Patient-Centered Medical Home

What is a Patient-Centered Medical Home?

The Patient-Centered Medical Home (PCMH) concept is about finding the best way to deliver patient care. A PCMH is more than just a place to go see the doctor. It's a way of thinking about healthcare that involves respecting and understanding the whole person: their unique needs, culture, values, and preferences. Care isn't provided by just one person, but by a whole team of healthcare professionals, including doctors, nurse practitioners, nurses, care managers, pharmacists, nutritionists, behavioral health specialists, social workers, educators, and care coordinators. PCMHs support patients in learning to manage and organize their own healthcare, making them active participants in their healthcare choices. 

This model functions most effectively when patients provide a complete medical history and information about care obtained outside the practice.

A Patient-Centered Medical Home has the following characteristics:

• Patient-Centered — Each patient has an ongoing relationship with their own personal physician who provides comprehensive care, understanding and respecting the patient's unique needs, culture, values, and preferences.
• Comprehensive Care — The personal physician leads a team of healthcare providers in the practice, and together they take responsibility for the ongoing care of the patient. This includes care for all stages of life: acute care, chronic care, preventive services, and end-of-life care.
• Coordinated Care — The personal physician is responsible for or arranges care with other qualified professionals across the complex healthcare system, including specialty care, hospitals, home healthcare, and community services and supports, with clear and open communication between all providers, patients and families. 
• Quality and safety — Having patients actively involved in decision making, using evidence-based medicine and clinical decision-support tools to guide decision making, and expecting physicians in the practice to be accountable for continuous quality improvement.
• Enhanced access to services — The practice has shorter waiting times, including same day access, expanded hours, around-the-clock telephone or electronic access to a member of the healthcare team, and alternative methods of communication, such as e-mail and telephone care. 

Baystate Medical Practices

All Baystate Medical Practices (BMP) primary care sites have been officially recognized as Patient-Centered Medical Homes. We have transformed our practices to PCMHs using the National Committee for Quality Assurance (NCQA) model.