A Nursing, Population Health & Lifestyle Blog

Tag: Patient Centered Medical Home

“We Don’t Know What You Do…”

This line, frequently uttered by a physician, is a bit of a running gag my bosses would rather me not mention. In New York state Patient Centered Medical Home (PCMH) is still relatively new.

When the role of clinical care manager was conceived, it did not come with a definitive list of responsibilities, rather an outline of what the position was meant to accomplish.

That role is evolving monthly and that can confuse patients and other members of the health care team that want to understand the best way to utilize a nurse clinical care manager.

Patient Centered Medical Home (PCMH)

Before I attempt to explain population health, It is a good idea to explain the Patient Centered Medical Home (PCMH) framework around it. Simply put, PCMH is a model in which primary care is organized and delivered. It is an active evolution of the primary care physician (PCP) practice. Below are the five main components to PCMH.

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