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What is a Patient-Centered Primary Care Home? by Faith Tuttle

February 26th, 2018 | Patient Centered Medical Home Blog

The concept of a patient-centered medical home is known across the nation by various names. The program in Oregon is managed by the Oregon Health Authority (OHA) and is known as Patient Centered Primary Care Home, or PCPCH. A PCPCH is a medical practice that puts the patient at the center of their care.

Since opening our doors in 1949, Grants Pass Clinic has provided patient-centered care under the medical home model, and the PCPCH program is one way we are able to be recognized for the outstanding way in which we care for our patients. Grants Pass Clinic has been a top rated PCPCH certified clinic since the beginning of the OHA program in 2011. In 2017, Grants Pass Clinic was the first clinic in Southern Oregon to achieve a 5-STAR certification – the highest level of certification under Oregon’s PCPCH program!

What does this mean for our patients? This means our care is:

  • Patient & Family Centered
    The patient and their family members are the most important part of the patient’s care.  PCPCH providers work with the patients and their families to develop paths of care centered around what works best for the patient.

    • We actively seek input from our patients and their families. Our Patient Family Advisory Council, or PFAC, gives us direct insight into our patients’ view on how we provide our care.  We renew our PFAC members on a regular basis, so if you are a Grants Pass Clinic patient or family member and are interested in working to improve our clinic, ask a member of your Care Team how to become a PFAC member!
  • Accessible
    Providing care when the patient needs it.

    • Our providers have access to our patients’ medical record – even when they are on call!
    • Our patients can send their Care Team a secure message or question about their health any time through our Follow My Health patient portal.
  • Accountable
    Taking responsibility for patients and providing quality care.
  • Comprehensive
    Offering patients many services under one roof!

    • Each patient has an educated Care Team that consists of a provider and their licensed nurses and certified medical assistants, along with other Care Team members who help support each patient throughout their health journey.
    • Care Management for chronic conditions like diabetes, high blood pressure, nutrition education, weight management, and many other conditions is available for ALL of our patients – pediatric patients too!
    • Our patients can have their lab orders taken care of at our on-site laboratory – even if the orders are from a provider outside of Grants Pass Clinic!
    • Our Acute Care clinic providers coordinate with our primary care providers to provide accessible, coordinated care when our patients need it.
    • Behavioral health providers are in house and available for appointments that coincide with the patient’s primary care and/or other appointments.  Most counseling appointments can be held right here at Grants Pass Clinic!
  • Continuous and Coordinated Care
    Our providers get to know their patients and work hand-in-hand with the patients and/or their families to improve the patient’s health.  If a patient needs care we do not have on site, the primary care provider coordinates the care, stays informed and up to date about the patient’s care, and co-manages the patient’s condition for better overall health.

National representatives from The Center for Medicare and Medicaid Services (CMS) are also taking an interest in what Grants Pass Clinic is doing. CMS has a program that requires clinics to further demonstrate their ability to provide patient-centered care. This program, known as Comprehensive Primary Care (CPC) Plus, is one more way we are able to demonstrate our effective patient care model. At the 2016 CPC National Conference, Grants Pass Clinic was recognized and awarded the CPC Champion for the entire State of Oregon for our outstanding efforts in the CPC program. Their top representatives spoke directly about our work with Care Management and Shared Decision Making Tools. The CMS Acting Administrator met with Grants Pass Clinic representatives to discuss the success of our comprehensive, patient-centered primary care efforts. Our CEO and PCMH Quality Improvement Coordinator were proud to accept this award on behalf of the entire Clinic!

Our strong foundation of patient-centered care continues to guide us in providing effective and comprehensive care for all our patients.

By Faith Tuttle, Quality Improvement Coordinator

5 Star Rating Grants Pass Clinic