Arkansas Center for Health Improvement

Patient-Centered Medical Home in Action: Focus on Team-Based Care

Primary care providers in our state are transitioning to a patient-centered medical home (PCMH) model of care delivery as part of an overall strategy to improve our health care system and to better manage the health of all Arkansans. One early adopter is the El Dorado multi-specialty practice, SAMA HealthCare Services. The staff at SAMA have made significant changes to their operating model to better coordinate patient care and improve work flow. With enhanced financial support through the multi-payer Comprehensive Primary Care Initiative (CPCI), SAMA has taken a creative, autonomous approach to meeting broad objectives for efficiency and quality.

By hiring additional support staff and, literally, tearing down walls, SAMA Administrator Pete Atkinson is now able to make real a vision he has shared with his colleagues for some time. 

“For years, we have wanted to create an environment in our clinic that promotes better team work and that is more focused on patient-centered care,” Atkinson said. “Many of the milestones in the CPCI are things that we were already doing, or working towards, but we did not have the necessary resources in place to make them work because of lack of funding.”

SAMA is home to four physicians, who with the help of their individual teams, may see 120–140 patients every day. Each physician-led team, or “pod,” at SAMA includes a combination of advance practice nurses (APNs), licensed practical nurses (LPNs), and care coordinators. 

This team-based approach has already helped increase access to care for SAMA patients. Atkinson and his staff have increased their number of same-day visits by closely monitoring staff schedules and facilitating collaboration between physicians and APNs. “I believe that pairing physicians with APNs provides a solution to many of the problems we face, especially in a rural community, continuity of care being the most important. It also increases the amount of same-day visits and strengthens the APNs’ clinical skills as they work side-by-side with a physician each day sharing a panel of patients,” Atkinson says. “Now almost no one is turned down for a same-day appointment.”

In transitioning to a PCMH model, part of the SAMA strategy includes helping patients feel comfortable relying on their entire care team and not just their primary care provider. According to Atkinson, SAMA physicians have helped educate patients about the role of APNs as physician extenders. “Patients see that the APN is on a physician’s team and directly working with him each day. This gives the patients peace of mind that the doctor is involved and the collaboration is real and not just on paper.”

Atkinson and the SAMA team have made positive changes that are working for their practice. While the PCMH journey is different for every practice, the goals of improved quality and efficiency remain the same. As the state’s health care practices transition to a more patient-centered model, each primary care practice in Arkansas has an opportunity to use up-front financial support and a thoughtful approach to reach these common goals. 


  • ACHI participation in the Arkansas Payment Improvement Initiative (link to Our Work – APII page)
  • Principles of Patient-Centered Medical Home Design for Arkansas (ACHI issue brief)
  • Arkansas Payment Improvement Initiative website:


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Arkansas Center for Health Improvement
1401 West Capitol
Suite 300 (Victory Building)
Little Rock, AR 72201