Innovations in Reducing Cost & Improving Quality of Health Care

Donald S. Furman, M.D. ~ Chief Medical Advisor

CAREMORE “It’s what we do”.

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Opening Slide

Edward Deming“Improve constantly”“Build quality into the product”

Peter Drucker “Knowledge has to be improved, challenged

and increased constantly, or it vanishes”“ the best way to predict the future is to create

it”

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CAREMORE

20 percent of the Senior Population

utilizes 70-80 percent of the cost.

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CAREMORE

Five Chronic Diseases' make up the vast

majority of the 70-80 percent.

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CAREMORE

30-40 percent of health care spending in the

United States is waste.

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CAREMORE

Chronic Diseases’ can be managed, but usually are not.

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CAREMORE

CareMore began in 1993 as a Medical Group with enrolled Medicare beneficiaries. It became CareMore Health plan when it obtained a CMS contract in 2001 and began offering a chronic care Special Needs Plan (CSNP) in 2006.

Since inception, CareMore recognized that chronically ill and frail seniors received uncoordinated, often inadequate, and unnecessarily costly care from the existing “system.”

CareMore has become a healthcare management system that coordinates and integrates care for chronically ill and frail seniors. It has organized a system to effectively care for those 20 percent. CareMore recognized that the present legacy healthcare system does not work.

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CAREMORE

Medical, Social, Psychological,

Functional, Pharmaceutical

CARE ACROSS DISCIPLINES

FRAIL CARE MANAGEMENT

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CAREMORE

Care Across Sites Hospital Medical Office Home SNF ALF Custodial Under a Bridge

FRAIL CARE MANAGEMENT

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CAREMORE

78% fewer amputations in Medicare diabetics than the national average

OUTCOMES

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CAREMORE

25-30 percent fewer hospital admissions than the Medicare average

OUTCOMES ESRD

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13-14 percent all cause hospital readmission rate at 30 days

National average in Medicare is 20%We believe we are on the way to

doing much better

CAREMORE

READMISSIONS

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CAREMORE

Average HbA1c for those patients attending

the clinic is 7.01LDL – 100Effective control of Hypertension with

wireless remote BP monitoringRequirement for all diabetics with HbA1c

eight times to be evaluated in the diabetes clinic

DIABETES

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CAREMORE

No hemorrhagic complications in the last 5 years

ANTICOAGULATION CONTROL

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CAREMORE

Clinical review and customized/supervised strength and fitness programs have led to 89% decrease in falls and 80% decrease in fractures as compared to national CDC study

Health plan benefits are clinically directed so OTC’s like Calcium and Vitamin D are free

OUTCOMESFALLS & FRACTURES

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CAREMORE

No barriers to careCoordinated with the rest of the systemCare broaden to SNF’s custodial home and the

homeFamilies includedThird decrease psychiatric in admissions; 50%

decrease in psychiatric hospital length of stay

OUTCOMESMENTAL HEALTH

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CAREMORE

Extremely low disenrollment rate

High levels of provider satisfaction

Very low MLR

Benefits are usually best in the markets in which we participate

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CAREMORE

Comprehensive, Coordinated, Longitudinal care for the 20% of the members who are frail

Constant clinical vigilance and predictive modeling to identify those in the 80% who may be becoming frail

Wellness and preventative maintenance of the 80% who are not frail; supported by infrastructure and technology to prevent any gaps in needed service

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CAREMORE CAREMORE INTEGRATED PATIENT CARE DELIVERY SYSTEM

A Cohesive Center of GravityDiabetes and Wound Care

Program

Diabetes and Wound Care

Program

Dietary/Nutrition

Counseling

Dietary/Nutrition

Counseling

House Call Team

House Call Team

Strength and Balance Training

Strength and Balance Training

First Fall Program

First Fall Program Effective

SpecialistsEffective

Specialists

On-Site Diagnostic Lab

On-Site Diagnostic Lab

Community Resources

Community Resources

24-Hour Care Management

24-Hour Care ManagementSmoking

Cessation Program

Smoking Cessation Program

Senior Patients

Case Manager/

NP

Extensivist

ClinicalCare Centers

(CCC)

PCP

CHF ProgramCHF Program

CKD Management

CKD Management

COPD Management

COPD Management

Hypertension Management

Hypertension Management

Mental Health Program

Mental Health Program

Transportation Services

Transportation Services

Clinical Pharmacy Program

Clinical Pharmacy Program

Provider PortalProvider Portal

ESRD Management

ESRD Management

Co-Morbidity ManagementCo-Morbidity Management

Crisis Intervention

Team

Crisis Intervention

Team

Nifty After 50Nifty After 50

Palliative Care Team

Palliative Care Team

HospiceHospice

Clinical ITClinical IT

AnticoagulationProgram

AnticoagulationProgram

Pre-Op ClearancePre-Op

Clearance

HospitalHospital

Wireless Blood Pressure

Monitoring

Wireless Blood Pressure

MonitoringHealthy Start

ProgramHealthy Start

Program

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CAREMORE

CAREMORE SERVES 30,000 MEMBERS THROUGH 11 CARE CENTERS IN LOS ANGELES AND ORANGE COUNTY CALIFORNIA

ON AN AVERAGE BUSINESS DAY, CAREMORE… *Proprietary

Provides more than 900 rides to patients to and from points of care *Prepaid

Makes or receives 3,385 phone calls arranging for care *No outsourcing

Sees 40 new members to assess health and establish personal care plans.

Provides more than 950 hours of homemaker services for the frail

Visits 27 homes to provide care or social support

Engages 4 families in end-of-life/hospice planning

Makes 235 follow up calls to patients in care programs

Provides 191 strength training sessions

Makes 90 care visits to patients residing in nursing homes/assisted living

Reads 567 blood pressures from monitors in the homes of hypertensive patients

Reads 369 weights from monitors in the homes of chronic heart failure patients

Sees 413 patients in our Care Centers for follow up and chronic care management

CAREMORE A DAY IN THE LIFE

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CAREMORE

Raf Score vs Revenue and Healthcare Cost and % of Membership

$0

$500

$1,000

$1,500

$2,000

$2,500

$3,000

$3,500

$4,000

0-.6

.8-.9

1.0-

1.05

1.1-

1.15

1.2-

1.25

1.35

-1.4

5

1.55

-1.6

5

1.75

-1.8

5

2.0-

2.25

2.5-

2.75

3.0-

3.5

4.0+

Raf Score Grouping

PM

PM

0%

5%

10%

15%

20%

25%

30%

35%

% o

f MM

% of MM Total Revenue PMPM Total Health Care Cost PMPM

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CAREMORE

Critical to success

Allows for rapid innovation

Allows for alignment

PREPAYMENT

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Decrease total cost of care

Improve quality

High patient and system satisfaction

NATIONAL IMPERITIVE

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Rapid rate of hypothesis generation, testing and implementation

Continuous care model and performance improvement

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CAREMORE

We can bend the cost curve in the Medicare population; payment reform is a critical driver in order to make this happen nationally

Medicare FFS System will not be the vehicle to signify decrease cost/increase quality

COMMENTS