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Health Watch/Shannon Lahnala Bleau, RN, BSN

Health care coordination with Patient-Centered Medical Home

May 17, 2012
The Daily Mining Gazette

Remember the good old days? The days when your doctor was the doctor you saw for everything from a nagging cold to a life-threatening disease? Your doctor was there for you, whenever you needed them. A lot has changed, but your doctor is still here for you. That's the inspiration behind Patient-Centered Medical Home (PCMH), a national movement in health care aiming to provide the optimal amount of coordination to help patients receive higher quality care, at a lower expense.

Portage Health Medical Group is a part of that movement and has implemented the PCMH model in our primary care practices. PCMH is a partnership between you and your primary care provider. It is a team approach, led by your primary care physician in which everyone works together to provide more effective, efficient and personalized care. This might include a dietician, social worker, home health service, diabetic educator and more. Done properly, this model can improve access to care, increase preventive services and enhance coordination of services. This is designed to improve your health and decrease the overall cost of health care.

It starts with patients and providers being proactive. All patients should have an annual wellness visit, where any and all issues of a person's health can be examined and discussed. Your primary-care provider will get all information and work with you on age-specific preventive services such as breast, cervical or prostate cancer screening, cholesterol and diabetes testing to help prevent or monitor chronic diseases. Together, you will develop a full understanding of your health, allowing you to discuss a plan to improve or maintain your health until the next visit. For those without serious health issues, the next visit could be a year away. For those with chronic issues, this could be once a week, month or quarter, depending on specific needs. The idea is that when you walk out of your provider's office, you'll know when your next appointment is, even if it's a year out.

If an issue arises at an appointment, your doctor is there to help you coordinate your care, including arranging specialist care when needed. That care is added to your electronic medical record, which can help your entire team of care providers coordinate and manage your unique medical history. When you take a step back and think about it, the idea is to combine the convenience and personal caring of good old-fashioned medical care from a single doctor, with today's advances in technology, medical advances, and needed specialty care.

Last year, three of Portage Health's primary care clinics were designated as patient-centered medical homes. We expect the fourth to be designated this summer. We are continuing to take steps forward from there, including doubling the size of our clinic on Michigan Tech's campus and adding additional providers to serve you better. Please call your primary care provider if you are overdue for an annual wellness visit. If you do not have a primary care provider, Portage Health would be happy to assist you.

Questions? Take a moment to learn more about the PCMH model and watch a brief video explanation by visiting

Editor's note: Shannon Lahnala Bleau, RN, BSN, is the quality support analyst and PCMH coordinator at Portage Health.



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