“Let’s face it, our pitch deck is the same as everyone else’s. We’re all using the same talking points. But what we do is different. The roles are different. The sites of care are different. The engagement model is different. The time spent with patients is different… It is funny, if we have one complaint from our patients, it is that they see and hear from CareMore staff too much.”
CareMore Health is an integrated health plan and care delivery system for Medicare and Medicaid patients. It was founded in Downey, California in 1993 and has since grown to serve over 130,000 patients in 8 states (Arizona, California, Connecticut, Georgia, Iowa, Nevada, Tennessee, and Virginia).1
As a Medicare Advantage plan and delivery system, CareMore is a pre-paid health care system, which means it receives an overall payment from the government for the expected costs of its beneficiaries (a prospective capitated plan), rather than fee-for-service. This allows it to use financial resources more creatively, because if it provides care more efficiently and keeps patients healthier than predetermined benchmarks, then it gets to keep the difference. The plan is required to meet quality standards and cover all traditional Medicare service to ensure it does not “skimp” on care.
CareMore primarily concentrates on identifying high-risk patients and providing them with coordinated services. They provide “high-touch” care for their most frail or chronically ill patients, and include supplemental benefits that most insurance programs would not typically cover, such as transportation (via Lyft) to its Care Centers.2
Every CareMore enrollee has an initial visit with a multidisciplinary team of clinicians – doctors, nurse practitioners, dietitians, social workers, and behavioral health specialists – who collaborate to personalize a plan for the specific medical and social needs of each patient. Everything from nutritional counseling to membership in one of their senior-focused gyms, called “Nifty After Fifty,” can be tailored to those needs “with the express goal of keeping patients out of the hospital.”3
Adapted with permission from the Commonwealth Fund4
In a 2017 article in the New York Times, Sachin H. Jain, president of CareMore, said: “In hospitals, we’re great at customizing care. We have different intensities for patients with different needs: an observation unit, a general medical ward, an intensive care unit. But on the outpatient side, we haven’t done that. In your average clinic, all patients get scheduled for 15 or 30 minutes, regardless of whether their problem list is empty or 10 pages long. Our model tries to fix that.”3 A 2017 Commonwealth Fund case study described the key features of CareMore’s approach as:
CareMore’s Care Centers function somewhat similarly to an integrated practice unit, in that teams work together to ensure coordinated care, focused on outcomes, and following detailed care protocols. The care team tracks care plans together using whiteboards and regularly reviews their most high-risk patients on a “war board” in the clinic center where the entire center team – case manager, doctors, social workers, house call team, behavioral health – review the cases together at least monthly and actively manage their care plans to try and keep these patients healthy and out of the hospital.4
They have also created the role of “extensivists” – internists who primarily care for patients in the hospital but then also care for the most vulnerable and complex patients before, during, and following hospitalizations. They care for 6-8 patients per day in the hospital, in skilled nursing facilities, or at Care Centers.3 This ensures continuity of care for these patients with complicated medical and psychosocial issues. The extensivists work hand-in-hand with case managers and care coordinators who develop plans of care and facilitates communication with patients, their families, and other clinicians.
In 2015, CareMore had 20% fewer hospitalizations, 23% fewer bed days, and 4% shorter length-of-stay than beneficiaries covered under fee-for-service Medicare.3
