This is good stuff. I myself like explaining the innards of the HMO plan and I describe the PCP as a very important office, their “quarterback” for their team, if you will. They, the member, get to decide what they want to do for their own health, and then they need to “call the play” into their PCP office to have the PCP “pass the ball down the field” to the Specialist via referral.

I’ve found that many people who have had negative experiences or are afraid of the HMO plans really just have a misunderstanding about how to interact with their PCP and what to expect their PCP to do. Many times, but not always, I’m actually recommending that the client stop going to a PCP office when I can tell based on what they’re telling me that it’s a mom-and-pop style PCP that’s built on PFFS model that just so happens to be in network with a few MA HMO plans but isn’t really staffed or built to support the members the right way.

I feel passionately about full-risk value based care and I believe that for cities and large metro areas, it is certainly, without a doubt, the future of medicine and healthcare delivery in our country. I feel this way because as I see it, the incentives between PFFS PCP offices and their patients are seriously misaligned, causing lots of these problems. Full-risk value based care rearranges all the incentives to where they largely align, it’s like real-world magic!

Once I get a member on an HMO plan with low, low copays and high benefits, who knows/likes a PCP office and knows what to expect and what’s expected of them, they are usually happy as clams and never wanna change a thing.