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Patient Centered Medical Home (PCMH)

The Patient-Centered Medical Home (PCMH) is a national health care movement that establishes the primary care physician’s office as the patient’s medical home. PCMH is founded on the patient/physician relationship, where the primary care physician’s team coordinates all of a patient’s medical care to improve patient health and outcomes.

The patient centered-medical home is a transformative process within a physician’s office and with a physician’s patient population and individual patients to achieve patient engagement, better health outcomes and long term cost effectiveness.

Following are the PCMH joint principles, developed and endorsed by numerous medical societies, including the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians and the American Osteopathic Association.

  • Personal physician – each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
  • Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
  • Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care, chronic care, preventive services, and end of life care.
  • Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community-based services). Care is facilitated by registries, information technology, health information exchange, and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
  • Quality and safety are hallmarks of the medical home.
  • Enhanced access to care is available through systems such as open scheduling, expanded hours and new options for communication between patients, their personal physician, and practice staff.
  • Payment appropriately recognizes the added value provided to patients who have a patient-centered medical home.
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