happens next is that I’ll ask and consult my primary care doctor on how I can manage my multiple health conditions. The doctor will then refer me to a trusted health organization that will conduct an interview regarding my current health condition and care preferences.

Where to Get Coordinated Healthcare?

Before we delve into how primary care providers can provide quality coordinated care to seniors, Let’s know first where you can obtain healthcare plans that have coordinated care available to them.

The process is relatively straightforward. First, check with your insurance provider to see if they offer Medicare health plans. If they do possess these health plans, you’ll need to confirm with them whether these plans have coordinated care included in them.

The following four Medicare plans usually offer coordinated care:

  • SNP’s or Special Needs Plans
  • POS or Point of Service Plans
  • PPO or Preferred Provider Organization Plans
  • HMO or Health Maintenance Organization Plans

How to Provide Quality Coordinated Care?

Now that we’ve covered what coordinated care is, let’s proceed with how a primary care doctor or a clinic can provide it. Here are some ways they can offer quality coordinated care to seniors on Medicare:

1. Referral to Accountable Care Organizations

Sometimes, primary care health clinics aren’t enough to alleviate your health conditions. As stated earlier, there’s a possibility that if you are a senior on Medicare; you could be referred to trusted organizations known as ACOs. ACOs or Accountable Care Organizations are a group of health specialists who coordinate and plan together.

Their main goal is to provide top-notch healthcare to all patients, seniors included. Their protocol tends to involve an interview regarding your health condition and preferences. Compared to a normal appointment at the hospital, this costs less money because you don’t undergo repeated tests. On top of that, ACOs also use electronic health records. They will use the records as a reference when addressing your healthcare needs.

Healthcare specialists will then coordinate with each other. Their primary task is to develop a suitable, personalized healthcare plan for you.

  • However, it’s worth noting that if your health provider, such as a primary care doctor, is part of an ACO, you can still visit other health providers that accept Medicare There’s no need to worry as your health benefits will remain intact.

2. Global and Professional Direct Contracting Model of Healthcare

This model of health care is great for senior citizens as it can improve primary care quality from health clinics and providers. Simultaneously, the Global & Professional Direct Contracting Model reduces your chances of hospitalization.

However, how does it work? The best way to describe this model of healthcare is that a participating doctor will receive letters from a direct contracting entity. These entities can be health clinics, specialists, or even health organizations.

Now, how will this benefit Seniors though? If the primary care doctor coordinates and works with the entity. They may receive the following benefits such as:

  • The option to be sent to a skilled nursing facility. It’s similar to hospital admission but with more perks ranging from therapy to dietary counseling.
  • Access to telehealth benefits such as dermatological and eye care services
  • Access to home visits from a primary care doctor or a nurse to assist in managing your healthcare plan.

3. The Oncology Care Model

The Oncology Care Model is best summarized as Medicare coordinating with many medical facilities and health clinics that serve cancer patients. Medicare will communicate and coordinate with these medical practices to become more focused on the patient’s health. This includes senior citizens, of course.

With that said, what should you expect from doctors and clinics that are a part of the Oncology Care Model? Here’s what you need to expect from medical centers that follow this model:

  • Patients will gain access to personalized care. They are tailored to the preferences and health needs of the patient.
  • A health hotline also becomes accessible to patients if the health center is an Oncology Care model participant. This health hotline is available 24/7.
  • Additional support in coordinated care becomes accessible to patients in this healthcare model. You could gain extra support in the form of resources that are previously unavailable.
  • To help you in your treatment journey, you can also gain access to support services from this healthcare model. They can range from financial help to psychological support and therapy.

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Age Doesn’t Matter When You Have Coordinated Care

Seniors are the most vulnerable age group as they tend to come into contact with chronic health conditions. At times, the care provided by a health clinic or a primary care doctor may not be sufficient to address these issues. That’s where coordinated care comes into the picture, the health providers in that network will help each other to concoct a plan that fits their patients.

Aside from providing a healthcare plan, coordinated care also offers a ton of benefits for the senior citizen. Through the care of many experts and the benefits, the senior citizen can enjoy more years to come; old but still healthy.