Slide 1
CareMoreInnovative Healthcare Delivery
PARTNERSHIP TO FIGHT CHRONIC DISEASE Wellpoint/caremore
washington dc - July 26, 2013
AgendaWelcome and Introductions
CareMore Who We Are
Understanding CareMores Model of Care
CareMore Care Centers
Question & Answer Session
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CareMore started over 20 years ago caring for seniors as a
Medical Group in Los Angeles, California. We were founded by a team
of physicians and continue to be guided by the ideas and direction
of physicians.
CareMore Who We Are
The name CareMore embodied the philosophy that inspired a
proactive model of care with a caring touch and a focus on
wellness. Years later, CareMore began serving Medicare seniors as a
Health Plan and continues to do so today through innovation of
healthcare programs, technology, and strong provider partnerships.
CareMore is solely dedicated to the Medicare market in California,
Nevada, Arizona, Virginia and New York. 3
1993 2009 2010 2011 2011WellPointAcquires CareMore Health
PlanCareMore TimelineCompany Expansion & Growth Highlights2002
CareMore establishes its Pre & Post Hospitalization Program
2008 2008 CareMore Expands to Santa Clara County2009 CareMore
Expands to Modesto, Pima, Clark County 2010 CareMore Expansion
Maricopa County 2002 1995 1995 Enrolled Medicare beneficiaries in
Southern CA 20012001CM obtains CMS contract to become a Health Plan
2006 2006CM begins offering a Chronic Care Special Needs Plan
(CSNP) (CA)1993 CareMore Medical Center founded by doctors (CA)
Key: CA = California VA = VirginiaCM = CareMore NY = New YorkCMS
= Centers for Medicare and Medicaid ServicesCSNP = Chronic Special
Needs PlansNV = Nevada2011 CareMore Expansion Riverside County 2012
2013 2012 Care Center ExpansionsDowntown LA, CATorrance, CACorona,
CAUpland, CAPleasanton, CA2013 WellPoint - CareMore East
ExpansionsRichmond, VA(Richmond City, Henrico, Chesterfield
Counties)Brooklyn, NY(Kings County)4
4Before you begin: To do the practice sessions for this course,
you'll need to have Microsoft Office Excel 2003 installed on your
computer.[Note to trainer: For detailed help in customizing this
template, see the very last slide. Also, look for additional lesson
text in the notes pane of some slides.]
PFCD StatisticsPartnership to Fight Chronic Disease, April 2013
White PaperTwo out of three Medicare beneficiaries, including those
covered by Medicaid, have more than one chronic condition. More
than half in Medicare have five or more chronic conditions reducing
the quality of life for seniors and driving healthcare costs up
significantly.Centers for Medicare and Medicaid Services, Chronic
Conditions Among Medicare Beneficiaries, Chart book: 2012 Edition,
2013
Almost $2 out of $3 spent on healthcare in the U.S. is directed
toward care for the 27% of Americans with multiple conditions.G.
Anderson, Chronic Care Making the Case for Ongoing Care, Robert
Wood Johnson Foundation, 2010 5
PHCD Statistics continuedPartnership to Fight Chronic Disease,
April 2013 White PaperThese statistics are startling. Yet, despite
the high prevalence of multiple chronic conditions, their
devastating health impact and the cost implications, there is a
notable lack of medical research on how to effectively prevent and
manage multiple chronic conditions. This leaves patients, family
caregivers, and health care providers with insufficient information
on which to base important health care decisions. Within the
current base of medical evidence and, as a result, in the breadth
of health care practice in the U.S., there is an unfortunate
disconnect between focusing on the individual patient and focusing
on the individual disease. D Campbell-Scherer, Multimorbidity: A
Challenge for Evidence-based Medicine, Evidence-Based Med 2010;
15(60):165-66.6
Disjointed Healthcare SystemThe existing health care delivery
model is disjointed and inefficient and ultimately fails to achieve
the proper measurements of prevention, coordination of care, and
the management of chronic illnesses for the frail and
unhealthy.
Patients with serious conditions see an average of 11 different
doctors which may result in lack of coordination of care and at
times unnecessary multiple medications being prescribed.
This leads to poorly managed and redundant care which in turn
increases cost and death rate.
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CareMore MissionProvide a focused, proactive and innovative
healthcare approach to counter the complex problems of the
healthcare system and support the needs of the frail and unhealthy
seniors.
Serve our members, caregivers and family by providing support,
education, and access to services to prolong an active and
independent life.
Protect precious financial resources of seniors and the Medicare
Program through innovative methods of managing chronic disease,
frailty and end of life.
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CareMore Model
9PCPSpecialistsHospitalUrgent Care/ERSNF
(Contracted)
The Triangular RelationshipPatient/MemberCare
CenterExtensivistNurse PractitionerMedical Assistants
TechniciansPrograms/ServicesNAF
(Employed)Communication
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The CareMore Model Close monitoring of non-frail members to
proactively identify at-risk members
Intensive hospitalist management of frail members (approximately
20% of members) that account for 60% of medical costs
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Non-Frail PopulationPrimary
CarePhysiciansMemberServicesContinuous FrailtyAssessment ToolsCare
CentersHospitalistsProviderRelationsFrail
PopulationCareMoreExtensivistsCareMore Care CentersPrimary Care
PhysiciansSpecialistsMemberServicesCaseManagers
CareMore Integrated Patient Care Delivery System12
PredictivemodelingIntegrated IT infrastructureLongitudinal
patient recordPoint-of-care decision supportEvidence-based
protocolsExtensivist ManagementStrength
TrainingFallCoumadinExerciseFoot
careNutritionistMonitoringDiabetesESRDCOPDCADCHFPalliative
CareHospiceMental HealthSocial WorkersPre-OpCase Manager/
NPExtensivistClinicalCare Centers(CCC)PCPEnd of Life CareSocial /
Behavioral SupportSecondary PreventionRisk Event PreventionChronic
Disease SupportFrailty Support
Healthy StartWound Clinic
The Results They WorkClinical OutcomesAverage HgBA1C =
7.08Amputation rates 78% less than national averageESRD
Hospitalizations 48% less than national average30 day readmission
rates 13.6% vs. 20% MedicareHospital ALOS = 3.0 days
13 CareMore Care Centers (CCCs)
14Care Center - Neighborhood/Community15
Social EnvironmentClinical SupportDesigned for seniors and
disabled individualsResource for family and caregiversFrequent
classes and activities to promote engagementPhysician and NP
support of chronic and frailty careWound carePhysical therapy and
strength trainingCardiac/pulmonary rehabNutritional
trainingDisease-specific group sessionsHealthy StartServes as an
anchor to a neighborhood4,000 square feet of clinical and 1,500 of
therapy spaceSupport 5,000 patientsLocated in the heart of the
neighborhoodTypical staffing includes MDs, NPs, MAs, podiatrist,
PT, nutritionist, psychologist, case managers, social workersCare
Center Facts
CareMore Neighborhood Care Centers
Nurse Practitioners Disease Management programs are the main
function of the CCC.
Extensivists Pre-Op, Post-hospital, and most frail patients.
Office Manager Keeps office running smoothly by monitoring wait
times and customer care provided by staff.
Our Friendly, Dedicated Staff17
Medical Assistants Assist patients while in CCC and helps with
coordination of care by submitting referrals ordered by
clinicians.
Case Management Teams Case management teams assist frail and
high risk patients by coordinating care between hospitals, skilled
nursing facilities and CCC to ensure they receive proper follow-up.
(CCC based) Specialist Many CCCs have mental health, podiatry, and
dermatologists in order to better serve our patients in the
neighborhood.
Our Friendly, Dedicated Staff, cont.18
CCC Environment
Safe and comfortable clean environment
Low glare surfaces
Modern clinical exam and consultation rooms with chairs
CareMore Care Centers - Programs
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Care Center ProgramsDiabetes ManagementWound Clinic
ProgramRoutine Podiatry Program Smoking Cessation
ProgramNutritional CounselingAnti Coagulation ProgramFall
Prevention ProgramHypertension ProgramCongestive Heart Failure
(CHF) ProgramChronic Kidney Disease (CKD) ProgramChronic
Obstruction Pulmonary Disease (COPD) ProgramEnd Stage Renal Disease
(ESRD) Program 21
Goal: Complete within the first 30 days of membership Healthy
Start Program
Comprehensive head-to-toe medical assessment On-site, same day
lab results Personalized Care Plan (Developed) Referrals for
Appropriate Treatment Plan
Review their medications22
Exercise & Strength Training Programs
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Nifty After FiftyUsually within the CCC or close by to offer
strength training, physical fitness, and social interaction.
CareMore offers members access to several facilities that
provide a supervised strength-training program for mature
adults.
We have partnered with Nifty after Fifty* locations thatoffer a
staff of highly trained specialists who have developed specific
treatment programs.
Nifty After FiftyPrograms specifically designed with a wide
variety of orthopedic and neurological conditions to proactively
reverse reduced muscle strength and mass that is common in mature
adults.
State-of-the-Art workout equipment with senior-minded
technology. Air compressed machines.
Convenient adjustable settings to provide comfort.
Easy to read digital boards to help monitor current workout with
built in tracking mechanism for future progress.
CareMore Care Centers The Results
CareMore A Day In The Life CareMore has approximately 76,000
members now enrolled with CareMore.
CareMore serves 76,000 members through our 41 Care Centers.
Today we will see 930 patients in the Care Centers for follow-up
and chronic care management
Today we provide more than 2,875 rides to patients to and from
points of care
Today we will make or receive 115 phone calls arranging Healthy
Start/Healthy Journey appointments
Today we make 85 post-discharge calls to our members
Today we see more than 76 new members to assess health, arrange
care programs and document personal care plans
Today we visit 30 homes to provide care or social support
Today we will engage 8 families in end-of-life/hospice
planning
Today we provide 1006 strength and exercise training
sessions
Today we fill 6,450 prescriptions
CareMore A Day In The Life continued Today we will make 300 care
visits to patients residing in nursing homes/assisted living
facilities
Today we will read 1165 blood pressures from monitors in the
homes of hypertensive patients
Today we will read 1125 weights from monitors in the homes of
chronic heart failure patients
Today we will see 105 behavioral visits, largely for
depression
Today 765 patients are monitored by a nurse practitioner.
Today 158 visits for routine Podiatry services at the CCC.
Today 80 visits to see a Podiatrist for medical services.
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CareMore ContactsAdmin Offices at Robious Road CCC 10030 Robious
Road, Richmond, VA 23235, 804-212-3450Dr. Michael Neiderer, D.O.
Regional Medical Officer [email protected] Linda Larue,
CPA, MS General Manager, Virginia [email protected] Tammy
Cauthorne-Burnette, MSN, FNP-BC, CLNC, WCC Nurse practitioner -
Richmond [email protected]
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Questions and Answers
