What is a patient-centered medical home?
The patient-centered medical home (PCMH) is a model of care that puts patients at the forefront of care. PCMHs build better relationships between patients and their clinical care teams. Research shows that PCMHs improve quality and the patient experience, and increase staff satisfaction—while reducing health care costs.
Practices, like GreenField Health, that earn this recognition have made a commitment to continuous quality improvement and a patient-centered approach to care.
The PCMH program, managed by the National Committee for Quality Assurance (NCQA), is the most widely adopted evaluation program in the country. Approximately 13,000 practices (with 67,000 clinicians) are recognized by NCQA. More than 100 health insurance plans support NCQA Recognition through financial incentives or coaching.
The benefits to patients are significant:
- Stay healthy. Patients who are treated in PCMHs tend to receive preventative services and screenings at a higher rate than patients not in PCMHs, helping keep them healthy.
- Better communication. A core concept of the PCMH model is to communicate with patients and their families/caregivers. The model emphasizes enhanced access so patients can get clinical advice or medical records when needed.
- Better manage chronic conditions. PCMHs are especially helpful for patients with complex chronic conditions. Research shows that these conditions are managed better in a medical home.
- Have a better experience. When attributes of team-based care are described to people, they say it is the type of care they want to receive.
GreenField Health is proud to be a PCMH.
--Which health insurance plans include GreenField Health for 2018?
Good question! GreenField Health participates in most of the major health plans. One big change for 2018 is that we are not part of the Providence Individual Plan network. Click here for the list. More Qs? Contact Mary Johnson at GreenField Health. She's happy to help!
--What is a Physician Assistant? Can they do the same things as an MD?
A Physician Assistant (PA) is a nationally certified and state licensed medical professional. They practice and prescribe medication in all 50 states, the District of Columbia, the majority of the U.S. territories and the uniformed services. Today, there are more than 108,500 certified PAs in the United States.
PAs can obtain medical histories, conduct physical exams, diagnose and treat illnesses, order and interpret tests,write prescriptions, perform medical procedures like joint injections, counsel patients on preventive healthcare, assist in surgery, and make rounds in nursing homes and hospitals, among many other medical services.
--I'm planning a trip overseas and have questions about what immunizations I need. Should I make an appointment, and can you recommend a travel health resource for me?
How exciting and fun to be planning a big trip! We actually have a Traveler's Heath resource page on the patient portal, where you can fill out a pre-travel assessment. Your clinician will review it and then advise you on what medical steps you should take, such as immunizations you may need. You can also access your immunization record on the Traveler's Health page and access a list of local travel medicine clinics. Bon voyage!
--What is 'Casual for a Cause'?
Casual for a Cause is GreenField Health's employee giving program. Each Friday GreenField staff dress down to raise money and goods for a not-for-profit. We choose four charities to support, one for each quarter of the year. Our causes for 2018 include:
Q1: Compassion First
Compassion First provides long-term, hope-filled solutions for survivors of sex trafficking and exploitation.
Compassion First reaches across the globe aiding in the prevention, and fight against child sex trafficking. Volunteers travel to underserved countries to train and educate police and communities; while at the same time searching, rescuing and returning kidnapped girls to their homes. After the return they provide “individualized support and education to help survivors heal from their trauma and reimagine their future.”
Q2: New Avenues for Youth
New Avenues is a Portland-based charity dedicated to “the prevention and intervention of youth homelessness.” Since the founding in 1997 New Avenues has directly more than 20,000 young people in Portland by supporting basic needs such as meals, and counseling to assisting with education, job training, employment and housing. New Avenues runs everything from drop-in day services to long term commitment such as PDX connect which offers support to young adults aging out of the foster care system. They also offer a culturally specific support system for the LGBTQ youth with the Sexual Minority Youth Resource Center and Bridge 13 community program.
Q3: Project Lemonade
Project Lemonade works directly with Oregon foster children and helps to provide them with new/gently used back to school clothing and supplies. In the 5 years since its founding Project Lemonade has served approximately 10,000 foster youths in 26 counties. In 2016 Project Lemonade added 2 new programs including a paid summer internship and WISH; which grants one foster youth a wish with a value of $250.
Q4: The Raphael House
This is charity has been here before but they help on so many levels that it bears repeating. The Raphael House is Multnomah County’s largest emergency domestic violence shelter. Every year 130 children and adults are served in the shelters and more than 1,200 call the crisis line. The Rafael House provides domestic violence survivors with ongoing advocacy helping to build a stable and safe future. They offer community training focused on the prevention of domestic and sexual violence, along with education and support for youths.
--Why can't I use email to communicate with my doctor--isn't it the same as sending a message through the patient portal?
Thank you for asking this question, because there is a big difference between email and secure messages sent via the patient portal. The emails you send and receive every day are not encrypted, meaning they fly through the web as clear text (in other words, easy to hack). Secure messages sent through the patient portal are encrypted and stored in a GreenField Health server protected by a firewall.
"We utilize secure messaging for all clinician-patient messages, which is why we ask you to use the patient portal to communicate electronically with your clinician or health coordinator," explains Brian Cooper, GreenField Health's IT Administrator, "Secure messaging ensures that any personal health information is ‘encrypted,’ or scrambled, if it goes beyond the safety of our firewall."
Why so protective? Aside from the federal safeguard law HIPAA, your personal health information is very, very valuable to identity thieves. According to the FBI, "Cyber criminals are selling the information on the black market at a rate of $50 for each partial EHR (electronic health record), compared to $1 for a stolen social security number or credit card number. EHR can then be used to file fraudulent insurance claims, obtain prescription medication, and advance identity theft."
Our policy here at GreenField Health is that all digital communications with patients go through the patient portal, period. A secure message ensures that your personal health information is protected and also is automatically attached to your medical record.
--My child's summer camp requires a medical release form signed by our GreenField doctor. What's the best way to do this?
Ah, summer camp forms means summer is nearly here! You have several options for getting this to us:
--Drop it off at the front desk, or
--Send it digitally to your clinician via secure message, or
--Fax it to 503-292-9510
For the drop-off and fax options, please include your clinician's name on a cover sheet.
In some cases, you may need an appointment to see your clinician. We'll follow up with you if so.
--Why did I get a bill for my annual preventive care exam? Isn't that covered completely under the Affordable Care Act?
It may have already happened to you: You came in for your annual exam, got the vitals checked, everything looks good, and you had some questions about that persistent sniffle. Pretty straightforward stuff. Then you get the health insurance bill. What's going on? You think, preventive visits are covered 100%, no deductible, right!?
It's true, the Affordable Care Act mandates that preventive care services are completely covered by health insurance, meaning that patients do not have out-of-pocket costs for a preventive visit. However, there is some confusion as to what a 'preventive' visit is, and how it differs from a ‘problem-focused’ visit. The difference between the two matters when it comes to your coverage and what you will pay out of pocket.
A Preventive Care visit
- Occurs once a year
- Does not require any payment
It involves a review of your overall health, which includes:
- Updating your medical history, including medications, family history, medical and surgical history.
- Assessing your personal health risks including family history, tobacco and alcohol use, nutrition, activity level, and weight.
- Measuring blood pressure, height and weight.
- Discussing an individualized preventive screening plan, which may include cancer screening, lab tests, and imaging studies.
- Reviewing the need for immunizations, such as tetanus.
A Problem-focused visit
- Involves the diagnosis and treatment of a condition or illness
- Requires more detailed discussions about a specific problem(s), possibly involving diagnostic tests and/or a physical exam
- Generates treatment plans to address new symptoms or manage a chronic illness.
Because it involves care (as in the diagnosis and/or treatment) of a problem (as in a condition or illness), it will require:
- A co-pay,
- And the possibility that the visit charge may be applied to your deductible,
- And if your deductible is satisfied, a co-insurance payment, depending on two variables: the services provided and your health insurance benefits.
The confusing gray area
During a preventive care exam, you and your clinician may re-evaluate existing medical problems or address new issues or symptoms. You may incur a charge for such a discussion depending on the complexity of the issue, the need for diagnostic tests and the extent of the treatment.
“At GreenField we provide comprehensive care,” says Dr. David Shute, GreenField Health’s Medical Director. “Annual visits include a preventive visit and often include a re-assessment of existing medical conditions and evaluation of any new problems.
“We believe this is an efficient use of a member’s time and the correct way to practice medicine,” he continues. “If we provide a significant amount of evaluation and management of a problem at an annual visit, we will bill for that service as well.”
What’s a patient to do?
You can do a few things to prepare for your preventive care exam:
- Know what your health insurance benefits are for both preventive and problem-focused visits.
- Draft an ‘agenda’ for your appointment. Do you have any medical issues that are new? Or other significant health concerns?
- Bring a list of medications and nutritional supplements that you take.
- Discuss any financial concerns about your health care with your clinician.
- Be prepared for a co-pay and possible deductible amount and/or a co-insurance charge because there may be symptoms or issues that warrant further investigation and treatment.
“We want to work with you to identify and treat active problems promptly—to keep you healthy and to help you live well,” says Dr. Shute. He adds that, while GreenField Health can assist with billing questions, only your health insurance provider can provide the most definitive answers about what your plan covers.
Please contact us if you have other questions about insurance billing matters. For billing questions, please contact Michelle Wing, firstname.lastname@example.org. For medical questions, please send a secure message to your GreenField Health clinician.
--What is your policy for prescribing controlled substances?
For your protection, GreenField Health follows state and local prescribing guidelines for safely prescribing controlled substance medications (opiates, benzodiazepines and stimulants).
Here’s what you can expect:
--You will be asked to review and sign a Controlled Substance Agreement (CSA) if you have a controlled substance prescription filled 3 or more times a year. A CSA describes how controlled substances will be prescribed, the risks of taking these drugs, and the responsibilities of both the recipient (you) and the prescriber (GreenField Health).
--We will also periodically check the Prescription Drug Monitoring Program (PDMP), which contains controlled substance prescribing history for Oregon residents. (www.orpdmp.com).
--Prescriptions will be written for 28 days (rather than 30) at a time. This ensures that a prescription refill will occur every 4 weeks, on the same week day (and not on a weekend). If you and your clinician decide prescribing 3 months at a time is appropriate, this can be done.
--All written prescriptions should be signed by your own primary care clinician and must be picked up at the office where you come for office visits. If you would like someone else to pick up your prescription, please let us know in advance.
--Prescriptions for controlled substances will not be mailed except in special circumstances.
--You will need to come in for an office visit every 3 to 6 months to make sure this medication is still the best plan for you. In some cases we may be able to substitute a phone visit for an office visit.
--You will be asked to call us 2 business days before you need a refill. This will allow enough time for your primary care clinician to review and authorize the refill.
For more information, click here.
--What is GreenField Health’s position about annual physicals? Are they necessary?
In a word, Yes. We think being proactive about health so important that we’ve revamped the annual physical to be a ‘comprehensive health evaluation,’ or CHE (pronounced ‘chee’). Our CHE visit is different than the traditional routine physical, which consists of an exam and a cursory overview of a person’s health (as defined by health insurers).
A GreenField Health CHE is an extended appointment in which a clinician makes a thorough examination based on preventive care guidelines as described by the US Preventive Services Task Force, an independent, volunteer panel of national experts in prevention and evidence-based medicine. The USPSTF makes recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.
“The USPSTF is an invaluable resource for our clinicians,” says Dr. David Shute, Medical Director for GreenField Health. “It tells us what preventive care is supported by research, and is continuously updated.
More importantly, he adds, it facilitates a dialogue between clinician and patient, “where together we make decisions that are tailored to each patient’s prevailing health concerns, questions, and preferences. A great thing about being part of GreenField Health is being able to take the time needed to have these discussions well.”
Specifically a clinician will:
--Discuss your current health concerns (as at any visit);
--Review your medications and need for lab monitoring for medication management;
--Check in about diet, exercise, mood, and use of alcohol and cigarettes;
--Consider what preventive tests, such as a mammogram or blood test for cholesterol, are needed;
--Address potential health issues related to health and family history or age-related conditions.
The CHE is designed to occur every 12 to 24 months, depending on your health status and preferences. Your clinical team may reach out to you periodically to schedule a CHE appointment.
--I received a e-survey from Press Ganey after my recent visit. Who is Press Ganey, and why did I receive this survey?
Press Ganey is an independent patient satisfaction company that works with more than 10,000 health care organizations nationwide. It was founded in 1985 by two physicians dedicated to understanding and improving the entire patient experience.
Based in South Bend, ID, Press Ganey sends out surveys on GreenField Health’s behalf to help us improve—at all levels, from the reception at the front desk, to clinical care, to billing and referrals. If you are one of the randomly selected members, you could receive a survey in the U.S. mail or electronically within a few days of your appointment. It includes a series of multiple choice questions, as well as open-ended questions for comments.
GreenField Health appreciates the feedback we receive in these surveys, especially the written comments. Thank you to those of you who have responded since we began this process in 2013. Also, no worries if you receive a survey and don’t care to respond. Just write ‘No, thank you,’ and send it back.
If you have any further questions, please contact Caroline Petrich, email@example.com, 503-384-2018.
For more information:
- "Doctors Strive to Do Less Harm by Inattentive Care," NY Times, 2/17/15
- "Hospitals try to reduce suffering: Reporter's Notebook," Gina Kolata, NY Times, 2/18/15
--How can I get a copy of my medical records?
We're happy to give you a copy of your medical records. They can be easily prepared and emailed to you in PDF format through a secure message. If you would like to have your records sent to a specific facility, you can make this request via the patient portal. In the main menu bar, go to 'Records.' Select 'Manage my medical records' in the drop down menu. On that page, click on the online form link under "Request records to be sent FROM GreenField Health." There is also an option to request records be sent to us from a different facility via the “Request records to be sent TO GreenField Health” link.
If you do not wish to request records through the secure portal, you can send us a 'Authorization to Release Medical Information' form by fax, as a PDF attachment in an email or as a hard copy via snail mail. Download the PDF form here.
More questions? Feel free to contact Fred Searing, GreenField Health Medical Records, at 503-384-2019 or fred.searing@greenfieldhealthcom.
--Does my monthly fee cover all copays?
The membership fee permits us to provide services beyond the scope intended by most health insurance products. These benefits include a reasonable amount of telephone and email consultation with or without a face-to-face visit, the convenience of a same day or next business day appointment always available, help with administrative forms, and the knowledge that your GreenField team is striving to bring better care to the community through innovation and social responsibility.
For further details, these additional benefits are defined on our fee page.
--How is the care at GreenField different than that at other offices?
In several ways. Here are a few highlights:
-Non-office based care is readily available. To us, service and convenience means we strive to deliver care when and where you want and need it. We do our best to take care of your needs over the phone or by secure email. The only time you should be seen in the office is when you want and need to be seen. Of course, a physical examination is often needed to best evaluate a new symptom, however many routine situations can be handled without an office visit, such as medication adjustments, interpretation of diagnostic tests, and arrangement of consultations with specialists.
-No long waits. We promise office appointments will be available the same day or the next business day for your urgent and/or emergent issues. A staff member will answer your phone call promptly. You will not suffer long delays in our office.
-Comprehensiveness. A strong team emphasis coupled with our routine availability by phone or secure email broadens our ability to extend each "visit" over space and time. This flexibility supports comprehensive care in many ways, including answering additional questions that may subsequently arise, coordinating your care with family, friends or other health professionals, and discussing the need for an appointment before you come in. We believe our enhanced communication and team strategies dramatically improve all our patients' care, and may be particularly beneficial to our older and more vulnerable patients and their families.
-A Personal Health Coordinator. We want to promote your long-term relationships not just with our doctors, but with our staff as well. Each clinician works hand-in-hand with a health coordinator (also known as a medical assistant). The health coordinator can help you schedule an appointment, refill prescriptions, convey health information and test results, and assist in the coordination of care with other health care providers.
--Do you accept Medicare?
GreenField Health is only accepting new patients who have Medicare Advantage insurance. Unfortunately at this time we are not accepting any new patients with Medicare or Medicare with supplemental insurance as our Medicare panels are currently full.
--What do you think about Integrative Medicine (Chiropractic, Acupuncture, etc.)?
We are very open to alternative and complementary modalities. In fact, we encourage our patients to explore any form of treatment that works for their particular needs, and we can help you to investigate potential new therapies through our electronic access to a variety of national databases of alternative and natural therapies. We particularly support those therapies for which there is quality research suggesting effectiveness. Our goal is to collaborate with our patients and their alternative providers as best we can for a holistic approach to healthy living.
--Do you have a HIPAA policy?
Yes we do. Click here if you'd like to review it.
--What if I want to be a patient at a GreenField clinic but my insurance won't pay for it?
We will always welcome patients who agree with our focus on Relationship, Service, and Reliability, and who are willing to pay for their office visits directly. Our fees will be reasonable and competitive with other offices. Since direct payment saves us the extra work and delay of submitting an insurance claim, we are pleased to offer a 20% discount for patients paying their office charges directly.
--What does the membership fee cover?
The membership fee permits us to provide services beyond the scope intended by most health insurance products. These benefits include a reasonable amount of telephone and email consultation with or without a face-to-face visit, the convenience of a same day or next business day appointment always available, help with administrative forms, and the knowledge that your GreenField team is striving to bring better care to the community through innovation and social responsibility. For further detail, these additional benefits are defined on our annual fee page.
--Does my FSA/HSA cover the membership fee?
We have had mixed reactions to this, and it seems to be plan dependent. We are happy to send you an example of a receipt that you can submit to your plan administrator to see if it will be approved for reimbursement. We do know that it would need to be submitted at the end of the year, as the plans will not reimburse prospective expenses. At this time, we are considering going for a private letter ruling from the IRS to get more clarity on this point, but we have had some success getting them approved to date.