Dr. Pano Yeracaris is the newly installed co-director of Rhode Island Chronic Care Sustainability Initiative, the patient-centered medical home initiative in Rhode Island. He has more than 30 years of medical practice and leadership experience and most recently served for nearly nine years as vice president and chief medical officer at Network Health, a Massachusetts-based Managed Medicaid Organization. He also played a substantive role in supporting the Massachusetts Patient-Centered Medical Home Initiative for which he served on the steering committee and co-chaired the Shared Savings and Reporting Work Group. He is board certified in family medicine and is a clinical instructor at Harvard Medical School.
PBN: Non-experts struggle to deal with some of the terminology in health care. What is a patient-centered medical home?
YERACARIS: At its most basic, a patient-centered medical home is a primary-care practice that brings together a care team centered on each patient’s unique needs, and will change just as a patient’s health care needs change. A patient with diabetes, for instance, might have a nurse care manager on the team to focus on strategies to help improve the patient’s diabetic numbers.
A PCMH primary-care practice adopts innovative approaches to patient care and new strategies to improve day-to-day practice efficiency. Focused on team-based, comprehensive and preventative care, PCMHs utilize tools, strategies and incentives to improve the quality of care, the patient experience and decrease costs. Tools such as electronic medical records and patient portals, for example, are used to enhance communication between patients and providers.
Rhode Island, one of the first states to adopt the PCMH model, is viewed as a leader in this national primary-care movement. We were one of the first states to get nearly all payers, like the four major health insurance plans, committed to this model.
Efforts to implement the PCMH model of care are led by the Rhode Island Chronic Care Sustainability Initiative, which now includes 36 primary care practices with 48 sites, and 303 physicians across the state.
PBN: What is the best part of your new role at CSI-RI?
YERACARIS: I have been incredibly impressed with the strong foundation that has been built at CSI-RI. We’ve recently launched a new integrated behavioral health committee and have seen an impressive commitment to expand communication and collaboration between primary care and behavioral health providers. Additionally, CSI-RI is working to build two pilot community health teams in South County and Pawtucket/Central Falls to expand coordination to community-based services for high-risk patients.
The best part of being co-director is being able to contribute to this exciting project. In many ways, my work with CSI-RI is a culmination of my 30-year career focused on primary care and health system transformation.
PBN: As of March 2014, there are 220,000 Rhode Islanders that have a PCMH. Where would you like to see that number a year from now? Five years from now?
YERACARIS: What started out in 2008 as a five-practice pilot program has grown to include 48 practice sites serving Rhode Islanders from Woonsocket down to Charlestown. In 2013, CSI-RI committed to expanding over a five-year period by adding approximately 20 practices each year, with the ultimate goal of providing over 500,000 Rhode Islanders access to a PCMH.
Last year, we welcomed 20 additional practices with 32 sites to CSI-RI, and this year, hope to add another group of practices.
PBN: HealthSource RI offers a health insurance plan with lower co-pays for patients who visit a PCMH versus those using a non-PCMH primary care practice. What other kinds of incentives exist to spur the transition to PCMHs, and what other kinds of incentives should be developed?
YERACARIS: Incentives for CSI-RI patient-centered medical homes exist for both patients and the practices. On the patient side, many Rhode Islanders benefit from extended office hours, more open scheduling and the overall efficiency of how a practice is run under the PCMH model. Many patients throughout the state were long-term patients at primary-care practices that underwent PCMH transformation just last year, and now note the many benefits they have experienced under the new model of care.
On the practice side, CSI-RI offers incentives to our practices that improve quality in seven key areas, including improved patient experience and reduction in inpatient and emergency department utilization. This has helped CSI-RI practices show positive results, such as consistently demonstrating increased quality and patient experience. South County CSI-RI practices, in collaboration with the South County Hospital, have demonstrated an impressive reduction in inpatient utilization.
The importance of assessing how to best expand our incentives to integrate behavioral health with primary care, add community health teams and include shared savings or other incentive alignments have been identified and prioritized by CSI-RI stakeholders, including the Office of the Health Insurance Commissioner, the Executive Office of Health and Human Services, participating health plans and our practices.
PBN: You continue to treat patients. Is your own practice part of a PCMH? If so, how has practicing within a PCMH changed how you deliver care?
YERACARIS: I practiced primary care for 13 years in a staff model HMO in Western New York (Health Care Plan) from 1984-1997. Along with many of the staff model HMOs of that time, we were working on ways to improve patient-centeredness, team-based care, and population health which became the foundation for the PCMH movement of today.
Over the last 16 years I have practiced primary care part time. The enhanced focus on team-based care, patient navigation, care coordination, care management, and expanded involvement of patients in decisions regarding their care have had a positive and profound effect on how care is delivered. There is still a long way to go. I believe there is a strong business case to be made regarding the value of a continued increase in primary-care funding and connecting health system transformation to expanded community and population health initiatives in a way that holds practices, health plans, and state and local governments accountable.