Patient Centered Medical Home Collaborative Model of Care

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The Greater Richmond Patient Centered Medical Home Model of Care is designed to improve health and health care by keeping patients at the center of the health care system.

Safety Net PCMH Model house

Safety Net Medical Home Model

The Patient Centered Medical Home Collaborative members are working together to implement an innovative model of care developed at the outset of the Patient Centered Medical Home Collaborative (PCMH Collaborative).  The model is based on the widely cited core principles of the Patient Centered Medical Home, adapted for the safety net setting.  The seven core principles of the model are illustrated in the graphic at right.

PCMH Collaborative members are putting the principles into practice by implementing specific standards of care as defined in the National Committee for Quality Assurance (NCQA), Patient Centered Medical Home Model of Care (PCMH).  The NCQA PCMH model is the most widely adopted approach to Patient Centered Medical Home development. It includes six standards and 27 elements which are listed in the table below.

To support their PCMH development, Collaborative members are utilizing a Toolkit developed and provided by Community Health Solutions. This PCMH Toolkit includes hundreds of documentation examples for recognition, pathways to Levels I and II recognition, and the PCMH Scoring Tool (used for both self-assessment and organizational management of the recognition process).

All six participating organizations are NCQA PCMH recognized. There are three levels of NCQA recognition, Level III being the highest. The level of recognition is determined by an organization’s performance on the 27 elements listed below. Each organization chooses a recognition goal (Level I, II, or III) appropriate to its infrastructure and patient population.

  • Capital Area Health Network: Level III Recognized
  • Cross Over Healthcare Ministry: Level II Recognized
  • The Daily Planet: Level III Recognized
  • Health Brigade (formerly Fan Free Clinic): Level II Recognized
  • Goochland Free Clinic and Family Services: Level II Recognized
  • Virginia League for Planned Parenthood: Level II Recognized

Browse the National Committee for Quality Assurance (NCQA) 2014 Standards, Elements, and Factors in the table below. Click here to view a one-page printable scoring summary.

Click here to load this Caspio Online Database.

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