Provider FAQs
What services are offered by Stanford Coordinated Care?
- There are two types of service available depending on the patient’s choice and health condition.
- A Primary Care Plus patient will be offered primary care services at Stanford Coordinated Care, with the option of returning to their previous primary care provider when their condition stabilizes. Our focus is on enhancing self-management and coordinating specialty care to improve the patient’s experience and reduce hospitalizations and emergency room usage when possible. Clinicians available to the Primary Care Plus patients include: primary care clinician, behavioral health specialist, a clinical pharmacist, physical therapist focusing on body mechanics and pain management, and a care coordinator with the time to assist patients between visits. Depending on a patient’s insurance coverage there is either no co-pay for these services or no co-pay once the deductible is met for a high deductible insurance plan. The claims data on high-risk patients indicates that only 3% of the cost of care is going to primary care, which would imply that these are patients largely lost to their primary care provider anyway.
- A patient registered with Chronic Care Support will continue with their current primary care provider but be assisted by a nurse or clinical social worker to enhance self -management and coordinate specialty care. The Chronic Care Support staff will coordinate their efforts with the patient’s medical providers. There is no charge to the patient for this support service.
What patients can be referred into Stanford Coordinated Care?
- The following patients are eligible to enroll: active employee of Stanford Hospital and Clinics or Stanford University or early retirees of Stanford Hospital and Clinics or Stanford University or their dependents whose primary insurance is Blue Shield of California or United Health Care/UMR. Patients who are referred will be screened to see if they have multiple chronic conditions and are having trouble managing or coordinating their care and might be helped by our comprehensive services.
Can family members take part in Stanford Coordinated Care too?
- Yes, family members can receive care with from the SCC if they fit the health profile and are covered by Blue Shield or UMR offered by the Stanford Hospital and Clinics or Stanford University
How were patients selected to be part of Stanford Coordinated Care?
- Blue Shield of California and UMR applied risk assessment tools to claims data to look for Stanford employees and dependents who are members with multiple, chronic conditions. These members are more likely to benefit from care coordination with our care team than members who have no current health conditions or only one current condition.
Is this service confidential?
- Yes, only the physicians and coordinated care staff will know who is enrolled.
When does Stanford Coordinated Care begin?
- SCC is now open for the University population.. Starting June 4th, the Stanford Hospital & Clinics employee population will be able to enroll.
Will health plan benefits, costs, deductibles or co-pays change?
- No, benefit plan remains unchanged. However, the patient’s employer will waive co-pays for SCC services depending on each member’s benefit plan.
Do referrals/authorization requirements change with Stanford Coordinated Care?
- No, you would refer to us like any other clinic if the patient has chronic illnesses and you feel they would benefit from dedicated help managing their care.
What about prescriptions and refills?
- The Primary Care Plus team would like most, if not all, a patient's prescriptions to be managed by our clinicians, with input from our Clinical Pharmacist, to maximize safety and efficiency.
What about claims?
- Claims are not impacted at all. There are no changes to claims mailing addresses and claims processing.
If this is an enhanced service, why doesn’t it cost more? What’s the catch?
- Stanford Coordinated Care is based on the idea that, for certain people, extra attention from the SCC care team can enhance the patient's experience, improve the patient's health, and thereby reduce emergency room visits and hospital admissions. The cost saved in avoiding these forms of expensive care is being used to fund Stanford Coordinated Care. We expect with time that such "pay now to save money later" arrangements will become commonplace. Our goal is to demonstrate that they work.
Tell me a little about the Care Coordinators:
- The coordination of care provided by the physician and the care team is critical to the success of Stanford Coordinated Care. This includes tracking care provided by other physicians and other medical service providers.
- Each Stanford Coordinated Care patient will have a Care Coordinator available to assist them with their needs. Our Care Coordinator can support patients by:
- Providing answers to questions and the information needed to understand conditions.
- Providing guidance through the health care maze by coordinating care with doctors and other health care practitioners, as well as scheduling appointments.
- Supporting patients and their family in the areas that they need assistance.
How long is the enrollment period?
- We are accepting enrollment year round.
How can I get more information?
- Call our office at (650) 724-1800or go online at www.stanfordhospital.org/coordinatedcare