Primary Care The Primary Care Physician (PCP) is responsible for providing and coordinating covered services for all Valley Health Plan Members who are assigned to that provider. VHP emphasizes the importance of a positive relationship between the PCP and the Member. Every effort will be made to ensure continuity of care and the provision of quality and costeffective health care to VHP Members.
Section 5:
The primary care physician is gatekeeper in charge of coordinating the delivery of all health care services to a Member, including referrals to appropriate specialists. This is accomplished through access to care 24 hours a day, 7 days a week. The PCP is responsible for the following: a) b) c) d) e) f) g)
Routine health care services Preventive medical services, see Section 14 Forms & Attachments Health risk assessments Coordination of referrals Treatment planning Follow up to acute hospitalization and/or emergency room visit Education of Member about access to care
SECTION 5: PRIMARY CARE
Scope of Primary Care Physician Practice The primary care physician may be a Internist, Pediatrician, Family Practice or General Practice provider. In addition to basic medical and preventative health care, an Obstetrician/Gynecologist may provide gynecological or obstetrical care. Members under the care of other primary care physicians may self-refer for OB/GYN services. The scope of practice of a PCP will include, but not be limited to diagnosis and treatment in the following areas: • • • • • • • • • • • • • • • • • • • •
Acute and chronic allergies and asthma Common skin lesions (rashes, warts, keratoses) and skin tags Skin biopsy and excision as appropriate and if experienced Diabetes mellitus controlled with diet, oral medication or insulin Thyroid dysfunction Peptic ulcer disease Gastroenterologic reflux Irritable bowel syndrome Differential diagnosis of abdominal pain including gynecological disorders Hemorrhoids Hepatitis and cirrhosis Routine pelvic examinations with PAP smears. Sexually transmitted diseases Diagnosis of abnormal vaginal bleeding Diagnosis of pregnancy Family planning Anemia Hemoglobinopathies Diagnosis and treatment of common infectious diseases Testing and initial evaluation of HIV-positive patients
www.valleyhealthplan.org rev.2020
Section 5
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