Do you have time for a Quality Minute about patient care?

An ongoing series of quick tips designed to be read in 60 seconds or less and provide your practice with information about performance in key areas.

Establishing patient care

Members are required to select a primary care physician when joining health maintenance organization plans. In cases when our BCN commercial and BCN Advantage℠ members don’t select a PCP, we assign them one.

If a patient hasn’t established care with their assigned PCP, that patient won’t be visible in Active Care Relationship Service or Admit, Discharge, and Transfer files. This can make managing their care more challenging and can affect the provider’s quality measure performance.

What you can do

• Verify the patient’s eligibility and PCP assignment at each visit.
• Ensure you have a process for regularly reviewing eligibility files and reaching out to patients who have yet to establish care.
• Encourage Medicare Advantage members to schedule their annual wellness visit to initiate care. There is no copayment for a wellness visit performed by their selected PCP or one within the same practice. However, a specialist copay may apply if a patient sees a PCP who is not part of their selected PCP’s practice. You can avoid this by asking them to select you as their PCP on the Physician Selection Form. The form can be found on BCN Health e-Blue℠ under Help Documents in the Resources section.
• Use the Member Transfer Request Form if you’ve made three outreach attempts and you’re not successful establishing the member’s care. This form can be also be found on BCN Health e-Blue℠ under Help Documents in the Resources section.

What we’re doing as a health plan

We recognize that care coordination is not solely the provider’s responsibility. Internally, we are working with our membership area to identify where members who haven’t visited their PCP are receiving care. Through targeted outreach, we aim to connect these members with their PCPs and support their health care needs.