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What it means to be in an HMO at the South Shore Medical Center

The Physicians and Staff of the Medical Center felt that it would be helpful for patients of the Major HMO's (HMO Blue, HPHC, and Tufts) to understand what it means when you choose a South Shore Medical Center PCP. Physicians and the administration feel that a mutual understanding will create a partnership with our patients that will allow us to better serve your medical needs.

1. Coordination of Care.

The underlying principal of the HMO movement is to ensure coordinated and cost-effective healthcare. Many patients make excellent use of our ready access, especially on weekends and major holidays. We are open every day except Thanksgiving and Christmas. Many enjoy the convenience of our Radiology and Laboratory services being under one roof. We hope that it is similarly convenient that we have many different specialists practicing in one location.

2. Referral Network.

Since the Medical Center has been in existence for over forty years, we have developed an extended network of highly competent local specialists that we call upon frequently to become part of an individual patient's Care Plan. Almost all of these providers are also on the staff of South Shore Hospital. We refer to this group as our Primary Network. If your Provider at the Medical Center wants you to see a specialist or get a second opinion, it will almost always be chosen from this Primary Network. Some patients get confused because almost every Provider in Eastern Massachusetts is a participating Provider with each of the major HMOs. However, if you join the South Shore Medical Center, you must be prepared to go to the more restricted Network that the Medical Center uses. Some patients change their Primary Care Facility if they do not wish to use the Network used by their PCP.

3. Prescription Drugs.

Each of the HMOs has an extensive list of medicines that they allow Providers to prescribe. Those formularies vary from HMO to HMO. Each of the Major HMOs takes inordinate steps to insure that the medicines that they select meet the highest of clinical standards. Since price varies from one medicine to another the HMOs are also very conscious about these variations. This is true at the Medical Center as well. Patients will always get the medicine that their Provider feels is best for them. They will not, however, always get the medicine that they see advertised on television. The medicines advertised on television are frequently much more expensive, specifically because of the increased cost of advertising. If you are a person who always wants the advertised brand, the Medical Center may not be the right Primary Care Facility for you.

4. Urgent Care.

The Medical Center is open everyday except Thanksgiving and Christmas and offers urgent care services Monday-Thursday evenings. Providers are on call 24 hours/day. We do this to make it convenient for our patients when they have an urgent problem and need to be seen on a same day basis. This kind of service should minimize the need for visits to the Hospital Emergency Rooms, where the waits are frequently several hours or more. Certainly, patients need to use good judgment in the case of what they feel may be a life threatening problem. In those situations, patients need to go to the Hospital in the safest and most expeditious manner. This frequently requires the use of "911." If you do go to the E.R. please let the Center know and arrange for all of your "follow-up" needs with your PCP.

5. Health Maintenance.

The Medical Center's Physicians and all the major HMOs believe, strongly, in the concept of maintaining your health, not just waiting for you to become sick. We encourage physicals appropriate for your age group. We will encourage you to undergo all of the accepted tests used for early detection of disease. This includes tests like mammograms, pap smears, colonoscopies, cardiac-risk blood screening. If you already suffer from a chronic condition like diabetes, congestive heart failure or respiratory problems, you will be referred to our Disease Management Program which attempts to rigorously treat those conditions and prevent them from getting worse.

6. Partnership.

Being a member of an HMO and a patient at the South Shore Medical Center means working together. The Medical Center needs to make care readily accessible, try to prevent problems from occurring or getting worse and making sure that we do this in the most cost effective manner, especially given the skyrocketing costs of health insurance. We can accomplish these goals when we all work together.