Care More. It’s What They Do.

As healthcare moves from a volume to value-based model, CareMore is striving to do more with less.

The system is broken. They’re fixing it.

Quality of care is the name of the game, and the players in our fragmented healthcare system are increasingly focused on improving coordinated care across all settings in order to meet this goal. Among healthcare organizations, CareMore, a California-based Medicare healthcare company, is making population health management work. Acquired by WellPoint, one of the nation’s largest health insurers for $800 million in 2011, CareMore’s business and operating models converge in a novel care delivery model that aligns incentives within capitation plans.

Across the spectrum from preventive health to management of complex, chronic disease, CareMore accomplishes the goal of reducing costs of high quality care for the aging population via coordinated operations of human capital:

  • Education and Behavioral Health Experts – Enrolled patients benefit from support groups, nutritional education, and counseling. Because CareMore bears the cost of total medical care, they are incentivized to invest in and provide prevention programs with the goal of curbing the progression of chronic diseases and their downstream costly interventions such as dialysis.
  • Extensivists – Physicians who provide continuous support during and following hospitalizations redefine the process flow of inpatient care by shortening the length of stay in the hospital and minimizing information hand-offs and the potential for medical error or inadequate follow-up.
  • Specialists – High-cost specialist care is reserved for when it is truly necessary in order to limit redundancy and confusion for patients.
  • Drivers – Low-cost investments in providing transportation for patients to and from the center limits missed appointments and the need for hospital visits.

The benefits of these changes are already evident, with CareMore’s rates of patients requiring rehospitalization within 30 days down to 12% compared to the national average of 20%. Less time in the hospital translates to higher quality of life for patients and profits that can be reinvested in preventive measures.

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Opening the Doors of Innovation and Communication

In an ecosystem dominated by payer-provider negotiations, CareMore reduces friction by integrating both roles. According to CareMore Chief Medial Officer, Sachin Jain, “Our edge comes from the fact that we are the payer and provider for our patients. Rather than waiting to find out whether insurance companies will pay for a new program designed for diabetic patients, we can roll it out on our own timeline and terms.”

By doing this, CareMore has control over quality and efficiency of program activities. Moreover, their customized electronic health record both facilitates communication between CareMore members and community providers and enables CareMore to collect data on their own patients for more immediate and rigorous evidence-based feedback on the efficacy of their innovations and where there is a need for improvement.

Smart Expansion

CareMore is looking to capitalize on a growing trend in which people are increasingly buying healthcare based on value. This market is expected to grow from $232 billion to $3.7 trillion by 2025, and CareMore’s approach to expansion further demonstrates alignment of its business model and operations. So far, CareMore has expanded to provide the Medicare Advantage plan to its members across eight states. CareMore develops centers in regions with considerable interhospital competition where they can better function in a climate conducive to payment negotiations. Resource allocation is then tailored to meet the new scope of patient demographics through educational program design and employee selection based on language needs and cultural competency.

CareMore recognizes its employees as its strongest asset and helps care providers maintain relationships with their patients over a longer period of time than a single episode of care. Recruitment efforts targeted at physicians motivated to work in a pay-for-performance environment and offer competitive compensation. Doctors derive increased satisfaction from work in which they are functioning at the top of their license, which translates into increased retention and an upward spiral of enhanced longitudinal relationships, patient satisfaction with their care, and investment in their personal health.

With these strategies in place, CareMore’s inventive alignment of business model and operations is positioned to meet the dual challenge of reducing costs while improving patient outcomes and quality of life.

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References:

An interview with CareMore Chief Medical Officer Sachin H. Jain, MD, MBA about CareMore’s future direction.

http://www.ajmc.com/journals/ajac/2015/2015-vol3-n2/lessons-from-caremore-a-stepping-stone-to-stronger-primary-care-of-frail-elderly-patients

http://content.healthaffairs.org/content/28/5/1317.abstract

http://www.healthcare-informatics.com/article/caremore-has-found-winning-business-model-population-health-management

http://www.theatlantic.com/magazine/archive/2011/11/the-quiet-health-care-revolution/308667/

 

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5 thoughts on “Care More. It’s What They Do.

  1. That’s amazing what they’re managing to do.
    How do you think they can capitalize on their momentum, and gain wide awareness with a model like this one?

  2. While Insurance companies always being at loggerheads with patients is the statues quo, it is excellent that Care More has managed to break that divide and come up with a business model that provides aligned incentives for all the stakeholders. Cost efficiencies through preventive health care is a difficult business model, and I like how they have created alignment with operations by providing transportation, customized electronic records, support groups (which play a pivotal role in behavior change) and in-house monitoring of patients. But, is their focus on preventive health care a means to lowering cost, or is their focus a low cost health care model itself? If we remove the effects of deliberate cost cutting measures such as expanding only to areas where negotiation is possible, deliberately limiting specialist care etc, is their “cost reduction through prevention” alone sustainable on its own?

  3. Thank you for a really interesting post. Seems like a really interesting approach. I am excited about your primary research as well! Seems like the synergies from integration are really significant.

  4. I wonder what it will take to get other insurance companies to adopt this kind of model, which really is ideal. Do you think payor-provider integration is the key? And if so do you think that is necessarily a good trend?

  5. Interesting post! I wonder how this compares to Iora Health and some other payer provider coordination companies in the market. Definitely fascinating. I wonder how scalable this model is especially given the payor relationships is solely with Wellpoint.

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