Patient Centered Medical Home Collaborative History

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The Greater Richmond Patient Centered Medical Home Collaborative was launched in the Fall of 2009 by the Richmond Memorial Health Foundation (RMHF) for two primary reasons: (1) core principles of the Patient Centered Medical Home Model of Care are aligned with recommendations published in the 2007 report: Bridging the Healthcare Gap: A Community Health Services Plan for the Greater Richmond Region; and (2) the Patient Centered Medical Home Model of Care (PCMH) has significant potential to improve the quality of healthcare for safety net patients in the greater Richmond region. The Greater Richmond Patient Centered Medical Home Collaborative (PCMH Collaborative) supports organizational and systemic capacity building across the safety net setting.

The PCMH Collaborative meets monthly to learn, to develop tools needed to implement the PCMH Model of Care, and to pursue collaboratively defined objectives to strengthen their organizations at the clinic level while strategically planning and integrating system-wide processes into the region’s safety net system. In addition, PCMH Collaborative members participate in teleconferences, webinars, peer learning activities, coaching, networking and web-based support. PCMH Collaborative members compile and share over breakthroughs, articles, data, and tools that advance implementation of the PCMH Model of Care to ensure that patients receive the right care at the right time.

Patient Centered Medical Home Collaborative members are committed to achieving Patient Centered Medical Home (PCMH) Recognition by the National Committee for Quality Assurance (NCQA). There are three levels of NCQA PCMH Recognition; each level reflects the degree to which a practice meets the requirements of the elements and factors comprising the standards. Each member has chosen a recognition level appropriate for its organization and scope of service.

Under the Patient Protection and Affordable Care Act (ACA), safety net providers may experience newly insured patients entering the healthcare system while continuing to serve those who do not qualify for health insurance. The Patient Centered Medical Home Model of Care is recognized as one way to increase community capacity to meet this need and to improve the quality of care. Accordingly, PCMH Collaborative members maintain organizational patient population/service profiles to identify how their patient population may be affected by health reform implementation.

The PCMH Model of Care, as a part of health reform legislation, is still evolving nationally as more healthcare providers and systems test and evaluate the Model. There is a risk that the model may be too demanding for some local safety net providers let alone private practices or health systems. There is also a risk that the model may not deliver all of the benefits its advocates profess.

Other patient centered medical home initiatives have been started across the country. Foundation Staff and Community Health Solutions are monitoring initiatives comparable to the PCMH Collaborative and are finding similar challenges, including unmet care coordination demands, workforce shortages, accessing referral to specialty care, increasing demand for services, limited health information technology, Patient Centered Medical Home Recognition challenges, and ongoing financial constraints. A common thread is emerging – transformation to the PCMH Model of Care is hard but attainable.

Through financial, social and intellectual investments, RMHF strives to change the conversation among safety net providers as these organizations address other funders about service delivery and the quality of patient care provided. The PCMH Collaborative is redefining the lens through which RMHF makes responsive grant investments. Safety net providers and other organizations working with the safety net consider the PCMH Collaborative work and priorities when developing funding proposals to RMHF.

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