Tag Archives: providers

Types of Providers

Types of Providers

If you have complicated health issues or your doctor has called another doctor an industry term you’ve never heard before, you may be left wondering what all these health care names really mean. We can help you make sense of the different types of providers.

Your Doctors

Primary Care Provider (PCP)

A primary care provider, or PCP, is your main doctor. It’s who you visit for routine checkups, preventive care, and general health problems. Each person in your family can have a PCP, or you can all see the same one.

If you’re on an HMO or POS plan, you have to choose an in-network PCP who will oversee your care and refer you to specialists. If you’re on a PPO plan, you don’t have to choose a PCP to get referrals, but you can to get personalized care and savings.

And if you’re a woman, you can set a doctor as your PCP or choose another in-network doctor, like an OB-GYN, to oversee free preventive care, your yearly well-woman visit, or a pregnancy.

Setting and changing your PCP is easy. Just log in to Your Health Alliance to update your PCP.

Specialist

A specialist is a doctor who provides health care services for a specific disease or part of the body, like dermatologists, who focus on skin care.

Usually, you’ll be referred to a specialist when your personal doctor wants you to check on specific issues or problems. You’ll also be sent to a specialist when you’re diagnosed with something serious, like a heart condition or cancer, or if you find out you’re pregnant. 

Surgeon 

A surgeon is a doctor who is qualified to perform surgery, and they have their own specialties. If you have a heart attack and need surgery, your surgeon will be an expert in heart surgery.

If you’re sent to the ER because of an emergency or diagnosed with a condition or disease, you might be sent into surgery. But if you need a minor procedure, like having your wisdom teeth out, you’re seeing a surgeon too. 

Hospitalist

A hospitalist is a dedicated, in-patient doctor who works only in a hospital or network of hospitals. If you’re taken to the hospital in an emergency or accident, you might be treated by a hospitalist.

Help with Your Care

Care Coordinator

Care coordinators help you figure out your health care in lots of ways, especially after a hospital stay, diagnosis, or if you have a chronic or complex condition.

They can help provide you with resources, educational materials, and self-care techniques, help you understand your doctor’s instructions, connect you to resources in your community, and help you plan for the future.

Health Coach

Health coaches can help you or your family plan for better health. Our health coaches can help you get the best care possible from your healthcare team and get the most from your coverage.

They’ll partner with you to help in areas like nutrition, weight and stress management, and preventive screenings and immunizations.

Nurse Navigators

You might get help handling your care from a nurse navigator when you’re discharged from the hospital if you get a serious diagnosis. For example, a cardiac nurse navigator will help patients with a primary diagnosis of heart failure or myocardial infarction.

They will usually start the process by visiting you before you leave the hospital, then they’ll stay in-touch to walk you through the first 30 days after discharge. 

Nurse navigators can help you organize your appointments, connect you to education on your diagnosis, medications, exercise, diet, therapies, and when to call the doctor. And they might host support groups that can help people like you.

Other Kinds of Care

Home Health Care

Home health care is medical care, treatment, or skilled care you can get in your home. You doctor might recommend this in situations where care in your own home will be easier for your case and condition.

Skilled Nursing Facility

You doctor might order medical care that must be given or supervised by a licensed health care professional in a skilled nursing facility. This type of care could include:

  • X-rays and other radiology services
  • Physical, occupational, and speech therapy
  • Storage and administration of blood
  • Use of appliances, like wheelchairs
  • Meals, including special diets
  • A semiprivate room or private room if medically necessary

Hospice Care

Hospice care is special care for people who are terminally ill, including medical and physical care and help with social, emotional, and spiritual needs. It also provides support for family and caregivers.

Other Help

Pharmacist

Pharmacists are healthcare professionals who practice pharmacy, which focuses on safe and effective medication use. You might not think about your pharmacist’s skillset when you pick up your drugs at the pharmacy, but they’re trained to know how drugs work.

They know which drugs can interact to protect you from dangerous drug combinations, they can explain the side effects of your drug to you, and they make sure you’re getting the right dosage of your drugs on the right schedule.

Social Worker

Social workers are there to help you with social problems that can affect your quality of life and health care. They can help you and connect you to resources for domestic violence, sexual assault, abuse and neglect, housing and food insecurity, home-delivered meals, substance abuse, mental health issues, advance directives, and more.

Other Providers

Medical Director

A medical director is a leader who recruits and manages doctors, nurses, and other personnel. They also examine and coordinate processes within their organizations to improve and guarantee the medical quality of the facility. 

 

If you need to find covered providers, use our Find a Doctor or Hospital tool to search for covered doctors, hospitals, and more.

Avoiding Kidney Disease

National Kidney Disease Awareness Month

March is National Kidney Disease Awareness Month, and it’s time to get the facts.

You could be at risk for kidney disease if you have diabetes, high blood pressure, or a family history of it.

Diabetes Management

 

Early stages of the disease have no signs or symptoms, so talk to your doctor about testing if you’re at risk.

A healthy diet and lifestyle is important to protect your kidneys, especially if you have diabetes or high blood pressure.

Conditions that Affect Kidney Disease

 

You might be asking, how can I keep my kidneys healthy? Your lifestyle choices and doctor can help.

Lifestyle Choices to Fight Kidney Disease

 

Who can you turn to if you’re diagnosed with kidney disease? Make sense of the types of providers who can help.

Providers Who Can Help

 

If you have this disease, it’s important to know which medicines you can take without hurting your kidneys.

Medications and Your Kidneys

 

This disease can also lead to kidney failure, which is extremely serious. Protect yourself before then.

Fight Kidney Failure

Save

Team Up for Greatness

Vantage Point: To Be A Star

There is a patch of I-5 South, just as you turn the bend, where The Tacoma Dome comes into view, and the sight always makes my heart jump into my throat. Opened in 1983, The Dome has hosted major concerts, professional sports competitions, and events. Most importantly for me, it’s also the place where Washington state high school athletes compete at the championship level.

My boys got to experience the honor of standing up among their peers as a part of a team of excellence on December 7, 2008, when Cashmere won the 1A High School Football State Championship. It’s a memory that I, and most of the town, which filled one whole side of the dome, will never forget.

This accomplishment started with the players, who had been honing their skills since grade school. It also took a school backing them with quality equipment and coaching, a town believing in them, and parents dedicated to supporting their goals. The second-string players, who only got a few seconds on the field that day, were just as important as the starters. In practice, they were the ones who helped the starters sharpen their skills. To say the least, they were all stars that day.

I am fortunate in my professional work to also be part of an amazing team. A team, which I say with great pride, whose Washington Medicare plans just earned 4.5 out of 5 stars from the Centers for Medicare & Medicaid Services.*

These Star Ratings measure more than just customer service. They also measure help managing chronic conditions, member complaints, working with providers to help members stay healthy, and members’ overall experience with the plan.

This achievement means a lot. It validates our efforts at Health Alliance and lets us know we are taking good care of our members. But just like a championship football team, we respect this is not an individual endeavor, and we appreciate all of you for sharing access to your resources and welcoming us into your communities. There is no way we could have accomplished this without your support and collaboration. As we share this esteemed recognition with you, please know, we sincerely count you as a member of our team, and we couldn’t have done it without you.

Shannon Sims is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant, and Okanogan counties in Washington. She has four sons and two grandsons. During her time off, she performs as part of a rodeo drill team on her horse, Skeeter.

 

*Medicare evaluates plans based on a 5-Star Rating System. Star Ratings are calculated each year and may change from one year to the next.

Washington Wildfire Season

Vantage Point: Service in Times of Crisis

As I stopped for gas in Cle Elum on my way to Seattle, the store clerk asked me, “How’s the smoke outside?”

“I’m from Wenatchee,” I said.

“So sorry,” she genuinely replied.

The word “sorry,” I have expressed it too many times during this summer’s devastating wildfire season. Everyone at Health Alliance has felt helpless, halfheartedly going about their day-to-day duties, distracted by worry for our friends and neighbors suffering to the north.

One person who’s not feeling helpless is Cindy Marshall, a registered nurse and Health Alliance’s utilization review coordinator. She took the time to become a Red Cross disaster nurse volunteer to help in these kinds of emergencies.

She told me the recent fire crisis has been extremely unique and challenging because the volatile, unpredictable winds keep shifting the fire danger, affecting many towns and causing new evacuation orders.

And it can be hard to help in these conditions. The Greater Inland Northwest Chapter of the American Red Cross has 11 stations spread over a large area right now, and many times they have set up a station, only to have to tear it down to move it to safety when the winds change.

Red Cross stations serve as a hub of activity during an emergency, but Cindy described entering a station to volunteer as anything but chaos. She knows exactly where to check in and which duties are most important. The station lead does a tremendous job of organizing priorities and reporting changes, and the team is experienced in troubleshooting solutions to issues as they arise.

Cindy is perfect for this role, as it’s much the same as what she does for Health Alliance. When one of our members has a healthcare emergency, Cindy is also there for them.

But the thing that makes Cindy truly exceptional, what keeps her volunteering weekends and evenings for the Red Cross and successful in her role at Health Alliance, is her caring and humble heart.

“So many people are doing so much more than me,” she said, crediting the firefighters who are putting their lives on the line and breathing in the heavy smoke.

To our members, community partners, and providers affected, please know that the word isn’t enough. We are more than sorry. We empathize with you through this crisis, and we will be here to support you in recovery.

Cindy expressed it best. “My number one priority is taking care of a person’s immediate safety and health care, but afterwards, sometimes the only thing you can do is hug them and let them cry.”

Shannon Sims is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant, and Okanogan counties in Washington. She has four adult sons and two grandsons. During her time off, she performs as part of a rodeo drill team on her horse, Skeeter.

Preparing for the End of LIfe

Vantage Point: Planning for Quality at End of Life: Education to Ensure Dignity

For Health Alliance Medicare, responsibility is not just paying health claims when our members visit the doctor, but more importantly, it’s stewardship—safeguarding and protecting by providing quality and education. Special people called star coordinators help do just that by developing and using Medicare quality and chronic care improvement programs.

On April 22 at 2 p.m., Health Alliance will partner with local experts Dr. Timiras, Dr. Weiss and Ginny Heinitz, RN, from Confluence Health as well as Bruce Buckles, executive director of Aging and Adult Care of Central Washington, to hold a Wenatchee educational event. What makes this opportunity unique is that it features an insurance company working in tandem with care providers and a community resource organization to help educate members on the daunting subjects of palliative care and advanced directives.

Not everyone knows palliative care is a team approach that not only improves the quality of life for patients facing problems associated with life-threatening illness but also serves as a support system to patients’ families. Through the prevention and relief of suffering by early identification, assessment and treatment of pain, palliative care addresses physical, psychosocial, and spiritual problems and affirms dying as a normal process of living.

In addition to palliative care, our expert panelist will provide valuable information on preparing advanced directives. People who work in the medical field often witness family and friends struggling alone to make decisions on behalf of their loved ones who did not document their wishes ahead of time.

Questions, such as who will make care decisions for you when you can’t, what kind of medical treatment do you want, how comfortable do you want to be, how do you want people to treat you, and what do you want your loved ones to know, can alleviate tremendous stress for the family in the event of a life-threatening illness.

Health Alliance hopes this educational opportunity will enhance quality of life and serve as a gesture of stewardship by teaching attendees how to ensure dignity and freedom of choice at the end of life. If interested in attending, please email Shannon Sims at shannon.sims@healthalliance.org or call 877-750-3350. Videos of the event will also be available here after the event.

Your Insurance Team's Support

Vantage Point: We Work Together to Support You

Painted in the stairwell of Samaritan Hospital is an inspirational message, “All of us, for each of you.” The same can be said of our Health Alliance Medicare team in North Central Washington that works together to provide elevated customer service for members and our provider partnerships.

Eileen, our program assistant, is the first face members see when they visit the Wenatchee office. Eileen feels that by supporting staff and prioritizing tasks, she can focus all her attention on members when they come in.

“Health Alliance isn’t just insurance coverage,” she says. “It is a place to come if you have questions, are seeking information, or would just like a cup of coffee and an ear.”

Jessica, our bilingual customer service representative, says, “The most rewarding part of my job is having the ability to see our members face to face, build relationships, and let them know I am here to listen and help.”

Through her role at Health Alliance, Teri, our customer service lead, hopes to insure our members only have good experiences when adverse situations arise. Teri credits the overall team from claims to medical management for its support in helping her achieve her goal.

Major procedures, hospitalization, surgeries, and discharge plans all need prior approval, and Cindy, our utilization review nurse on the medical management team, uses her experience in risk management, coupled with patient advocacy, to take care of our members through major health issues, thus controlling unnecessary costs.

Medicare is not only complicated for our members, it can be complicated for providers as well. Therefore, Leslie, our provider relations specialist, works directly with clinical staff members to help them understand policies, procedures, and operating systems. By providing face-to-face customer service at the provider offices, it makes providers’ jobs easier, positively impacting their care of our members.

The Centers for Medicare & Medicaid Services ranks Medicare Advantage plans on a five-star scale, and factors within that quality scale relate to providers assessing, managing, and controlling chronic conditions. Amanda, our coding consultant, works directly with physicians to provide coding education and finds it rewarding when she and the doctors learn something from each other, ensuring overall great health care to our members.

Whether they’re working with members or providers or making medical decisions behind the scenes, these are just a few of the local people committed to working together toward the common goal of ensuring quality of care, setting Health Alliance Medicare apart in North Central Washington.