Patient Centered Medical Home

A Patient-Centered Medical Home is a model of care designed to provide the patient with a Physician led Care Team that emphasizes coordination, communication and evidence based care resulting in an improved patient experience and outcome.

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  • Services Offered
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Patient Centered Medical Home sealMedical homes can lead to higher quality and lower costs, and can improve patients’ and providers’ experience of care.

NCQA Patient-Centered Medical Home (PCMH) Recognition is the most widely-used way to transform primary care practices into medical homes.

NCQA is a private, non-profit organization dedicated to improving health care quality.

Services Offered
  • Evidence based care provided by your personal Physician and Care Team
  • Same day appointment scheduling for urgent and routine care
  • Timely response to your medical questions by phone or the MyChart patient portal
  • Referrals to Specialty Care Physicians
  • Care Coordination after hospitalization/care transition
  • Community resource referrals
  • Wellness visit reminders for Preventive Care and Screenings
  • Behavioral Health Consultations to help you identify and address barriers preventing you from reaching your health improvement goals
  • Chronic Care Management with Personal Care Manager
    • Long term disease management, education and monitoring
    • Self management tracking and counseling
    • Self directed goal setting, attainment strategies and support
    • Medication adherence, monitoring and education