Patient-Centered Medical Home as Quality Initiative


The changing health needs of different patients are something that requires evidence-based care delivery and treatment models that result in reduced medical costs. Leaders in the healthcare sector have been focusing on different initiatives that can improve quality and maximize people’s experiences. A good example of such innovative strategies is the patient-centered medical home (PCMH) which has become common in different parts of the world, including the United States. This paper gives a detailed analysis of this model, its sponsors, and potential outcomes.

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Key Features

The original idea behind the PCMH was to transform care delivery in the United States by introducing several core functions or attributes. The first one is that of comprehensive care whereby different professionals collaborate to provide chronic care, acute medical support, preventative and wellness services to the targeted patients. Some of them include registered nurses, physician assistants, advanced practice nurses, educators, nutritionists, care coordinators, and physicians (Marsteller et al., 2018). The second attribute is that such experts collaborate to provide holistic or patient-centered services to the individual. Family members of the targeted patient are involved in the care delivery process in order to learn more about their preferences, culture, needs, and values.

The third aspect is that of coordinated care whereby professionals work together and liaise with other elements in the health system, such as community service centers, hospitals, and specialty care facilities. The formation of this model ensures that individuals are able to receive timely services while reducing waiting time (Hegwer, 2016). The final attribute is that of quality and safety. The involved individuals and agencies are usually committed to improving patient experience continuously through the power of clinical decision-support technologies and evidence-based medicine. The adoption and utilization of data analytics ensure that all patients receive high-quality and timely medical services.


The establishment of PCMHs was an innovative idea aimed at improving the accessibility and effectiveness of medical services. Many health care providers in the US have appreciated this concept in an attempt to achieve maximum outcomes in medical delivery. This means that physicians and practitioners present their inputs and resources to establish such systems and ensure that they continue to function optimally (Hegwer, 2016). Different associations in this country have partnered to establish principles that professionals in the healthcare sector can select to support the delivery of comprehensive services. Some of them include the American Osteopathic Association (AOA), the American College of Physicians (ACP), and the American Academy of Pediatrics (AAP).

Different organizations have also been in the frontline to offer incentives and financial support to this innovative idea. The best example is the PCMH-Facility Improvement Grant Program that ensures that more people have access to exemplary services. The Patient Protection and Affordable Care Act (PPACA) has also been authorizing various programs that support this concept. The government is currently funding the healthcare system to make this innovation a success (Hegwer, 2016). It trains more professionals and equips them with additional tools and resources, such as team-based practices and health information technology (Marsteller et al., 2018). Medicaid has also been funding various state-based PCMHs by compensating physicians and health systems within the framework. Payers provide financial incentives to ensure that every established PCMH system delivers the intended aims.

Intended Areas to Improve

The PCMH innovation was designed and introduced as a powerful model for improving or addressing various gaps that were affecting the integrity of America’s healthcare system. The first one was the fact that many patients used to seek medical support from different facilities, thereby increasing complexities and duplication of services. Pioneers of this concept wanted to design a new system that would make it possible for individuals to receive comprehensive health support for various illnesses and complications (Joshi, Ransom, Nash, & Ransom, 2014). This aim was attainable since such PCMHs would bring together different professionals to work as teams and improve patients’ health outcomes.

The idea of patient-centered care was another target of this innovation. Most of the existing facilities and care delivery procedures were not addressing the unique needs of every specific patient. This strategy was capable of making sure that all medical procedures delivered holistic and personalized medical care. Another unique aspect of PCMH was to improve the level of coordination. Such a model would ensure that family members and patients received timely communication, medical guidance, and information from the point of admission to that of discharge (Reynolds et al., 2015). Community services professionals would also become part of the process to improve patient health outcomes. The concept was expected to create a scenario whereby all stakeholders and professionals were committed to quality and safety. They would work as a team, utilize emerging technologies, share ideas, and apply data analytics to improve health outcomes.

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The introduction of the PCMH model has led to positive results in the US healthcare sector. Firstly, treatment is currently being coordinated in such a way that patients are able to receive personalized and timely services (Marsteller et al., 2018). This means that the available medical support is relevant and understandable to them. Secondly, the innovation is centralized and synchronized in a proper manner. This means that the existing settings are capable of facilitating partnerships and ensuring that individuals get the right care or treatment (Reynolds et al., 2015). Thirdly, the utilization of different technologies and tools has made it possible for many community members to receive timely services, such as health information exchange (HIE), patient registries, and electronic health records (EHRs).

Fourthly, the innovation has managed to minimize most of the challenges associated with language barriers and cultural differences. The presence of online tools and resources explains why many systems and networks continue to address emerging challenges. From this analysis, it is agreeable that the coordinated care associated with PCMHs in the United States has improved the level of communication, thereby meeting the diverse needs of many community members. The acquired information is then analyzed in order to offer additional insights for increasing responsiveness and collaboration (Marsteller et al., 2018). Different regions and states in this country are currently embracing these models since they have the potential to transform patients’ experiences. Such innovative ideas will also address most of the health challenges affecting the American population.


The above discussion has supported the formation of PCMHs since they are capable of improving people’s health outcomes and minimize medical costs. The involvement and resources gained from different sponsors will continue to support the sustainability of such PCMHs. The government and other agencies should, therefore, implement these PCMHs in an attempt to improve the quality of medical services available to the greatest number of American citizens.


Hegwer, L. R. (2016). Business imperatives for population health management. Healthcare Executive, 31(4), 10-20.

Joshi, M., Ransom, E. R., Nash, D. B., & Ransom, S. B. (2014). The healthcare quality book: Vision, strategy, and tools (3rd ed.). Chicago, IL: Health Administration Press.

Marsteller, J. A., Hsu, Y., Gill, C., Kiptanui, Z., Fakeye, O. A., Engineer, L. D., … Harris, I. (2018). Maryland Multipayor Patient-centered Medical Home program: A 4-year quasi-experimental evaluation of quality, utilization, patient satisfaction, and provider perceptions. Medical Care, 56(4), 308-320. Web.

Reynolds, P. P., Klink, K., Gilman, S., Green, L. A., Phillips, R. S., Shipman, S., … Davis, M. (2015). The patient-centered medical home: Preparation of the workforce, more questions than answers. Journal of General Internal Medicine, 30(7), 1013-1017. Web.

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