Innovations in Reducing Cost &
Improving Quality of Health Care
Donald S. Furman, M.D. ~ Chief Medical Advisor
CAREMORE “It’s what we do”.
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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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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FRAIL CARE MANAGEMENT
CAREMORE
CARE ACROSS DISCIPLINES
Medical, Social,
Psychological,
Functional,
Pharmaceutical
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FRAIL CARE MANAGEMENT
CAREMORE
Care Across Sites
 Hospital
 Medical Office
 Home
 SNF
 ALF
 Custodial
 Under a Bridge
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CAREMORE
OUTCOMES
78% fewer amputations in Medicare
diabetics than the national average
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CAREMORE
OUTCOMES
ESRD
25-30 percent fewer hospital
admissions than the Medicare
average
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CAREMORE
READMISSIONS
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
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CAREMORE
DIABETES
Average HbA1c for those patients attending
the clinic is 7.01
LDL – 100
Effective control of Hypertension with
wireless remote BP monitoring
Requirement for all diabetics with HbA1c
eight times to be evaluated in the diabetes
clinic
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CAREMORE
ANTICOAGULATION CONTROL
No hemorrhagic complications in
the last 5 years
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CAREMORE
OUTCOMES
FALLS & FRACTURES
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 15
CAREMORE
OUTCOMES
MENTAL HEALTH
No barriers to care
Coordinated with the rest of the system
Care broaden to SNF’s custodial home and the
home
Families included
Third decrease psychiatric in admissions; 50%
decrease in psychiatric hospital length of stay
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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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 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 Gravity
Smoking
Cessation
Program
Clinical
Pharmacy
Program
24-Hour Care
Management
Diabetes and
Wound Care
Program
CHF Program
ESRD
Management
Transportation
Services
CKD
Management
Crisis
Intervention
Team
COPD
Management
Provider Portal
Extensivist
Hypertension
Management
PCP
Co-Morbidity
Management
Mental Health
Program
Wireless Blood
Pressure
Monitoring
Healthy Start
Program
Senior Patients
On-Site
Diagnostic Lab
Pre-Op
Clearance
Case
Manager/
NP
Dietary/Nutritio
n Counseling
Community
Resources
Clinical
Care Centers
(CCC)
House Call
Team
Nifty After 50
Anticoagulation
Program
Clinical IT
Strength and
Balance
Training
Hospice
First Fall
Program
Effective
Specialists
Hospital
Palliative Care
Team
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CAREMORE
CAREMORE A DAY IN THE LIFE

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
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CAREMORE
Raf Score vs Revenue and Healthcare Cost and % of Membership
$4,000
35%
$3,500
30%
% of MM
Total Revenue PMPM
Total Health Care Cost PMPM
$3,000
25%
$2,000
15%
$1,500
10%
$1,000
5%
$500
4.0+
3.0-3.5
2.5-2.75
2.0-2.25
1.75-1.85
1.55-1.65
1.35-1.45
1.2-1.25
1.1-1.15
1.0-1.05
0%
.8-.9
$0
Raf Score Grouping
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% of MM
20%
0-.6
PMPM
$2,500
CAREMORE
PREPAYMENT
Critical to success
Allows for rapid innovation
Allows for alignment
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CAREMORE
NATIONAL IMPERITIVE
Decrease total cost of care
Improve quality
High patient and system satisfaction
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CAREMORE
Rapid rate of hypothesis generation,
testing and implementation
Continuous care model and performance
improvement
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CAREMORE
COMMENTS
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
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