Make the most of your patient-centered medical home
Most frequent questions and answers
At Grace Health, we want to give you the best health care available. That’s why wehave adopted a different wayof doing things called the patient- centered medical home.
Patient-centered medical home is not a building, and we won’t be coming to your house. Patient- centered means that you will have ateam of health care providers working together to meet your unique health needs.
We want you to feel “at home” with your health care. You’ll see familiar faces who care about you and your health. We’ll work with you to make sure you’re getting the best possible health care.
Before your visit:
- Prepare a list of questions and concerns
- List new medications and any updates to your medical records
During your visit:
- Ask Questions
- Help make decisions
- Discuss any other health care providers you’ve seen
After your visit:
- Follow your care plan
- Tell your team if there are any changes
- Prevention / wellness
- Chronic disease management
- Care coordination between providers
- After-hours and urgent care
- Evidence-based care
- Self-management support
- Patient specific education
- A patient-centered medical home is all about you!
- We offer you better access to care
- We deliver high quality personalized care
- We help guide you through a complex and sometimes confusing healthcare system
- We partner with you to manage your health
- We assist you in selecting your personal clinician
- Primary care practices that earn the Distinction in Behavioral Health Integration from the National Committee for Quality Assurance (NCQA) have put the right resources, evidence-based protocols, standardized tools and quality measures in place to support the broad needs of patients with behavioral health conditions.
- This distinguishes practices that provide integrated behavioral healthcare and services as a part of a patient-centered medical home.
- PCMH Distinction in Behavioral Health Integration helps practices provide comprehensive whole person care that acknowledges the behavioral health needs of the individual beyond the core requirements of NCQA PCMH Recognition.
- Receiving the PCMH Behavioral Health Distinction shows that we have proven that we have the appropriate care team in place to manage the broad needs of patients with conditions related to behavioral health.
The NCQA defines the patient-centered medical home as a way of organizing primary care that emphasizes care coordination and communication to transform primary care into “what patients want it to be.” Medical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care. Click here for a video that explains more and answers
The medical home encompasses five functions and attributes:
01.
Comprehensive Care
As a patient-centered medical home, Grace Health meets the needs of our patients’ physical and mental health. This includes preventative and wellness care, acute care, and chronic disease management. In order to provide quality, comprehensive care, Grace Health has incorporated a team approach to treat each patient. Our teams may include physicians, advanced practice nurses, physician assistants, nurses, medical assistants, and care coordinators.
02.
Patient-Centered
The patient-centered medical home 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.
03.
Coordinated Care
The patient-centered medical home coordinates care with all of the entities in the health care system, including specialty care, hospitals, home health care, and community services and supports. This type of coordination is particularly critical during transitions between sites of care, such as when patients are sent to a specialist, need diagnostic testing, or are discharged from the hospital.
04.
Accessible Services
The patient-centered medical home makes services more accessible and wait times shorter for those with immediate needs, includes enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team. The medical home practice adapts to patient’s preferences to provide the easiest access possible.
05.
Quality and Safety
The patient-centered medical home focuses on quality and quality improvement by continuously improving patient outcomes by participating 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. Sharing robust quality and safety data and improvement activities publicly is also an important marker of a system-level commitment to quality.
