Team Based Patient Care
PCMH
Specific Roles
Screenings
Community Resources
100

PCMH & ACO focus on the patient and the healthcare team to provide the best outcome for the patient.

What is the Purpose of Health Care Delivery Models?

100

This is a healthcare delivery model that coordinates patient treatment through the PCP to ensure medical necessity of services.

What is the Patient-Centered Medical Home?

100

Licensed by individual states. Can perform more complicated clinical tasks and can oversee the case management of patients with chronic conditions.

What is a Registered Nurse?

100

A mammogram is done, recommended to start at age 40.

What is Breast Cancer Screening?

100

Assist with transportation to and from medical appointments and DME.

What are transportation and medical equipment?

200

Examples are PT, OT, ST, pharmacists, mental health specialists nutritionists, and dentists.

What are other healthcare providers?

200

Approach that includes care for the patient's needs, not just medical/physical concerns.

What is Comprehensive Care?

200

Prepare and dispense medications.

What is a Pharmacist?

200

Recommended at age 45 and can be done with a FOBT or colonoscopy.

What is a Colorectal Cancer Screening?

200
Offer daily activities for older adults.

What is adult day programs?

300

Examples are MD, DO, NP, or PA.

What are primary care providers?

300

Provider-directed medical practices oversee all specialty care, hospital, home health care, and community services.

What is Coordinated Care?

300

Physicians who diagnose, prescribe, and treat mental, behavioral, and emotional disorders.

What is a Psychiatrist?

300

LDCT is recommended for adults ages 50-80 who have smoked for 20 20-pack-year history or recently quit within the last 15 years.

What is a Lung Cancer Screening?

300

Housing for older adults or disabled individuals that provides nursing care, housekeeping, and preparing meals as needed. Patients must be able to partially care for themselves.

What is assistive living?

400
Examples are medical assistants and administrative staff members.

What are support staff?

400

Having open scheduling, extended hours, and communication portals available to the patient.

What is Accessible Services?

400

Work with patients experiencing mental health challenges.

What is a Psychologist?

400

Recommended for osteoporosis and postmenopausal patients younger than 65 years. 

What is a Bone Density Screening?

400

Offer services for individuals who can no longer perform basic daily living activities independently.

What is long-term care?

500

This role helps patients with chronic conditions.

What are nurse case managers?

500

This includes delivering quality health care.

What are Quality and Safety Commitments?

500

Work with patients and families in times of transition or crisis.

What is a Social Worker?

500

Recommended for patients over 40 years old. Risk factors include diabetes or history of glaucoma.

What is a Dilated Eye Examination?

500

Provide programs to promote health and overall well-being in the community.

What are community health programs?

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