Let me introduce you – here’s your doctor.

Not sure what it means when you hear the phrase Primary Care Physician, or PCP? Let me explain.

I grew up in a small town. Our town was lucky enough to have our own doctor. People called him the “town doctor” in conversations. It wasn’t uncommon for you to hear someone saying “I can’t shake this cold,” and someone replying “Well, go see the town doctor. He’ll fix you right up.”

Our town’s doctor was Dr. Sanders, and he was my doctor. In fact, he took care of everyone in my family – grandparents, mom and dad, aunts and uncles, sisters and cousins. We went to him for sports and school physicals in the fall each year. We saw him when we had a stomach ache or a cold. My mom called him one Sunday when I fell and took out the corner of the coffee table with my chin, requiring stitches. He took care of all that, times hundreds, every day until he retired at age 70.

We also called Dr. Sanders our “family doctor.” Today, he would be called a primary care physician, or PCP. A PCP may be a family doctor, general medicine practitioner, or in this case, a rural medicine physician.

Whether we’re talking about then or now, the role hasn’t changed much for doctors like Dr. Sanders. He or she would still be the one  you would call first when there is a health problem. If you said “I need to call the doctor,” this is “the doctor” you would mean.

I recently read a statistic from the Pew Research Center that 1 out of 3 adult Americans in our modern day “cough and click culture” go to the web first for health information. While the web is a good place for information about a health problem you know you have, it isn’t the best place to go if you have symptoms and want to know what the real problem is. It isn’t where you should go to decide what you could do, if you should see a specialist, or which kind of specialist you would see.

You really shouldn’t use the web to diagnose yourself based on the limited information you know to look for. The fatigue and joint pain you are having may lead you to worry that you have Lupus, a chronic and devastating disease. A doctor can run tests to rule out Lupus and may instead trace your problems to stress, lack of sleep, certain meds or other root causes that can be easily fixed.

If you had “your” doctor, or PCP, already established, your first step would likely be to call for an appointment. Having your own personal doctor is probably the single most important thing you can do for your health. It means you’ll have someone in your corner making sure you get the care you need.

  • Your PCP will already know your health history, what health problems you have, and what meds you take. This means you have someone who can help you make informed choices about your care.
  • Your PCP will handle your routine health care needs such as for physicals and yearly exams, and be there when you need care right away, such as with colds and the flu.
  • Having a PCP means you can focus more on staying healthy, instead of only seeking help when you are sick or hurt. Your doctor becomes your health coach, showing you better ways to stay healthy and live longer.
  • Your PCP can guide you to the best place to go when you need more care, and follow your care each step of the way. If you need to be seen by a specialist, your doctor will coordinate the care, especially if you need to be seen by more than one specialist.  This keeps your care on track and helps you avoid unnecessary visits.
  • Early diagnosis and care can keep many common health problems from getting worse. Having your PCP manage your care means problems can be caught early, before they become serious or lead to other major illnesses. For example, identifying high blood pressure early and getting it under control could prevent you from having a stroke later on.
  • If you happen to have a chronic health problem, such as asthma, diabetes or a heart problem, your PCP can also make sure you have access to specialized care and maintenance care that can help to keep it from getting worse.
  • Your PCP will also coordinate your care in and out of hospitals or outpatient programs.

Do You Have an HMO Plan?
That doctor-patient relationship is at the center of an HMO plan.  An HMO, or Health Maintenance Organization, is designed to give you personalized care because your care is managed by a PCP. Your PCP becomes that personal doctor who partners with you to keep you healthy and well. Having a PCP means you can focus on prevention through routine care, or catch problems before they get to be big problems. And you can focus on making sure big problems get the ongoing attention they need so that they don’t become worse, even life-threatening.

Your HMO, Your PCP and You   
To make the most of your relationship with your PCP and get the most out of your HMO, keep these tips in mind:

  • If you are new to an HMO or are choosing a new doctor as your PCP, make your first appointment as soon as possible. Having a relationship with your personal care doctor will help you avoid delays when you’re sick or hurt, or need to get a referral to see a specialist.   
  • Each person on your plan can pick their own PCP. Your PCP’s name and contact information will be listed on your member ID card. If you later decide your PCP isn’t right for you, you can change your PCP choice.
  • Always call or go to your PCP first when you need care. Your PCP will be able to make informed choices and direct you where you need to go. That may mean going in to see your PCP, going to a retail health clinic or urgent care center, or heading to an emergency room.
  • If you need to be seen by someone else, make sure to start with your PCP (unless it’s an emergency). Your PCP will turn in a referral to BCBSTX and then let you know if the referral is approved.
  • It’s important you get all your care from providers in your HMO network, and call your PCP before you see any other doctors, have tests run or go to the hospital. You need your PCP to coordinate with other doctors, making sure they are in your network and provide other doctors with information about your health care needs. This will help you have fewer out-of-pocket expenses and ensure you are directed to the appropriate provider. If you get care from a provider who is not in your HMO plan’s network, in most cases you may have to pay the full cost of your care.

So, What's the Difference Between a PCP and an HCP?

According to UC Berkely, a Health Care Practitioner (HCP) is a person who has been trained in a specific kind of medicine to help target health issues. These can be doctors, nurses or specialists.

Most often a doctor (MD), a primary care provider (PCP) is a health care practitioner who manages a patient’s health over a long period of time. This is a care provider who sees people that have common medical concerns or are seeing preventive care. A PCP can also be a physician assistant or a nurse practitioner.

Both will file claims with your insurance provider. Long story short, a PCP is a type of HCP, but an HCP might not be a PCP. It is always a good idea to talk to your doctor—by that we mean your PCP-- about any other treatments that you receive from a specialist or other provider or HCP. Make sense?

To get information about your health plan or need to fine a PCP, log on to Blue Access for Members and use our  Provider Finder, a search tool that lists the providers who are part of your HMO plan’s provider network.

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