What is a Patient-Centered Medical Home?

Our Patient Centered Medical Home (PCMH) Initiative is based on a model showing that the quality of care you receive is best when provided by a team, led by your primary care provider, of health care professionals working together with you and your family. We will work with you to make sure all the health care services you need are coordinated.

Patient Centered Medical Home providers can be described by 5 functions/attributes:

  1. Comprehensive Care
    Accountability for meeting most of each individual patient’s health care needs whether it be physical or mental. This includes acute care, chronic care, prevention, and wellness. In order to provide care that is comprehensive this requires a team of physicians, advanced practice nurses, nutritionists, social workers and more, but we can link you to providers and services within the community to give you the comprehensive care that you need.
  2. Being Patient-Centered
    We don’t just give you health care, but we build relationships with our patients to better understand the needs. Partnering with patients and their families allows us to gain understanding and a unique ability to actively support patients in learning to manage and organize their care how the patients chooses. We value our patients and believe the patient to be core members of the care team.
  3. Coordinated Care
    Not only do you receive Comprehensive Care, but understand that your care is also coordinated. The ability to coordinate during transitions between different locations of care, such as when patients are discharged from hospitals. Medical home practices are said to excel when it comes to communication between families, patients, the medical home, and members of the broader care team.
  4. Accessible Services
    Know that services are accessible, responsive, and that we can be reached by several means of communication whether it be email or telephone.
  5. Quality and Safety
    Primary care medical homes should be committed to quality improvement, and even quality itself by having an ongoing engagement in various activities of involvement such as using clinical decision support tools, and evidence-based medicine to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management. The ability to share quality that is robust and safety data and improvement activities publicly is an important marker for system-level commitment to quality.

The model of a medical home is to improve health care and holds promise by transforming the organization and delivery of such.  The Agency for Healthcare Research and Quality (AHRQ) has defined medical homes not simply as a building or a place, but as an organizational model of primary care that delivers core functions of primary health care.

 Read more about PCMH and AHRQ