Healthy World, Healthy Nation, Healthy You

The Patient Centered Medical Home, Transforming Delivery of Primary Care

Joseph A Greco, MD, FAAFP
Program Director, Bryn Mawr Family Practice Residency Program
Designated Institutional Officer, Bryn Mawr Hospital


JosephDr. Greco received his BS from University of Notre Dame and his Medical Degree from Jefferson Medical College in Philadelphia. He is doubly Board Certified in Family Medicine and Hospice and Palliative Care Medicine. Dr. Greco is a Fellow in the American Academy of Family Physicians, completed an additional Fellowship in Academic Medicine and a Physician Leadership Program at The Wharton School. Currently, he serves as the Program Director of Bryn Mawr Family Practice Residency Program and as the Designated Institutional Official at Bryn Mawr Hospital. He has been honored several times as one of his region’s “Top Docs” in Family Medicine and has spoken at national conferences about the New Model of Primary Care Delivery Systems.


As Medicaid spending continues to overwhelm state budgets, the medical home model of care offers one method of transforming the health care delivery system.  Medical homes can reduce costs while improving quality and efficiency through an innovative approach to delivering comprehensive patient-centered preventive and primary care.

This show will address the following issues, challenges, stories, solutions

  1. It is increasingly more difficult to delivery primary care services given the metrics and reimbursement structures set up by insurers when coupled with the expectations of the patients to have personal time with the primary care provider and personal follow-up.
  2. A new delivery model was imperative to help remedy this situation, in part at least, to fix a broken health care system in that it is very fragmented and often disjointed. The new healthcare reform laws embrace this model and address some of the concerns as we strive to create value based reimbursement while providing high quality, evidence based medicine to the general public.
  3. Healthcare teams need to manage disease cohorts and patients must be actively involved in their care for the new model to be successful.

Accreditation for Medical Homes Focus on Patient Perspectives

The Accreditation Association for Ambulatory Health Care (AAAHC) in 2009 introduced the first accreditation program for medical homes to include an onsite survey. Unlike other quality assessment programs for medical homes, AAAHC Accreditation also mandates that PCMHs meet the Core Standards required of all ambulatory organizations seeking AAAHC Accreditation.

AAAHC standards assess PCMH providers from the perspective of the patient. The onsite survey is conducted by surveyors who are qualified professionals – physicians, registered nurses, administrators and others – who have first-hand experience with ambulatory health care organizations. The onsite survey process gives them an opportunity to directly observe the quality of patient care and the facilities in which it is delivered, review medical records and assess patient perceptions and satisfaction.

The AAAHC Accreditation Handbook for Ambulatory Health Care includes a chapter specifically devoted to medical home standards, including assessment of the following characteristics:

  • Relationship, including communication, understanding and collaboration between the patient and the provider and physician-directed health care team. Where appropriate the relationship between the medical home and the patient’s family or other caretakers also is assessed.
  • Continuity of care, including the requirement that a significant number (more than 50 percent) of a patient’s medical home visits are with the same provider/physician team. The standards also require documentation of all consultations, referrals and appointments in the clinical record; and proactively planned transitions of care (e.g. from pediatric to adult or adult to geriatric or from inpatient to outpatient to nursing home to hospice).
  • Comprehensiveness of care, including preventive and wellness care, acute injury and illness care, chronic illness management and end-of-life care. Standards for the provision of appropriate patient education, self-management and community resources also are addressed.
  • Accessibility, including written policies that support patient access and routine assessment of patients’ perceptions and satisfaction regarding access to the medical home. Medical care must be available 24/7, 365 days a year.
  • Quality, including patient care that is physician directed, the use and periodic assessment of evidence based guidelines and performance measures in delivering clinical services, and ongoing quality improvement activities.

3 Key Points:

  1. What is a PCMH and how is it different than old fashion “family doctor?”
  2. How did Bryn Mawr Family Practice become a certified Level 3 PCMH? The first one in the Main Line Health System, Bryn Mawr, PA.
  3. How does patient-centered care engage the patient/caregivers and what can they do to maximize their health in partnership with their Primary Care Doctor?


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