Patient-Centered Medical Home Model

Payers and patients are demanding greater value for their investment in the current health reform landscape. The promising patient-centered medical home (PCMH) model has emerged to meet their needs. This model combines two core concepts of public health: patient-centeredness and medical homes.

  • Patient-centeredness represents a shift in patient orientation from recipient to partner. The provider‘s role is characterized as collaborative, empowering, relational, communicative, respectful, and empathic.Qu
  • Medical home emphasizes not a fixed address or person but essential primary care functions and attributes—access, coordination, quality, comprehensiveness—that contribute to the twin goals of an improved experience and better outcomes.

There are many definitions of PCMH, but we admire the Oregon Health Authority’s  definition for its simplicity and clarity:

  • Access to care: Patients get the care they need when they need it.
  • Accountability: Recognized clinics are responsible for making sure patients receive the best possible care.
  • Comprehensive: Clinics provide patients all the care, information, and services they need.
  • Continuity: Clinics work with patients and their community to improve patient and population health over time.
  • Coordination and integration: Clinics help patients navigate the health care system to meet their needs in a safe and timely way.
  • Patient- and family-centered: Clinics recognize that patients are the most important members of the health care team and that they are ultimately responsible for their overall health and wellness.
Why Should SBHCs Pay Close Attention to this Reform Movement?

One word: sustainability. With a big boost from the Affordable Care Act (ACA), and largely through the Centers for Medicare and Medicaid Services (CMS) and state Medicaid agencies, national and state policymakers are aiming to foster integrated systems that deliver higher quality, better coordinated, and more cost-effective preventive and primary care across the entire population. PCMH is a popular tool for redesigning primary care practices in service to that aim.

Quality improvement (QI) is a vital component of PCMH recognition. Please review our Quality Improvement: Practical Solutions for Improving Patient Care for tools and resources to help enhance your QI processes. Another vital component of PCMH recognition is documenting your work against a set of nationally-recognized performance measures, such as the School-Based Health Alliance’s set of standardized performance measures.

National PCMH Recognition Programs