Patient Centered Medical Home

Coordinated, Accessible, Patient-Centered Care

patientdoctorPatient-Centered Medical Home Our strong foundation in primary care and prevention has led to the successful redesign of our care sites to support the Patient-Centered Medical Home (PCMH) model. A significant achievement for our organization this year was obtaining NCQA recognition for 60 of our primary care clinics (representing 332 providers) as Patient-Centered Medical Homes (PCMH). Our PCMH care sites include senior centers, charity clinics, family medicine, internal medicine, and pediatrics.

Our PCMH model ensures that every patient who walks into one of our primary care sites is matched with a primary care physician. Our primary care physicians are the hub of all relevant care needs of the patient and manage a team of care coordinators and other non-physician providers that not only coordinate care within the walls of our clinics, but seamlessly transfer patients across multiple entities that may include community care, labs, specialists, and hospitals.

HealthTexas is among the top three medical groups in the nation to have the largest network of NCQA recognized patient centered medical homes. This tremendous accomplishment has been instrumental in laying a solid foundation for care coordination and population management throughout our clinics. It also prompted redesign efforts that have improved the patient experience, while at the same time incorporated key elements of managing patient populations
like: pre-visit planning, patient access, ambulatory care coordination, patient/family activation,
disease management, and preventive services.