Patient Centered Medical Home Model

Coordinated Care is committed to supporting its network providers in achieving recognition as Patient Centered Medical Homes (PCMH) and will promote and facilitate the capacity of primary care practices to function as medical homes by using systematic, patient-centered and coordinated care management processes. In alignment with the vision of DHHS, it is de Coordinated Care goal to have all of its primary care providers recognized as a PCMH by an accrediting agency. Coordinated Care will support providers in obtaining either NCQA’s Physician Practice Connections®-Patient-Centered Medical Home (PPC®- PCMH) recognition or the Joint Commission’s Primary Care Medical Home Option for Ambulatory Care accreditation.

The purpose of the PCMH program is to promote and facilitate a medical home model of care that will provide better healthcare quality, improve self-management by members of their own care and reduce avoidable costs over time. Coordinated Care will actively partner with our providers, with community organizations, and groups representing our members to increase the numbers of providers who are recognized as PCMHs (or committed to becoming recognized) and who achieve the meaningful use of health information technology (HIT). 

Coordinated Care has dedicated resources to ensure its providers achieve the highest level of PCMH recognition with a technical support model that will include:

• Readiness survey of contracted providers
• Education on the process of becoming certified
• Resource tools and best practices.

From an information technology perspective, we will be offering several HIT applications for our network providers who are either recognized PCMH’s or are committed to becoming NCQA or Joint Commission accredited medical homes. Our secure Provider Portal offers tools that will help support PCMH accreditation elements. These tools include:

• Online Care Gap Notification
• Member Panel Roster including member detail information
• Trucare Service Plan
• Health Record
• Provider Overview Report

For more information on Patient Centered Medical Home recognition and best practice models visit the following web sites: 

• NCQA Patient Centered Medical Home Recognition Program
• Joint Commission PCMH Accreditation Program
• Primary Care Development Corporation
• National Center for Medical Home Implementation
• Understanding and Running a Patient-Centered Medical Home
• Patient-Centered Primary Care Collaborative

Health Home Provider Resources:

• Health Home Services Brochure
• Health Home Member Handbook