Primary Care Provider: Why Every Oregon Resident Needs One

female doctor meeting with patient in office

 

In many ways, primary care providers (PCPs) are the backbone of the United States healthcare system. Providing a range of services spanning a large majority of personal healthcare needs — such as preventing and treating common illnesses like the flu and managing chronic conditions like diabetes — a primary care provider is often the first point of contact for any health concern. Yet, there are plenty of people who do not have a dedicated PCP. In fact, 20% of U.S. adults say they don’t have a primary care physician.

At least for Oregon residents, that’s about to change. Passed into legislation in 2024, Oregon Senate Bill 1529 introduces a new PCP requirement for the administration of health care benefits in the state of Oregon. Under this bill, members of Oregon-based commercial health plans* must select a PCP within 90 days of enrollment, or else one will be assigned to them. This new legislative requirement underscores the importance of having a designated PCP and is intended to promote this essential aspect of healthcare.

Keep reading to learn more about why having a PCP is so important, the benefits of building a strong doctor-patient relationship with a PCP, the specifics of Oregon Senate Bill 1529, and how to choose the right PCP for you.

Why Having a Primary Care Provider is Important

Think of a PCP as more than just a doctor: a PCP is your advocate, guide, and partner in maintaining and improving your overall health and well-being. As someone who plays a pivotal role in managing your health, a PCP is your dedicated resource for managing chronic conditions, identifying health risks, and providing regular health screenings. Regular visits to a PCP let you receive proactive care — not just reactive treatment.

No matter the quality of your health, a PCP is essential. But if you have a chronic illness such as diabetes, hypertension, or asthma, a PCP is even more invaluable. Your PCP can work with you to create a comprehensive long-term care plan, monitor your condition, and make adjustments to your treatment as needed. This continuous oversight helps prevent complications and keep your condition well-managed.

Even for “healthy” patients, regular visits to a PCP for routine check-ups are vital. Routine check-ups let your PCP gain an understanding of your health baseline, which enables them to spot any changes that could be a concern. PCPs also provide routine health screenings that are necessary for maintaining good health. These screenings allow for early detection of potential health issues. By identifying risks early, your PCP can intervene with preventive measures, reducing the likelihood of serious health problems down the line.

PCPs also act as a central point to manage referrals, lab tests, and specialist visits. This helps guarantee that all your healthcare providers are on the same page, facilitating the most coordinated and efficient care possible. Having a complete view of your medical history empowers your PCP to make better-informed decisions in the coordination of your care — letting you feel more reassured as a patient that you are getting care that’s tailored to you.

Why You Should Establish a PCP Before You’re Sick

Another reason it’s great to have a PCP? Having a designated PCP makes your life easier when you get sick. Getting sick is never fun; it’s even less fun when you’re scrambling to find a doctor. Whether it’s seasonal flu or something more serious, searching for a doctor when you’re sick adds unnecessary stress and delays your care. Establishing a PCP before you need one helps ensure timely and convenient access to medical attention when you need it most.

Plus, seeing an established PCP when you’re sick can lead to better health outcomes because they’re familiar with your health history. This continuity of care results enables more accurate diagnoses and effective treatment plans, ultimately improving your overall health. Plus, existing patients often have priority for appointments, so when you have an established PCP, you can typically get in to see your doctor sooner than if you were a new patient. Not to mention, this removes the variables of long wait times and high copays at an urgent care or emergency room. With an established PCP, you can rest assured that whenever you get sick, you have direct access to personalized and efficient care with predictable copays.

Understanding Oregon Senate Bill 1529

Now in effect, Oregon Senate Bill 1529 requires all members of Oregon-based commercial plans* to designate a PCP within 90 days of enrollment or else have one assigned to them. By introducing this requirement and encouraging individuals to select their own PCPs, the bill intends to promote preventive care and, in doing so, reduce the strain on urgent care facilities and emergency rooms. The logic here is that individuals with established PCPs are less likely to rely on emergency services for non-urgent health issues.

If you receive health insurance through an employer-sponsored health plan, this impacts your health plan enrollment process by requiring you to designate a PCP when you enroll in benefits. If you do not designate a PCP within 90 days of enrolling, you will be assigned a PCP by your health insurer. Either way, this should be viewed as a good thing! Whether you select your PCP during enrollment or have one assigned to you after the 90-day window, having a designated PCP gives you reliable access to primary care, which benefits your overall health and well-being.

Employers: you can assist teammates in complying with this new requirement by providing ample information and resources to help employees make “the right choice” when choosing their PCPs. In the next section, we’ll explore the top things to keep in mind during the PCP selection process.

How to Choose the Right PCP

Choosing your PCP is a big decision. After all, your PCP should be someone you feel comfortable trusting with your healthcare needs. While it may seem tedious, taking the time to find the right PCP for you is time well spent. As you research your options for PCPs, here are key factors to consider:

  • Proximity: Consider the location of the PCP’s office. Choosing a provider close to your home or workplace makes it easier to attend appointments and access care when needed.
  • Expertise: Look for a PCP with expertise that matches your health needs. Whether you require specialized care for a chronic condition or general primary care, you’ll want to make sure to find a provider with the right expertise.
  • Insurance coverage: Ensure that the PCP you choose is covered by your health plan. Most health plans offer a wide range of options for in-network PCPs, and employers can assist in navigating plan networks to make informed decisions.
  • Patient reviews: Reading patient reviews lets you gain insights into the quality of care provided by a PCP. Look for providers with positive feedback and a strong reputation for patient satisfaction.

Don’t Wait — Choose Your PCP Today

We hope this blog has highlighted the benefits of seeing a PCP and given you more clarity on the requirements of Oregon Senate Bill 1529. When you establish care with a PCP, you’re taking a big step toward comprehensive personal healthcare. We encourage you to take the time to review your health plan and select a PCP if you haven’t already.

Questions along the way? IBG is here to help. We understand that changes that impact your health plan can be confusing and that finding in-network providers is sometimes easier said than done. If you need support navigating the process, don’t hesitate to contact us.

*Please note that Oregon Senate Bill 1529 does not affect Medicare or Medicaid.

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