Patient-Centered Medical Home (PCMH)
The Choice ACO-ES’ Patient-Centered Medical Home (PCMH) is not a building or house, but a way to provide better coordination of your health care service that is focused on you, the Medicare patient. It’s called a “home” because we want you to think of us first for all of your health care needs. Like family, we know who you are and design your health care around what we agree will work for you; to treat the “whole person”. “Your PCMH” will promote improved health outcomes for you, especially if you’re living with a chronic medical condition such as diabetes or high blood pressure.
Your personal physician will lead a Care Team who will work with you to improve or maintain a healthy lifestyle and coordinate your care whether you are visiting your doctor’s office, taking a health education class, going for a test, or being discharged from a hospital. Helping you navigate the health system of services available to you in and out of your PCMH is one part of the service your Care Team can offer you.
As a Medicare beneficiary’s you always have the right to choose their health care practitioner and the PCMH is not a HMO, managed care plan or health insurer. Instead, it is merely a way to provide you with more health care services, as you need them when you come for a doctor’s visit.
The PCMH is part of a new health care service designed to help improve your care while lowering health care costs over time.
ADVANCED CARE PLANNING
Take Care to Plan Your Health Care Decisions In Advance
– “Just In Case”
At Choice ACO-ES, it is important for you to provide your doctor and your Care Team with information about your health care choices at the end of life or if you become unable to speak for yourself. Referred to as “Advance Directives” or “Advance Care Planning”, you explain and document the type and extent of health care services you prefer if you become unable to make medical decisions on your own, which are then stored with your medical record so that the instructions are clear to your doctor and other Patient-Centered Medical Home (PCMH) Care Team members. Your doctor or other members of your PCMH Care Team can provide you with the forms to complete explaining your Advance Care Planning decisions. The forms may also identify another person who can make those decisions on your behalf (for example, you can name them as an agent or give them power of attorney over your health care decisions). Such medical care could include routine treatments and life-saving methods. Advance directives are sometimes also called living wills, giving you a say and peace of mind knowing your wishes and preferences for your health care will be handled as you prefer at all times.
Once submitted, you can access and review your Advance Care Planning forms at any time and you will be asked from time to time to update the information in the event you change your mind about some of the information in your Advance Care Plan. You can change the information in your Advance Care Plan anytime you like by notifying your doctor or other members of your Care Team.