Hospitals

4 things CareMore is doing to improve the Medicare patient experience and why consumerization isn’t one of them

Sachin Jain, CareMore CEO, said the consumerization of healthcare doesn't serve Medicare patients well and highlighted how the Anthem-owned group is adding touch points in senior care that address practical needs.

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Although there’s a lot of excitement around the push to consumerize healthcare with the aid of digital health as one component of the drive to value-based care, Dr. Sachin Jain, CEO of integrated health system CareMore Health,  is not convinced. In a talk at the Wharton Healthcare conference earlier this year, he sought to make a case for why Medicare and Medicaid patients are not well-served by a consumer-centered approach. Instead, he is an advocate for a patient-centered, low tech approach that’s delivered by improving care where it is most needed.

“We have spawned an industry with a lot of self-congratulatory taglines,” Jain said. “The reason we need empowered patients is because they recognize that the [health] system by itself isn’t delivering what they need in an instinctive and proactive way. So we have gone down this rabbit hole of consumerism that is based on the fact that we have a broken healthcare system that is nonintegrated that doesn’t necessarily deliver in a proactive way what patients need when they need it.”

Jain highlighted some of the programs that Anthem-owned, Los Angeles-based CareMore has rolled out across eight states and which are designed to be more sensitive to the needs of members.

Founded by Dr. Sheldon Zinberg, Anthem-owned, Los Angeles-based CareMore has a presence in eight states, most recently Texas, and is also adding Washington, D.C. Next year, it plans to expand to 13 states, according to Jain. About 34.2 percent of its members are diabetic and much of its patient population have multiple comorbidities. The average age of its patients is 74.

Jain highlighted some of the programs that CareMore has rolled out which are designed to address the needs of members in diifferent ways.

Extensivists and care coordination

Dr. Sachin Jain

Jain noted that the company provides the same doctors at all cycles of care, who are referred to as extensivists. The idea is that these physicians are well acquainted with their patients and have a better understanding of their medical history. Increasing their role reduces the pressure on patients, caregivers, and other family members to transmit accurate medical information at what can be a stressful time.

Extensivists are the physicians who take care of the sickest patients in hospitals, in skilled nursing facilities, and in post-discharge clinics.  They partner with primary care to manage the sickest patients, oftentimes assuming responsibility for primary care for the highest-risk patients, Jain explained.  Because it’s the same doctor who sees patients across the acute continuum, we are able to care for patients in the setting that is most cost-efficient.

One patient’s baseline might look much worse than another but the idea is that if a physician knows their patient they can avoid unnecessary admissions. If Mrs. Jones shows up at the hospital looking worse for wear her doctor might conclude that she’s better than she was previously. It also reduces the number of handoffs which is frequently when adverse events happen.

“That is the reality of this type of work — we have lower readmissions, lower admissions and shorter lengths of stay across all of the markets in which we operate,” Jain said. “I would love to tell you we have some phenomenal tech solutions that ensure that all of this information flows seamlessly. But the reality is when you have the same teams taking care of people all the time — the same case manager, the same doctor. you don’t actually need those tech solutions.”

Limits of consumerization 

One aspect of consumerization that particularly bothers Jain is the idea that people should pay out-of-pocket for medication they need to stay out of the hospital, such as insulin and be encouraged to shop around to find the cheapest price for it. The risk is that they either won’t buy the medication or they will try to make what they have last and give themselves inadequate doses.

“This whole skin in the game concept is really just healthcare economics gone wrong,” said Jain. “There are certain things we should pay for when utilization gets out of control, but what is the point of giving someone a huge copay for insulin?”

He pointed out that CareMore takes care of the prescription drug gap for Medicare patients, referred to as the doughnut hole.

This draws attention to a larger issue of who should be responsible for medication adherence — the patient or the provider? Jain is one of many who believes strongly that it is the provider’s responsibility. Poor medication adherence can lead to complications and readmissions, the kind of costly medical expenses for which hospitals are trying to reduce.

Preventive care from head to toe 

One element of CareMore’s approach is to use innovative touch points to support preventive care. One of the challenges encountered by the elderly and those with mobility issues is cutting their toenails. By enlisting care professionals to do that, they can avoid the risk of seniors accidentally harming themselves or infections that can lead to amputations.

Another priority for the business is addressing loneliness. Roughly 15 percent of  adults aged 60 years old or more experiences depression, anxiety disorders, and dementia, among other psychiatric disorders, according to data from the World Health Organization. That number is expected to reach 15 million by 2030. Senior-focused gym program “Nifty After Fifty” at many of its care centers is intended to foster social connections between seniors. Last year the health system hired a Chief Togetherness Officer, Robin Caruso, to oversee the initiative.

A study evaluating the program’s effectiveness showed a 75  percent increase in the intervention group’s use of the Nifty After Fifty year-over-year. For a group of 600 people, use of the program went from 12 percent last year to 20 percent this year, according to stats cited by Jain. Despite the Intervention group’s co-morbidity index score being elevated compared to the non-intervention group, their admits were 5 percent lower during the 2017 intervention period, and their total medical expense per member per month is lower by 13 percent, Jain noted in an email.

Image: Getty Images

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