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Case Management Our Case Management program identifies those patients who require more intensive oversight and coordination of their care. Working with a team of physicians, our case managers serve patients with chronic ailments including, but not limited to: Congestive heart failure Chronic pulmonary disease Chronic renal disease Dementia Stroke Coma Cancer Substance abuse Hospitalist Care If you are hospitalized, Northridge Medical Group offers the expert care of our Hospitalist physicians. These are well respected community physicians who are highly trained in the evaluation and treatment of patients whose illnesses are severe enough to require a hospital stay. Since they care for all of our hospitalized patients, the level of experience they have is extensive. They manage your care and coordinate the care of the other physicians who may be involved in making you well, including the appropriate specialist consultants. Because of their expertise, the Hospitalists are able to get better clinical outcomes, better patient satisfaction, and better physician satisfaction, and they help to keep your hospital stay a shorter one. They are patient advocates who make sure that tests are done and the results are found out as soon as possible so that the care you need can be started in as short a time as possible. The Hospitalists work with you and your family members to ensure you understand what is going on during your hospitalization and what to expect after discharge. The Hospitalist who cares for you is usually not the same physician who acts as your primary care provider for your out-patient problems in the office. However,  every effort is made to keep your regular doctor informed of your progress, and the Hospitalist closely works with your physician to make your transition of care following discharge as smooth as possible. The Hospitalists assess your needs at the time of your discharge and coordinates your post-discharge care with the help of nurse case managers. They communicate your needs to your primary care physician and specialists so that you remain well once discharged. It has been recognized that the use of Hospitalist physicians results in a higher quality of in-patient care and this system has been widely adopted by physicians and accepted by patients. Health plans have similarly not only encouraged the use of Hospitalists but also recognize this method of hospital care as a best practice.

Knowing how to distinguish a true medical emergency from an urgent situation saves lives as well as unnecessary out-of-pocket expenses. A true emergency is a life- or limb-threatening situation and you should call 911 immediately or go to the nearest emergency room for immediate medical attention. Examples of true emergencies include (but are not limited to): Deep cuts, significant active bleeding or severe burns Seizures Sudden blackouts or being unable to move or speak Severe chest pain Breathing problems or choking Injuries from an animal attack Poisoning A broken bone or sudden, severe pain and swelling in a joint If time permits or if you’re unsure if the injury or illness is a true emergency, call your primary care physician for advice prior to obtaining emergency care; however, you should always seek immediate medical attention in any situation you believe to be life- or limb-threatening.

Choosing the right physician to care for you and your family members is one of the most essential health care decisions you can make. Each of your covered family members may select a personal primary care physician based on services that are most appropriate for individual needs. In order to receive the optimal coordination and continuity of care, it’s important to establish an honest, open relationship with your respective physician. If you have not already selected your primary care physician, call the Member Services Department listed on your health plan ID card.

What is an IPA?
A An IPA, or Independent Practice Association, is a group of doctors that provide medical services to individuals enrolled in health plans.

Q What is the difference between an IPA and my health plan?
A A health plan provides its members with medical, hospital and preventive care services through a contracted network of physicians, hospitals and other health care providers. An IPA works with your health plan to provide or direct all actual medical care and health services.

Q How do I choose a physician to care for my family and myself?
A You can select a physician by calling the member services representative listed on the membership card provided to you by your health plan. It is important to establish a relationship with a primary care physician early on in order to receive the optimal coordination and continuity of care.

Question markQ How do I know if my doctor is part of Northridge Medical Group?
A You can refer to the list of physicians included in this Web site. Or you can call our Customer Service Department at 1-888-252-6426.

Q How do I make an appointment with my Northridge Medical Group physician?
A It’s as easy as calling your physician’s office directly for an appointment.

Q How do I get a referral to see a specialist?
A Northridge Medical Group has a comprehensive network of contracted specialists and ancillary service providers. Once you have selected your primary care physician, he or she will work with Northridge Medical Group to direct you to the appropriate contracted specialists or services when medically necessary. In fact, our turnaround time for referrals exceeds industry standards; in many cases, your specialist referrals are approved the same day.

Q What do I do in case of an emergency?
A In the event you or a family member suffers any life- or limb-threatening illness or injury, you should always call 911 or go to the nearest emergency room immediately. Examples include (but are not limited to) significant active bleeding, seizures, blackouts, chest pain or problems breathing. (See Emergency Care in the Health Care Services section of this Web site.)

Q As a member of Northridge Medical Group, what hospital do I use?
A Northridge Medical Group is affiliated with Northridge Hospital Medical Center and other fine medical centers throughout the area.

Q Where can I call if I have questions regarding my health plan?
A Call the Member Service Department listed on your health plan ID card.

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Q What if I want to change my primary care physician?
A You may make changes by calling the Member Service Department listed on your health plan ID card.

Q Who do I call if I have questions regarding claims or referrals?
A Whenever you have questions or concerns regarding claims or referrals as well as eligibility, authorization or general patient issues, you can call our Customer Service Department at 1-866-604-3334. We guarantee a 48-hour follow up or answer to your inquiries.

Who could possibly have predicted the huge changes that would occur in health care during the lifetimes of the post-World War II Baby Boomers? During this period, a vast majority of technological advances have occurred including CT scans, MRI scans, nuclear studies, PET scans, 3-D imaging, digital imaging, vascular imaging, genetic testing – the list goes on and on – all developed during our lifetime. It’s a wonder how anyone was able to diagnose anything without all these tests. And this doesn’t even include the huge advancements in treatment of diseases such as diabetes, heart disease and cancer, to name a few. Boomers have latched on to the concept of consumer-driven health care and, by insisting on information, education, quality and efficiency, have truly had an impact on the way medicine is practiced. More and more pressure is put on physicians to diagnose as early as possible, use the best diagnostic tools to get there and treat with the most advanced treatments available. When illness strikes, volumes of information from many sources, including the Internet, are absorbed and digested so that informed decisions can be made.

 

Yet, in spite of this, Americans spend more money to achieve what many consider only a little above average, but not stellar, results. We claim to have the best health care in the world. People come from all over the world to get this care when they have serious illnesses and that is something to be proud of. But there is a lot still to be accomplished.

 

The types of decisions we, as Baby Boomers, have to make are much different than the ones our parents had to make. Our parents pretty much held to the attitude of doing “whatever the doctor says,” often to the point of deification, and, in many cases, not really wanting to know or understand about the illnesses they had or the details and choices of treatment. All this information did was make them more confused and frightened, they would say. For us, there are many more choices to consider. What type of health plan do I want? Which doctor do I want? Which specialist do I want? Which test should I have that can give me the most information with the least risk? Which treatment alternative should I accept and with the least risk for complications. Without a doubt, we have become experts when it comes to our health care. We are willing to do all sorts of things to make sure we are diagnosed correctly, get the best treatment possible at the least risk (money being no object), and challenge the best physicians to be even better.

 

But, in spite of the enlightenment and knowledge we have about our health care compared to our parents, how much effort and how much money are we willing to spend on our health maintenance? You know, doing the things that help us detect diseases at their earliest stages, sticking to our treatment plans and taking medicine when we are supposed to, as well as maintaining healthy lifestyles that don’t promote lung cancer, obesity, diabetes and heart disease? No one can be perfect and no one can prevent or control every disease, but are we putting the same effort into these issues as we do when we are already sick? The number of women who get their routine mammograms and PAP smears and of men who get their prostate checked is astonishingly low compared to the number who should be getting them, in spite of all the publicity about these diseases. How many of us insist on getting the tests for blood in the stool for detecting colon cancer early? If we have diabetes, do we insist on getting our blood tested at least every year, as recommended, or are we happy to just get our prescriptions refilled over the phone? The same goes for high cholesterol. Do we insist on getting it checked routinely or do we get irritated when the PCP wants to see us first as he or she is supposed to do? Maybe it’s time for us to put as much energy into our health maintenance as we put into our health care. It would seem to be one of the better decisions we could make. We are pretty conscientious about making sure our children get all their preventive immunizations and vaccinations but we are not practicing what we preach when it comes to our own preventive health measures.

 

As Baby Boomers, another area of decision making that challenges us more than it ever challenged our parents is the choices we may have to make about the health care of our parents themselves. The choices our parents had for the care of their parents were much more limited than they are today. Because of the medical advances that have resulted in longer life spans,  some of the decisions our parents made for their 65-70-year-old parents, we are now making for our own 80+-year-old parents. Whether we like it or not, parents may want to transfer the responsibility for difficult decisions to their children, regardless of whether they are capable of making these decisions themselves or not. The older our parents are, the more difficult the nature of the decisions. Are they capable of caring for themselves and taking their medications and, if not, can we care for them or do we need to find people who can help us do it? Are they still capable of driving or are they a danger to the health of others? Are they still able to make good decisions for themselves? Do they (or we) want their physicians to treat a terminal cancer to the very end with every means possible to give them just that little bit more time, regardless of quality of life? Are there treatments they can get to extend their lives and maintain some semblance of quality and happiness or would these treatments just be prolonging their suffering? At what stage of their disease is it time to say “no more”? These decisions are very personal for all of us. There is no textbook to follow and each person’s circumstances are unique. The one thing we should do is talk to our parents, while we can and they can, about these issues before they happen, whenever possible, and no matter how difficult the conversation might be. The decisions we make about them should always be as we know they would want them to be. Having them make advanced directives is a way to memorialize their desires before they are incapable of expressing their wishes.

 

In spite of our best efforts, we may not always be able to get our parents to deal with these issues. When the time comes, – and it will come for every one of us – all we can do is make the best decisions we can, based on who we know our parents to be and with their best interests, not ours, in mind. Sometimes during the emotional turmoil that naturally occurs when our parents are in their final stages of life, we may unwittingly make decisions about their care that makes us, rather than them, feel better.

 

As you can see, I have written this article in terms of “we.” That’s because I am a Baby Boomer who has faced many of these same issues I have discussed. I got that prostate test, not because I was conscientious about following recommendations (doctors are the worst patients), but because I lost a good friend at 50 years of age. It was a good thing I did because I caught myprostate cancer early. Of course, as is true of anyone else faced with this disease, I had to make difficult decisions about how I wanted it treated. I also had to decide to change to a lifestyle that wasn’t inviting lung cancer, heart disease and diabetes, maybe not as early as I should have. And I had to help make difficult decisions about a mother with terminal cancer and a father with a major stroke. Making the types of decisions we face as Baby Boomers is not as easy as it might seem. I know there is always a certain reaction people have when the letters “HMO” come up. But remember what HMO stands for: Health Maintenance Organization. The concept of an HMO has always been to emphasize preventive health care and health maintenance, in addition to caring for the acutely and chronically ill patient. Unfortunately we, as Boomers, don’t always keep up with our responsibilities to ourselves by doing the very things that promote our well being.

No, that doesn’t mean I’m going to pick on you. But it does mean that it’s time to remind you about something that is extremely important to your health and well being:

Call your primary care physician’s office

Ask to speak to the scheduling person

Scheduling yourself for your annual examination – and getting that

Examination done!Illness has a funny way of sneaking up on you, even when you’re feeling well and doing your best to take good care of yourself. That’s why it’s so important to have an annual examination, which can help ensure your wellness as well as to catch any health issues that may be developing at an early, treatable stage. It is easy to postpone things when you’re feeling well. But, in order to stay that way, you must get your “maintenance” work done. That means women need to have Pap smears and mammograms as recommended, and men need to be vigilant about prostate health. Other important health issues that can be addressed at your annual exam include blood pressure, cholesterol and bone health. In addition, you should discuss with your physician whether or not your stool needs to be tested for blood and talk about your medications. Even if you’re plugging along just fine, it’s important to regularly address these issues with your primary care physician. Often, hidden health issues can be present that can change the course of what may be a minor injury or illness to one of much greater magnitude. (At early stages, cancers and cardiovascular disease can be notoriously silent without symptoms. The same can be said for high blood pressure and diabetes.) So don’t be caught off guard. Get that annual examination – and give yourself the upper hand for health.