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Our Services

Patient-Centered Medical Home (PCMH)

Service Details

You and your health care at the center of your medical home team

Patient-centered medical home (PCMH) is not a building or a place: it is an approach to providing comprehensive primary care for children, youth and adults. PCMH is a health care setting that facilitates partnerships between individual patients and their personal physicians along with the patients’ family. In this personal model of health care, a team of health professionals collectively take responsibility for your care, with your primary care physician leading the way.

Your medical home team will make sure you get the care you need in wellness and illness to heal and maintain your health.

What is your role in patient-centered medical home?

  • Understand that you are a full partner in your own health care.

  • Learn about your condition and what you can do to stay as healthy as possible.

  • Commit to following the care plan that you and your medical team have agreed is important to your health.

  • Learn the value of communication. If you do not understand any part of your care, ask them to explain it in a different way.

  • Communicate with us if you obtain care from another health professional so we are fully updated on your medical issues and care.

Who makes up your medical home team?

Primary care physicians will collaborate with you in providing the highest quality of health care through evidence-based medicine and technology.

Advanced practitioners work closely with your physician to deliver the medical care you need.

Nursing staff may consist of medical assistants, licensed practical nurses, or registered nurses, each highly trained to assist you and your primary care physician in the delivery of your health care needs.

Hospitalists work closely with you, your family and your care team and keep your primary care provider informed while you are in the hospital. They help ensure you understand the follow-up care necessary after you are discharged.

Case managers will assist and manage care for those that have a high risk of being readmitted to the hospital or who may have multiple and/or complex health issues.

Licensed clinical social workers provide counseling and facilitate referrals to social/community health resources as needed.

Pharmacists will provide medication management to achieve treatment goals and help address barriers to medication compliance.