The patient-centered medical home model

The patient-centered medical home model
The patient-centered medical home model

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The patient-centered medical home model

            The chronic care model refers to an organizational approach through which people suffering from chronic diseases can receive care in the primary care settings. It is population-based. Moreover, it creates supportive, evidence-based, and practical interactions between the activated, informed patient and proactive, and prepared practice team.

This model identifies some vital healthcare system elements which promote care for chronic diseases that is high-quality. Within the elements, there are particular change concepts, which are used by the team to guide the improvement efforts. The care redesign processes applied agree to the change concepts.

            In the same way, the aim of the patient-centered medical home is ensuring that the patients receive better care (Varkey, 2010). The model focuses more on patient needs. Some of the aspects through which care access can be improved include increased communication between the patients and providers through telephone and email, and extending the office hours. The elements of the chronic care model increase care coordination as each contributes in its own way.

One of the goals of the patient-centered medical home is also increasing care coordination. Moreover, the latter model aims to enhance the overall quality and reduce costs simultaneously (The Commonwealth Fund, 2009).

            The patient-centered medical home model has a keen focus on the whole person, and different healthcare professionals participate in the care provision. There aspects are not focused on the chronic care model where attention is solely on the chronic disease. Similar to the chronic care model, the patient-centered medical home model integrated all health care aspects for overall health improvement. A unique characteristic of the patient-centered medical homes is that patients seek care from personal physicians who lead care teams within the medical practice (National Business Coalition on Health & National Health Leadership Council, 2010).

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Elements that are most significant for achieving safety and quality goals

The patient-centered medical home model

            This model also has some elements that promote achievement of its set goals. These are physician-led practice, whole-person orientation, coordinated and integrated care, access, and focus on safety and quality. These elements have to interact for the care being provided to be relevant. Same as the chronic care model, evidence-based medicine is given a lot of emphasis as it helps improve the patient outcomes. Moreover, the care team has to offer comprehensive care that is both coordinated and integrated (Institute for Healthcare Improvement, n.d.).

Chronic care model

            This model identifies the cardinal elements that every healthcare system should have for high-quality care for chronic diseases to be realized. The elements are as follows; clinical information systems, decision support, delivery system design, self-management support, health system, and community. Under each element, there are evidence-based change concepts and in combination, they foster interactions that are productive and meaningful between informed patients that are very active in their health and well-being and providers with expertise and resources.

Based on this model, these elements should all interact for chronic diseases to be managed and prevented effectively. In essence, the factors in the community that contribute to chronic diseases should be addressed and measures taken to promote safer communities (Varkey, 2010). In addition, patients should engage in self-care and management; healthcare delivery should be safe, personalized, and high-quality; the best decisions should be made for better care provision; and the clinical side should also be effective.

As such, chronic diseases can be prevented and managed appropriately. All the elements of this model are important for safety and quality goals. Each of them has a cardinal contribution, and ignoring any would result to inefficiencies.

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Structuring the models to achieve the best medical outcomes for individual patients at the lowest cost to society

            In relation to the chronic care model, the organizations being created should be committed to offering high quality and safe care. Basically, the business plan of the health system should reflect a dedication to applying the model across the organization. Moreover, the clinical leaders should ever be dedicated and visible members whose roles performance should be perfect. Again, the community resources should be mobilized so that the patients’ needs can be met. As a result, the chronically ill patients can be kept active, involved, and supported.

Moreover, it is necessary that the patients are prepared and empowered to as to participate in their healthcare. The delivery system design should assure self-management support and effective, efficient care. Birenbaum (2011) indicated that the decision support should promote care that agrees to patient preferences and scientific data. In relation to the clinical information systems, data should be organized to promote effective and efficient care (Varkey, 2010).

            For the patient-centered medical home model to be effective, the team of providers have to cooperate. In addition, there has to be payment reform and health information technology. Considering that medical homes might be virtual or physical network of services and providers, there has to be health information technology that can facilitate information sharing and communication among providers. In addition, the providers receive financial incentives that enables them focus on quality as opposed to volume.


Birenbaum, A. (2011). Remaking chronic care in the age of health care reform: Changes for lower cost, higher quality treatment. Santa Barbara, Calif: Praeger.

Institute for Healthcare Improvement. (n.d.). Chronic care model. Retrieved from

National Business Coalition on Health, & National Health Leadership Council. (2010). Patient-centered medical home: Has the time come? : National Health Leadership Council, Portland, ME, June 22-24, 2010. Washington, D.C: National Business Coalition on Health.

The Commonwealth Fund. (2009). Can patient-centered medical homes transform health care delivery? Retrieved from

Varkey, P. (2010). Medical quality management: Theory and practice. Sudbury, MA: Jones & Bartlett. Chapter 7, “Utilization Management”

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