Who We Are

Patient Centered Medical Home

WHAT IS A PATIENT-CENTERED MEDICAL HOME?

The Patient-Centered Medical Home (PCMH) model is an approach to delivering high-quality, cost-effective primary care. Using a patient-centered, culturally appropriate, and team-based approach, the PCMH model coordinates patient care across the health system. It helps to build better relationships and promotes communication between patients and their healthcare providers, improve the quality of care patients receive, increase access to clinical and non-clinical resources to patients and improves patient and staff satisfaction while decreasing overall healthcare costs.

Family Health Matters is accessible, continuous, comprehensive, patient-centered, coordinated, compassionate, and culturally effective care. Our main goal is to be your healthcare partner by serving as your medical home. We are committed to coordinating your treatment, through your primary care provider and/or care management team, to ensure you receive the most up-to-date, evidence-based care.

This means our practice, as your Medical Home, is a central resource for all of your care needs. In a Medical Home, your doctor, nurse or physician's assistant and their staff who see you for routine check-ups – making you feel like you are the most important part of the healthcare team. You are welcome and invited to participate in all aspects of your care.

As your Medical Home, we will also help you find needed information and resources, such as information about:

  • Specialists including mental health providers

  • Your Health conditions and the latest treatments available to treat them

  • Home care, equipment, and vendors

  • Supports and respite services for your family

  • Other key local services

  • A Primary Care Provider (PCP) is a doctor, nurse practitioner or physician assistant who is assigned to you to manage your healthcare needs.

    Some patients will have a Care Management Team: A Care Management Team is comprised of your primary care provider and any other providers, counselors, social workers, etc., who are assigned to you to help manage your healthcare needs

  • Evidence-Based Care is an approach to medical practice where the provider makes decisions about the patients’ care based on evidence from well-designed, well-conducted, up-to-date research.

  • Our practice would like to be available when you need us. Please ask about any special communication or access needs that you have.

    We have “policies” with your needs in mind…for example:

    When you call for an appointment you will be seen on the same day for sick care. All attempts will be made to schedule you with your primary care provider.

    When you have tests or procedures done you will get the results within 1 week. Depending on the results and your preferred method of contact, you will be notified by phone, mail or via the patient portal.

    If you are referred to a specialist, with your permission, we will share information with the specialist and with you in a timely manner.

  • Take care of you (and your family) when you are sick and well and help you all to stay well.

    Help you plan your care and/or set goals for care, for now and in the future.

    Talk with you about any testing or treatment that you need

    Work with you and other care providers to coordinate care

    Provide access to evidence-based care, patient education and self-management support

    You Can Make Care Better and Appointments Go Well if You:

    Are prepared to share how you are doing (at work, at home, sleep, etc.)

    Write down and bring your main questions and concerns

    Bring in a list of any other providers you see with their contact information

    Ask for help in creating and sharing a complete record of your care

  • To be successful as a Patient-Centered Medical Home we need you to play an active part in the healthcare team.

    Here are some things you can do to help:

    Inform of us immediately of any visits to other healthcare providers, specialists, emergency/urgent care visits, hospitalizations, etc.

    Bring any old records, paperwork, discharge summaries, etc. that you may have from these visits. If you do not have old records, please sign a release of medical information so that we can receive these records.

    Always inform the Emergency Department, Urgent Care, specialists, etc., that we are your primary care provider.

    Always bring an updated list of medications, including doses, with you to your appointment.

    Keep your contact information up-to-date.

    Don’t be afraid to share information with your provider/care team. ASK for help.

    ASK questions if you don’t understand. No question is dumb.

  • 24/7 Access to Medical Advice

    Do you have a question about your health? Do you need to seek medical advice from one of our providers but our facilities are closed?

    An on-call answering service is available when the office is closed. This line can be used for non-emergency clinical advice after hours. Please call our Main Line at 714-441-0411 and follow the prompts.