SAMA HealthCare Services's Patient-Centered Medical Home
- Need: The traditional model where providers work independently from one another in treating patients proved to lack care continuity at SAMA Healthcare Services in rural Arkansas.
- Intervention: The family practice clinic shifted to a team-based model of care where the medical staff works together in pods in order to create a patient-centered medical home.
- Results: SAMA doubled the amount of patients seen in 1 day and at least 90% of patients receive medical treatment from a provider within their pod.
Up until 2012, SAMA
HealthCare Services of El Dorado, Arkansas operated
as a traditional clinic. Their healthcare providers
worked independently from one another, each having their
own patient caseload. SAMA's administration began
noticing that this encounter-based practice was affecting
the continuity of care among patients, especially when a
patient had to see a provider unfamiliar with their
medical history when the patient's primary provider was
In 2012, SAMA was one of 69 Arkansas medical facilities
that participated in the Health Care
Payment Improvement Initiative for the state of
Arkansas, a byproduct of the Center
for Medicare & Medicaid Innovation Model. This 4-year
demonstration project initiated SAMA's transition from a
primary care model to a
patient-centered medical home (PCMH), serving
patients through provider teamwork.
SAMA was able to hire additional staff and, instead of
continuing to function as individual providers, old and
new staff were put into teams, or "pods." Each of their 6
pods are made up of a leading physician and a combination
of advance practice nurses (APNs), licensed practical
care coordinators (CCs), and care managers (CMs). A
psychologist and a licensed professional counselor (LPC)
also assist each team in meeting patients' behavioral
Below are some practices that make the SAMA PCMH model
- Patients are assigned to a pod, allowing each pod
staff member to get to know their patient's health
- Particular responsibilities remain distinct among the
medical staff, but collaboration among all team members
takes place for each patient case.
- A patient's health information is shared among the
pod through a facility-wide electronic medical records
- Instead of reviewing the patient's health information
after their visit (as is common practice), the CC does so
prior to the visit to stay current on the patient's
- Each pod is associated with a color worn by every pod
staff member and painted on the walls of its correlating
nurses' stations and exam room.
An interview with SAMA's Administrator and developer
of the pod system, Pete Atkinson.
As the largest primary care physician group in South
Central Arkansas, SAMA offers a multitude of services,
- Care management
- Behavioral health
- Clinic pharmacy attached to waiting room
- Radiology, including CT and MRI, and ultrasound.
Results received within an average of 1 hour
- Echocardiogram studies
- Bone mass density testing
- Mole and lesion removal
- Certified diabetic education and treatment
- Full service lab
By operating in this PCMH model, SAMA has doubled the
amount of patients seen at the clinic in just 18 months.
Overall, their continuity of care has helped to keep
patients seen within their pod more than 90% of the time.
In order to measure their progress, SAMA administration
regularly monitors how their results compare to the state
and national averages.
- In 2016, 78% of SAMA's diabetic patients received
potentially limb-saving foot exams, an increase from 56%
the previous year.
- Open seven days a week with a provider on call 24/7
every day of the year, SAMA's on-site services prevented
an estimated 880 emergency room visits, saving $2.6
- The percent of patients with poorly controlled
diabetes dropped from 19% in 2014 to 15% in 2015,
compared to a national average of 30%.
- The number of breast cancer and colorectal cancer
screenings was significantly higher than the Arkansas and
In 2016, SAMA Healthcare Services joined Aledade Arkansas, a primary
care physician-led Accountable Care Organization. They
were also accepted into
Arkansas's statewide market of the Comprehensive Primary
Care (CPC), a Centers for Medicare & Medicaid
Services initiative that fosters collaboration between
public and private healthcare payers to strengthen
Below are some publications that further describe SAMA's
SAMA reported that the largest barrier in implementing
this new model was the staff turnover after announcing
the new model. The required quick adjustment proved to be
hard on some staff who were unwilling to change. Other
barriers included the time it took to find and hire
qualified staff, as well as providing education on the
Since SAMA is an independent clinic, the administration
was free to design a structure that met their needs. The
pod model is a unique idea that was created by SAMA's
Administrator Pete Atkinson in order to better coordinate
patient care and improve work flow. The model can be
replicated by keeping these 3 things in mind:
- Persistence is key. Revamping an old system is not
easy, but it is worth it in the long run. Stick with the
plan in spite of hardships.
- In order to have the best team, be willing to give
ultimatums for staff members who are unwilling to conform
to the new system.
- Be fluid. Attempt new things and be open to changing
direction if they are unsuccessful.
December 22, 2015
Date updated or reviewed
February 8, 2018
Suggested citation: Rural Health Information Hub,
SAMA HealthCare Services's Patient-Centered Medical Home [online]. Rural Health Information Hub. Available at:
[Accessed 21 February 2024]
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