Fall/Winter 2016

So you have a Medical Home – now what?

If you’re like tens of thousands of Moda Health members, you recently selected a health plan that requires a Medical Home.

A Medical Home is a clinic that provides you with a team of doctors who work together on the best treatments to help you achieve better health and wellness. You will likely see a single primary care physician (PCP) most of the time, but the entire clinic provides the team support — other PCPs, nurse practitioners, front-office coordinators and more. The Medical Home serves as your first point of contact for your healthcare needs and helps you coordinate with the other health professionals that you visit, too.

Since the concept of a Medical Home is new to many of you, it’s important to understand how to make this personalized, team-based approach work for you. Here are answers to some of the most common questions about the Medical Home, which is required on Synergy or Summit plans.

Do I need a referral to see other doctors?
Your Synergy or Summit plan isn’t an HMO, so referrals are not required for you to see other providers. If you’re already seeing a specialist, you don’t need to stop seeing them but you should let the PCP at your Medical Home know that this specialist is part of your care team.

Like all the medical professionals you see, you’ll want to verify that any specialists you visit are in-network providers so that you can make the most of your Moda coverage. If you’re looking for a new specialist — a counselor for behavioral health, perhaps, or a specialty clinic for your colonoscopy — we encourage you to ask for recommendations from your PCP, since they can help you find someone who will be an active partner with you on your wellness journey.

How do I build a relationship with the PCP at my Medical Home?
The best way for you to start your Medical Home experience off right is to have an in-depth conversation with your provider at your next appointment. Along with health screenings, your annual checkups are designed for you and your primary care provider to discuss your health needs.

Even if your PCP is someone you’ve seen for years, it can’t hurt to view your next visit as a chance to start fresh. Ask about your provider’s philosophy for care, go over your medical history with them, discuss any ongoing health issues or life changes that may be on the horizon, and aim to build a long-range plan for your healthcare together.

This may feel uncomfortable at first — many people don’t like to ask questions in the doctor’s office or feel too vulnerable to share their less-than-perfect medical history. Do your best to overcome these feelings and have an honest conversation. It will help you and your provider craft realistic goals and expectations for your physical and mental wellbeing.

What do I do after hours or when I need urgent care?
You may be wondering what to do if you don’t feel well on a Saturday or have other healthcare needs outside of regular business hours. As part of your conversation with your PCP, find out what hours your Medical Home is open, including evenings and weekends. If your Medical Home has extended hours, you may not see your PCP during those times, but other members of your care team will be able to treat you.

Once you know the hours of your Medical Home, discuss how you should behave during those hours, and how you should behave outside of them. Ask your PCP what to do when you need care and it’s not an emergency, but you need treatment quickly. Should you call to make an appointment first, arrive at your Medical Home in person, call the nurse line, or seek care at an in-network urgent care facility? Get the answers ahead of time, so you’re prepared to act when the unexpected happens.

What should I do when I have questions about what’s covered at my Medical Home?
The Medical Home model is fairly new, and each clinic is different in its knowledge of the Synergy and Summit provider networks. Your doctor’s office will have an administrative expert, most likely the person you speak to when scheduling your appointments, who can work with you and Moda’s customer service representatives to help you anticipate what your health expenses will be, whether for routine care or for more complicated services. Consider them part of your care team along with all the other professionals at your Medical Home.

Wait! I didn’t select a Medical Home when I enrolled. What should I do now?
Selecting a Medical Home is easy. Simply log in to myModa, click on the Medical Home tab, and follow the prompts. Or visit modahealth.com/medicalhome for a visual guide to walk you through the process. Once you’ve selected a Medical Home, we will send you a confirmation email for your records. Don’t delay — you deserve care that’s smart, affordable and focused on you.

Still have questions? Visit modahealth.com/medicalhome for more details about selecting and using your Medical Home.