Patient-Centered Medical Home

Sapphire Community Health has been recognized by the National Committee for Quality Assurance (NCQA) as a Patient-Centered Medical Home. The NCQA PCMH standards emphasize the use of systematic, patient-centered, coordinated care that supports access, communication, and patient involvement.

What does that mean for you as a patient? It means that our provider-led care teams deliver comprehensive, coordinated, accessible, evidence-based care and self-management support.

1. Comprehensive Care

As a patient-centered medical home we provide for a large majority of each patients each patient’s physical and mental health care needs, including prevention and wellness, acute care, and chronic care. Providing comprehensive care requires a team of care providers. This team might include physicians, advanced practice nurses, physician assistants, nurses, nutritionists, social workers,  and care coordinators. We bring together large and diverse teams of care providers to meet the needs of our patients.

2. Patient-Centered

The primary care medical home provides health care that is relationship- based with an orientation toward the whole person. Partnering with patients and their families requires understanding and respecting each patient’s unique needs, culture, values, and preferences. The medical home practice actively supports patients in learning to manage and organize their own care at the level the patient chooses. Recognizing that patients and families are core members of the care team, medical home practices ensure that they are fully informed partners in establishing care plans.

3. Coordinated Care

The primary care medical home coordinates care across all elements of the broader health care system, including specialty care, hospitals, home health care, and community services and supports. Such coordination is particularly critical during transitions between sites of care, such as when patients are being discharged from the hospital. Medical home practices also excel at building clear and open communication among patients and families, the medical home, and members of the broader care team.

4. Accessible Services

The primary care medical home delivers accessible services with shorter waiting times for urgent needs, enhanced in-person hours, around-the-clock telephone or electronic access to a member of the care team, and alternative methods of communication such as email and telephone care. The medical home practice is responsive to patients’ preferences regarding access.

5. Quality and Safety

The primary care medical home demonstrates a commitment to quality and quality improvement by ongoing engagement in activities such as using evidence-based medicine and clinical decision-support tools to guide shared decision making with patients and families, engaging in performance measurement and improvement, measuring and responding to patient experiences and patient satisfaction, and practicing population health management. Sharing robust quality and safety data and improvement activities publicly is also an important marker of a system-level commitment to quality.