PeaceHealth’s Team Fillingame Uses Patient Activation Measure to Customize the Medical Home


Lisel Blash, Catherine Dower, Susan A. Chapman

May 2011

PeaceHealth Medical Group received a grant to pilot a patient-centered medical home in one of its practices in Eugene, Oregon. “Team Fillingame” revised staff roles and added a part-time mental health worker to address patients’ social, behavioral and medical needs. Using a patient activation measure (PAM), the team tailors and coordinates patient care to fit patients’ level of activation and acuity. Cross-trained medical office assistants play a key role in providing health coaching, protocol-based supervised phone triage, and pre-visit planning.

This 2014 summary updates the original 2011 case study with new information on staffing, clinical outcomes, reimbursement, and more.

Innovative Workforce Models of Health Care is a series of case studies showcasing primary care practices that are expanding the roles of medical assistants and other frontline workers in innovative ways. The organizations selected are implementing practice models that improve organizational viability and quality of care for patients while providing career development opportunities to frontline employees. This research is supported by the The Hitachi Foundation.