Patient Centered Medical Home

WELCOME TO YOUR MEDICAL HOME

Your health and wellness is a top concern of our office. To give you the best care, doctors and patients must work together. This idea is called the Patient Centered Medical Home. We will work with you to manage your health care needs.

As your Medical Home, we will:

• Take care of short term illness and long term chronic diseases
• Discuss your goals and how you would like to improve your health
• Listen to you and address your concerns
• Help you stay healthy by giving you easy to understand information
• Respond promptly to your calls, questions and concerns
• Have a doctor on call after hours for your urgent needs
• Remind you when vaccines and tests are due
• Notify you of test results in a timely manner
• Help coordinate care with specialty doctors if needed

As your Medical Home, we trust you to:

• Follow the care plan that is agreed upon as best you can
• Tell us about all medications and over the counter supplements you are taking
• Let us know when you see other health care providers and ask them to send us a report about your care
• Keep your appointments or call to reschedule or cancel
• Call if you do not receive your test results within 2 weeks
• Use the after-hours line only for issues that can’t wait until the next work day
• Call the office before going to the Emergency Room if possible so someone who knows your history can care for you
• Learn about your insurance so that you know what it covers or work with us to help develop a payment plan
• Pay your share of the visit fee when you are seen in the office
• Give us feedback to help us improve our services

Principles of Patient-Centered Medical Home

1. Each patient has an ONGOING RELATIONSHIP with a personal physician trained to provide first contact, continuous and comprehensive care.
2. PHYSICIAN DIRECTED – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients, using a planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family.
3. WHOLE-PERSON ORIENTATION – patients actively participate in decision-making and feedback is sought to ensure patients’ expectations are being met.
4. The goal of the physician and the team is to assure that patients get the indicated care when and where they need and want it in a CULTURALLY AND LINGUISTICALLY APPROPRIATE MANNER.
5. CARE IS COORDINATED AND INTEGRATED – 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, for all stages of life: acute care; chronic care; preventative 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).
6. QUALITY AND SAFETY – evidence-based medicine and clinical decision-support tools guide decision making. Learn more about your health condition and tools to help manage it under our “Services” menu.
7. 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 the practice staff.
8. INFORMATION TECHNOLOGY is utilized appropriately to support optimal patient care, performance measurement, patient education, and enhanced communication.
9. Physicians in the practice accept ACCOUNTABILITY for continuous quality improvement through voluntary engagement in performance measurement and improvement.