Patient Centered Medical Home

Spectrum Health Services, Inc. takes great pride in receiving recognition from the NCQA as a Patient-Centered Medical Home (PCMH). In essence, this approach focuses on maintaining patient well-being rather than solely addressing illness. Your physician assumes the role of team leader, working alongside nurse practitioners, physician assistants, and other vital healthcare professionals. Together, this dedicated team orchestrates evidence-based care, ensuring comprehensive health management across various settings, including outpatient, inpatient, and, if required, nursing home care.

Our medical providers integrate the latest research evidence and clinical expertise This includes evidence-based lifestyle interventions.

Defining the PCMH

The medical home model holds promise as a way to improve health care in America by transforming how primary care is organized and delivered. The medical home encompasses five functions and attributes:

1) Comprehensive Care

The primary care medical home is accountable for meeting the large majority of each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This team might include physicians, advanced practice nurses, physician assistants, nurses, pharmacists, nutritionists, social workers, educators, and care coordinators. Although some medical home practices may bring together large and diverse teams of care providers to meet the needs of their patients, many others, including smaller practices, will build virtual teams linking themselves and their patients to providers and services in their communities.

2) Patient- Centered

The primary care medical home provides 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.

3) Coordinated Care

The primary care medical home coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication among patients and families, the medical home, and members of the broader care team.

4) Accessible Services

The primary care medical home delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email and telephone care. The medical home practice is responsive to patients’ preferences regarding access.