My wife has a complicated medical syndrome that has involved her going to large number of different doctors. We just got a call from her internist suggesting that she should enroll in CareFirst’s Patient-Centered Medical Home (PCMH) program.
Reading the Carefirst website it sounds like they set you up with a nurse who personally coordinates your care to give you the best possible outcomes, which all sounds good, but I am concerned that it is really just a ploy to convince her to avoid treatment and tests that are costing them a bundle.
Looking for reviews and assessments what I mainly see is studies indicating that these programs save the health insurers money, and mixed reviews about how it is to work for them.
Does anyone here with chronic diseases have any experience with these programs?
Did they help you coordinate the care you needed, or were they just new way to figure out how to deny treatment?
This issue is particularly sensitive because with the help of my wife’s pain management doctor we have been fighting with the insurance company to allow her to maintain the pain management and anti-anxiety medication regimen that has been working for her for the past 15 years. So if the PCMH would allow her to talk over her situation and argue her case a member of the insurance company (rather than just get a flat rejection from a reviewing doctor who as never examined or talked to her) than that would be a plus. But if the coordinator is just going to tell her that she would be so much better if she stopped taking methadone and practiced meditation instead. Then it could make things much worse.