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Your Guide to Health Insurance, Wellness & Discounts

Value-based Primary Care for the Medicare Eligible

Many primary care practices follow fee-for-service models, which often prioritize volume of patient visits over quality of care. A value-based, managed-care model puts an emphasis on wellness and prevention to support better health. It aligns the incentives for patients, providers and insurance companies by simultaneously improving health outcomes and care quality, lowering medical costs and improving the patient experience.

Your health is one of the most important aspects of your life — if not the most important. However, when you are feeling well, you can easily overlook preventive care. This can lead to poor health and can impact how you live your life and stop you from doing the things you love. There are times when there can be underlying problems affecting you, even if they don’t cause symptoms. This is where preventive care through effective primary care comes in: it can play a central role in your overall health. Accessible and effective primary care is important and can have a positive impact on both your health and your finances.

A primary care doctor (also known as primary care physician, primary care provider) is your partner in healthcare, and the first line of defense against poor health. They are specially trained professionals who can address most of your healthcare needs, such as maintaining your health, as well as preventing, detecting, and treatment of short-term (acute) and long-term (chronic) diseases. A primary care physician, along with a team of healthcare professionals, such as nurses, nurse practitioners, and physician’s assistants, work together in an synergistic approach to provide you with the best care possible.

With so many different types of doctors out there, it may be overwhelming and confusing to decide what type of doctor you should see when you feel sick. As the name implies, primary care is your initial point of contact with the healthcare system. Primary care doctors are not limited to a specific problem area (such as physical or mental health), or a particular organ system (e.g., cardiology, pulmonology, gastroenterology). Rather, primary care manages your care comprehensively, looking at all aspects of your health. There are different types of primary care doctors (for example, pediatricians, family/​general practice physicians, internal medicine physicians, and gynecologists), and whom you see depends on your age and gender.

In contrast, specialty care focuses on a particular area of medicine. Specialist doctors undergo additional education and training for a specific discipline. Examples include neurologists, psychiatrists, and cardiologists. There are also subspecialists, whose expertise are even more focused than a specialist. For example, a specialist in oncology (branch of medicine that deals with cancer) can pursue a subspecialty in gynecologic oncology, which narrows their practice to cancers involving the female reproductive system.

There are many reasons you might change your current primary care physician and many factors to consider ranging from personal preference, availability, and accessibility. Finding and keeping the right primary care physician can be difficult, and the process itself can be a little daunting, but it doesn’t have to be.

A primary care physician (also known as a primary care doctor, or primary care provider) is a medical doctor that specializes in family medicine, general internal medicine, or general pediatrics. They’re the first doctors you’ll see and are responsible for continuing your primary care. This type of care is varied and may be centered on short-term conditions (like managing bronchitis), long-term conditions (such as treating high blood pressure or diabetes), or preventive measures (like annual check-ups, blood work, and immunizations). A primary care physician is specifically trained to carry out these services, as opposed to specialists, who focus on a particular field of medicine. A primary care doctor is also responsible for coordinating other health care services for your treatment.

Reasons to consider changing your primary care physician?
There are many reasons why you may want to consider going to a new primary care doctor, and sometimes they may be out of your control. No matter what your circumstances are, there are no binding rules that require you to stay with your current doctor — and the decision to leave is completely your choice. Below are some of the reasons that compel people to change primary care providers.

A recent re-location
Moving to a new city or state is one of the main reasons you might change doctors. When looking for a primary care physician, it’s important that their office is convenient for you. Although some practices also offer services like online scheduling, telemedicine (also called e-visits), and online access to your health records, having your doctor within easy physical access comes in handy, especially if you’d rather have a consultation in person.

Your current primary care physician is moving or retiring
Sometimes, it may not be you who’s changing locations, but your doctor. Maybe they’re retiring or taking their practice elsewhere. It can be difficult when this happens, especially if you have already formed a good relationship with them. There are ways to help take the stress out of finding a new PCO. First request copies of your medical files and organize them. You can then start to research other doctors in your area who can fit your needs.

Changes in Insurance Can Trigger a Change
Not all primary care doctors are part of an insurance program, and not all of them are affiliated with hospitals. You may consider changing your primary care physician if your insurance plan changes for any reason (e.g., financial, work-related, change in your marital status), or if your current primary care doctor decides to drop your insurance plan. Using your insurer’s directory or website can help you find out whether your network covers a certain doctor.

Your decision can also be affected if you have a preferred hospital, especially if you want a doctor who is affiliated with your medical center of choice and has admitting privileges. This way they’ll be able to provide you with continuing care in a hospital where you’re comfortable. You can still see your doctor even if they aren’t part of your insurance plan, but it will cost more as you’ll be paying out of pocket. You can always ask your doctor’s office what plans they accept and you can change into one of those plans if needed.

You’re not getting the care you need
Availability and competency are key practical factors that you want to consider with your primary care doctor. If your current doctor is overloaded with patients and you find yourself having to schedule appointments that are months away, or if you feel as though the care you’re receiving falls short of your needs, it may be time to switch doctors. Medical needs change over time. For example, developing a long-term condition like diabetes or high blood pressure requires regular visits to the doctor. Patients with long-term conditions might want a primary care doctor who has open, flexible schedules. On the other hand, those with fewer health issues may not be as limited by a doctor’s availability.

You don’t have a good relationship with them
Not surprisingly, more than half of Americans consider a doctor’s personality when choosing a physician. People have different personalities, and sometimes they just don’t feel comfortable with a certain primary care provider. Trust is crucial when choosing your primary care doctor, while establishing a good relationship with them also is important for your overall health. Even if you initially had a good relationship with your doctor, one bad incident can be enough to make a dent in your relationship. Aside from the doctor, you should also look at the office staff.

They’re in charge of a lot of the technical aspects of your care, such as scheduling your appointments, addressing insurance issues, and relaying your messages to the doctor. Because healthcare is a team effort, a good doctor with a bad staff (or vice versa) can still make your visits unpleasant. On the other hand, a good doctor with an efficient, welcoming staff can improve your overall experience.

Your primary care doctor is a partner in your care — it should be their goal to keep you healthy. That’s why it’s important to find a primary care provider that meets your standards, suits your needs, and with whom you can build a good relationship for years to come.

Primary care for the Medicare Eligible

Oak Street Health provides primary care services to Medicare eligible adults from a team of doctors, nurses and other professionals, dedicated to keeping you well. Oak Street Health offers same day appointments, in-center events and more.



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