What type of medical care is provided in a patient-centered medical home (pcmh)?

The patient-centered medical home (PCMH) is a provider-based model for care coordination that can be implemented within a primary care practice. The PCMH, as defined by the Agency for Healthcare Research and Quality (AHRQ) and the Patient-Centered Primary Care Collaborative, is a model for providing patient care that is comprehensive, patient-centered, coordinated, accessible, and high quality.

In 2007, the Joint Principles of the Patient-Centered Medical Home were released by the American Academy of Family Physicians, the American Academy of Pediatrics, the American College of Physicians, and the American Osteopathic Association.

Characteristics of the PCMH model include:

• A strong relationship between every patient and a primary care physician
• Coordination between the physician and the practice’s team of clinicians
• Coordination of the patient’s care across various healthcare settings
• The use of health information technology and analytical tools to facilitate care coordination

More about this model:

• PCMH Standards and Capacities
• Examples of PCMH Models
• Patient Centered Medical Home Model Implementation Considerations

Resources to Learn More

AHRQ Patient Centered Medical Home Resource Center
Website
Shares links to resources for researchers, evaluators, and providers that explain different aspects of the PCMH model and considerations for implementation.
Organization(s): Agency for Healthcare Research and Quality

Building Your Medical Home Toolkit
Website
The toolkit provides information to support the development and/or improvement of a pediatric PCMH.
Organization(s): American Academy of Pediatrics

Patient-Centered Medical Home
Website
This website provides resources on NCQA’s patient-centered medical home model for providers interested in becoming a PCMH.
Organization(s): National Committee for Quality Assurance

The Patient-Centered Medical Home's Impact on Cost and Quality: Annual Review of Evidence, 2013-2014
Document
This review document resents outcomes reported by PCMH programs in peer-reviewed literature, program evaluations, and other publications.
Organization(s): Patient-Centered Primary Care Collaborative
Date: 1/2015

Patient-Centered Primary Care Collaborative Webinars
Website
A collection of webinars produced by the Patient-Centered Primary Care Collaborative on a range of PCMH-related topics.
Organization(s): Patient-Centered Primary Care Collaborative

The Safety Net Medical Home Initiative: Patient-Centered Care for the Safety-Net System
Document
This toolkit provides implementation guides for providers interested in becoming a PCMH.
Organization(s): The Commonwealth Fund
Date: 10/2014

Juniper Health, Inc. is implementing the Patient-Centered Medical Home (PCMH) model to improve our care for patients. We believe that the PCMH model is a strong avenue for the care of our patients. Through this model, working together with their health care team, patients are able to achieve their best quality of life.

What is Patient-Centered Medical Home Recognition?

The Patient-Centered Medical Home (PCMH) model is a health care setting that provides comprehensive, coordinated and patient-centered primary care to patients of all ages. PCMH emphasizes the partnership between a patient and his or her personal healthcare provider, and when appropriate, family members. At Juniper Health, Inc., the first step in managing your own care is to choose a provider. You will then be assigned to a care team, which is trained to provide comprehensive and coordinated care to each patient. PCMHs build better relationships between patients and their clinical care teams. Research shows that PCMHs improve quality, the patient experience and staff satisfaction, while reducing health care costs. Practices that earn recognition show that they have made a commitment to providing quality improvement within their practice and a patient-centered approach to care.

For more information on PCMH or NCQA, visit www.ncqa.org.

Our Responsibilities:

The hallmarks of the PCMH model include comprehensive, patient-centered and coordinated care, accessible services, quality and safety.

• COMPREHENSIVE CARE: JHI is accountable for meeting the large majority of each patient’s physical and mental care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This team may include physicians, dentists, dental hygienists, advanced practice nurses, physician assistants, nurses, nutritionists, social workers, educators, and care coordinators. This team links JHI and our patients to providers and services in our communities.
• PATIENT-CENTERED: JHI provides primary health care that is relationship-based with an orientation toward the whole person. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Recognizing that patients and families are core members of the care team, medical home practices ensure that they are fully informed partners in establishing care plans.
• COORDINATED CARE: JHI coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication.
• ACCESSIBLE SERVICES: JHI delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone access to a member of the care team, and alternative methods of communication, such as telephone and electronic care. The medical home practice is responsive to patient’s preferences regarding access.
• QUALITY AND SAFETY: JHI demonstrates a commitment to quality and quality improvement by ongoing engagement in activities such as using evidence-based medicine and clinical decision-support tools 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.

Patient Responsibilities:

• Participate in the development of a plan to improve your health and be comfortable working with your care team when it comes to health and wellness coaching, education, and advice.
• Provide a complete medical and social history at your initial visit and update your history, as applicable.
• Inform your care team about any care obtained outside of the practice so that they can provide the most comprehensive care possible.
• Use our self-management support system to ensure that you are at the center of your healthcare.
• Please feel free to provide any feedback you think may help us to improve our care.

Watch this video to learn more:

What is patient

What are the functions of a patient

What is a patient

What is an example of a Pcmh?