Health Dialog Connections

Back to the Future: Welcome to the Patient Centered Medical Home (Guest Post)

A patient being consulted by a doctor at a patient-centered medical home

There once was a time when if you got sick, you’d call the family doctor. The doctor would take care of you quickly and coordinate any additional care that you needed. In those days, your family doctor was a “home base” for all your medical needs. 

Over time, the role of the family physician got lost. Doctors’ offices were often organized to be efficient for the people who worked there, not for the patients. Now, if you get sick, you may have a hard time reaching your doctor by phone. When you get through, you’ll probably be squeezed into a busy schedule and spend hours waiting for a few minutes with your healthcare provider. If you have questions afterwards, you may feel left on your own to manage your care.

As a primary care doctor, the challenges my patients faced were frustrating me, too. I wanted my practice to provide easy access to comprehensive medical care. And so, we made changes that led us to become a certified patient-centered medical home (PCMH).

Healthcare Organized Around Your Needs 

The patient-centered medical home isn’t a place. It’s a new way to organize how a primary care office works. In the PCMH approach, a primary care doctor leads a team of nurses, medical assistants and other staff who all work together with you so you can:

  • Get care when you feel you need it
  • Communicate with your doctor more easily
  • Get ongoing help coordinating and keeping track of all your healthcare needs

By combining teamwork with communications and information technology, the PCMH is able to give you more personal, responsive care, like yesteryear’s family doctor.

Getting Care When YOU Feel You Need It

The PCMH is set up to let you see your healthcare providers when you feel it’s necessary, not just when a test result or diagnosis dictates that you need to go in. My patients often get appointments on the day they call, and nearly always within 24 hours, even for physical exams – and with no long waits. This may sound too good to be true, but when you understand how the PCMH works, you’ll see it’s for real.

Please Don’t Make an Appointment on Your Way Out

In a “regular” practice, patients with chronic conditions, such as diabetes or heart disease, are typically told to schedule their routine follow-up appointments as they leave the office. These appointments fill the schedule for weeks in advance. If you get sick and need prompt care, there’s little time to fit you in.

In a PCMH, people with chronic conditions are told how often they need to be seen, but they are asked to call and make an appointment a day or two before they’d like to come in. This leaves time free in the daily schedule for people who need urgent care, while still making it easy to schedule appointments for routine care.

But perhaps you’re thinking: If I don’t make an appointment while I’m in the office, I’ll forget and I won’t get the care I need.

Better Monitoring for Chronic Conditions and Preventive Care

In a PCMH, you’re more likely to get the care you need. A member of your primary care team enters your information into a computer registry, which helps the team track your care schedule. If you don’t schedule your care on time, someone will be in touch with you. And if you’re managing a chronic condition, a health coach may contact you from time to time just to see how you’re doing and to support you in achieving excellent health.

If you do see your doctor for a sudden problem, you may find that your provider takes a little extra time to see how you’re doing with other health conditions you may manage. In a PCMH, your team is looking out for your total wellbeing all the time.   

You’re Part of the Patient Centered Medical Home Team

You’re the most important member of your PCMH team, and your role is to be actively involved in your care.  To help, the PCMH makes it easy for you to access your medical records online and email your doctor with non-urgent questions about your health and treatment plans.  You can ask questions whenever they come to mind and get answers efficiently.

How to Find Your Way Home

Many primary care offices are beginning the “makeover” process so that they can become certified patient-centered medical homes. Your health insurance company may have a list of these practices in your area.

The National Committee for Quality Assurance has a directory of primary care physicians that have earned their approval as PCMH practices.

To learn more about the PCMH, see these sites:

Thomas F. Lyon, MD, is a board certified family physician with 25 years of experience in private practice. In 2008, his Pennsylvania practice was among the first in the nation to receive the highest level of PCMH certification from the National Committee for Quality Assurance (NCQA). The practice was also the first in the nation to achieve a 3-year PCMH recertification from the NCQA in 2011. 

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