CareMore is a health care delivery system and health plan headquartered in Southern California with operations in eight states including Arizona, California, Georgia, Iowa, Nevada, Ohio, Tennessee, and Virginia. It is division of Anthem, Inc (NYSE: ANTM). and has annual revenues of $1.2 Billion and serves over 150,000 patients. CareMore integrates both payment of health care, as well as the delivery of care and focuses on management of chronic disease and frail, high-risk patients. It has been regarded by United States health policy experts as one of the most innovative models to reform Medicare and the care of senior populations.
History and Philosophy of Care
CareMore was initially a medical group founded in 1991 by Sheldon Zinberg, a gastroenterologist and professor of medicine at the University of California, Irvine. Zinberg believed that care delivered to frail senior patients with multiple chronic diseases was poorly coordinated and ineffectively delivered. The name CareMore was chosen because Zinberg believed that it embodies a philosophy that inspires proactive care and a caring touch. He and his colleagues built a philosophy of care that includes: 1) a willingness to thoughtful challenge the status quo; 2) equal attention to medical, social, and psychological needs of the patient; 3) obsessive attention to detail, 4) an explicit approach to care delivery for each chronic condition, 4) the selection and development of clinicians in key roles as confident generalists; and 5) a total system of care view that takes on the perspective of the patient and clinicians. From this philosophy evolved several processes and innovations to better manage the care of patients.
Notably, CareMore began using employed physician hospitalists in the mid-1990s, but expanded their role to include the treatment of patients outside the hospital. Known as "extensivists" and supported by sophisticated information technology systems, these physicians generally split their time between the hospital, where they round on a small group of members each day, and an outpatient clinic, where they see recently discharged and other members at high risk of admission. Once or twice a week, these physicians also see members in skilled nursing facilities. The program reduced readmission rates and has led to lower length of stay and below-average inpatient utilization in a high-acuity population.
CareMore also operates neighborhood-based care centers that act as supplementary extensions of the patient's primary care physician offices. The care centers provide 14 chronic disease management programs careful tailored for senior populations. The care centers are explicitly located in the communities in which patients reside to enhance access and support frequent visits. Programs exist for chronic kidney disease and end state renal disease; congestive heart failure; coronary artery disease; chronic obstructive pulmonary disease; diabetes; and medical management. There is explicit focus on secondary prevention and patients undergo Healthy Start upon joining CareMore to better understand their prevention needs. There is also a wound care clinic; virtual home monitoring for high risk patients; nutrition counseling; and foot care. Risk event prevention is delivered in the form of a fall-prevention program; anticoagulation clinic; and pre-operative management clinic. Social workers and mental health professionals are embedded to provide added social and behavioral health support to patients. For particularly high-risk patients, CareMore provides significant at-home services. CareMore's Touch program is focused on institutionalized patients; in this case, CareMore assumes responsibility for the primary care of patients and often provides multiple weekly visits to keep patients out of acute care settings. CareMore's neighborhood based care centers are considered an alternative to the primary care medical because it minimizes the burden of primary care practices to transform themselves and instead offers multiple important services as extensions of the primary care practice that they would otherwise be unable to deliver.
Nifty After Fifty Physical Fitness Facilities
CareMore provides its members access to senior-focused exercise facilities usually called "Nifty After Fifty" or "Encore Wellness." These facilities provide patients with age-appropriate physical fitness equipment, physical therapy, training, and classes. The centers also provide seniors with an opportunity to socialize with one other as it was felt that one of the important health care risk factors for seniors is loneliness and social isolation.
In many markets, CareMore provides its patients with transportation services to minimize barriers to care for patients.
Evolution into a Health Plan
CareMore Medical Group initially provided services to health plans as a capitated medical group, but eventually launched their own health plan to support the further evolution of the delivery model to focus more on frail elders. In 2006, a group led by Alan Hoops, Leeba Lessin, and John Kao and funded by JP Morgan's CCMP Capital acquired CareMore with the intent of refining and expanding the model of care as a Medicare Advantage plan. Hoops and colleagues led the successful expansion of CareMore to Arizona and Nevada and grew CareMore 15% annually. In 2011, Anthem acquired CareMore from CCMP Capital. Anthem acquired CareMore to strengthen its foothold in Southern California and also to prepare the company for the coming wave of value-based care. Anthem's then-CEO Angela Braly noted, “CareMore [is] a perfect strategic fit with the direction in which we’re moving our company. We have been focused on delivering greater health-care value, and finding ways to put the patient in the center of the system … That’s the entire focus of the CareMore model.”
Executive Leadership CareMore's Chief Executive Officer is Leeba Lessin. Lesson was a member of the senior executive team at PacificCare and was part of the group funded by CCMP Capital that led the acquisition from Zinberg. Lesson has built on Zinberg's legacy and has been a leading voice in the national health care delivery reform discussion. She has asserted that 35% of health care costs for the chronically ill care be avoided; benefit design should lead with patient access and compliance considerations, not actuarial risk considerations; and prepayment (capitation) is freedom, not risk. CareMore's Chief Medical Officer is Sachin H. Jain. Jain, a Harvard-trained internist, was part of the federal teams implementing the HITECH and Affordable Care Acts, and was also Chief Innovation Officer at Merck and Company. He joined the company in early 2015 and has participated in the expansion of CareMore model of care from Medicare to Medicaid.
- "Medical "Extensivists" Care for High-Acuity Patients Across Settings, Leading to Reduced Hospital Use". INNOVATIONS EXCHANGE - Innovations and Tools to Improve Quality and Reduce Disparities. Agency for Healthcare Research and Quality (AHRQ). December 18, 2013. Retrieved 2014-05-29.
- LATTMAN, PETER (June 8, 2011). "WellPoint to Buy CareMore for $800 Million". DealB%k. New York Times. Retrieved 2014-05-29.
- Blesch, Gregg (August 22, 2011). "WellPoint completes CareMore acquisition". OUR SOLUTIONS POWER HEALTH CARE. Modern Healthcare. Retrieved 2014-05-29. External link in
- Official website
- Article on CareMore's History
- Wellpoint press announcement, acquisition of CareMore
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