CareMore: Radical care for those who need it most. Vivek Garg, MD, MBA

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Eustacia Rodgers
5 years ago
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1 CareMore: Radical care for those who need it most Vivek Garg, MD, MBA

2 DOWNEY, CA THE BIRTH OF AN IDEA 25 YEARS AGO

3 RELENTLESS COMMITMENT + UNSWERVING DEDICATION TO PATIENTS FOCUS on sickest of the sick MANAGE care properly PREVENT progression of disease Sheldon Zinberg, MD #

4 Our Focus CareMore s Medicare Patients 34% 34.2% of our patients are diabetics 19% 19.4% of our patients live at or below 120% of the FPL 43% 43% of our patients live with 2 or more co-morbidities 74 The average age of our patients is 73.6 years old (ESRD, CKD, CHF, Diabetes, COPD, BH, ACC)

Our Model CareMore s Medicare Clinical Model

comprehensive prevention, chronic disease

Intensive Case Management Manage transitions &

Extensivists Manage care in hospital, SNF, and

5 Our Model CareMore s Medicare Clinical Model Neighborhood Care Center Coop to PCP to provide comprehensive prevention, chronic disease management via interdisciplinary care team Intensive Case Management Manage transitions & high risk episodes, coordinate visits Extensivists Manage care in hospital, SNF, and post-discharge clinic; link to PCP Traditional Gap Traditional Gap PATIENT PCP ACUTE

Our Impact We help patients avoid chronic disease progression Status Quo CareMore Redesign Outcomes Diabetes No time for insulin teaching No nutrition or exercise support No intensive follow-up No

6 Our Impact We help patients avoid chronic disease progression Status Quo CareMore Redesign Outcomes Diabetes No time for insulin teaching No nutrition or exercise support No intensive follow-up No coordinated foot/wound care Intensive patient education Concentrated care (longer, frequent visits) Integrated nutrition & wound care Home monitoring when needed 77.1% lower A1c 66% fewer amputations Status Quo CareMore Redesign Outcomes CKD/ESRD Late diagnosis of CKD Inadequate dialysis planning Admissions from avoidable factors Dialysis centers with no primary care Early CKD diagnosis & management Optimal hemodialysis access Intensive case management Urgent response to dialysis centers Monthly preventive care (access, wounds) CKD 3 to ESRD progression delayed by 18 years 45% fewer admissions 85% fewer hospital days

7 Our Impact We keep patients healthy at home & out of the hospital 20% fewer admissions 271 PTMPY % fewer readmissions 17% PTM 13.7% 37% lower length of stay 5.4 (days) 4.1 Medicare Average CareMore (2016) Medicare Average CareMore (2016) Medicare Average CareMore (2016) CareMore 2016 Hospital Metrics. Admissions and days are rates per 1,000 beneficiaries. Inpatient LOS is in days. Medicare averages from most recent data available, 2013 HHS Health Information Warehouse CareMore ( Hospital Metrics. Admissions and days are rates per 1,000 beneficiaries. Inpatient LOS is in days. Medicare averages from most recent data available, 2013 HHS Health Information Warehouse

Our History CareMore s Evolution Local Phenomenon Regional

establishes a culture of radical care redesign for the most

while successfully replicating clinical outcomes Industry

8 Our History CareMore s Evolution Local Phenomenon Regional Phenomenon National Phenomenon CareMore Medical Group establishes a culture of radical care redesign for the most complex patients CareMore expands the clinical model beyond CA while successfully replicating clinical outcomes Industry change fuels CareMore s growth and diversification to Medicaid, provider collaborations

Our Models CareMore s Medicaid Care Model Extensivist Acute & Post- Acute Care Convenient Primary & Chronic Disease Care Integrated Behavioral Health Our Care Center (CCC) serves as neighborhood hub

9 Our Models CareMore s Medicaid Care Model Extensivist Acute & Post- Acute Care Convenient Primary & Chronic Disease Care Integrated Behavioral Health Our Care Center (CCC) serves as neighborhood hub for patients and the care team Convenient access and expanded hours (transportation support, evening / weekend / same-day visits) enables patient engagement Our primary care team focuses intensively on identifying, preventing, and managing chronic conditions in Care Centers and at home CareMore Care Center Our extensivist team manages patients fully through acute/post-acute episodes at hospitals and SNFs Mobile / Home Care Social and Community Engagement Care Management Our integrated, co-located behavioral health team provides ready access to consultation and treatment for serious mental illness and substance abuse Our care management, social work, and community health worker teams manage high-risk patients and episodes prospectively, with equal focus on physical, behavioral, and social health

10 Our Impact We manage medical, behavioral & social health proactively

reflect CareMore population utilization vs other PCP average in similar

11 Our Impact Upstream care leads to fewer specialist, ER, hospital visits Other PCPs ABD Non-Dual Tennessee Medicaid Other PCPs TANF Female Results reflect CareMore population utilization vs other PCP average in similar geographic area. Results reflect Q1 Q claims and are non risk-adjusted..

12 New Frontiers Now, we are bringing integrated care to the home

Our Footprint CareMore in 2018 Las Vegas, NV Delegated Medicare Advantage Provider + Medicaid Care Delivery Des Moines, IA Medicaid Care Delivery Indiana, Kentucky & New Hampshire

5 Long Island, NY Provider Collaboration California Delegated Medicare Advantage Provider 4 4.

13 Our Footprint CareMore in 2018 Las Vegas, NV Delegated Medicare Advantage Provider + Medicaid Care Delivery Des Moines, IA Medicaid Care Delivery Indiana, Kentucky & New Hampshire Provider Collaboration Connecticut Home-Based Care for Duals Connecticut Provider Collaboration) Long Island, NY Provider Collaboration California Delegated Medicare Advantage Provider Washington, DC ( 18) Medicaid Care Delivery Southern California PE-Vivity JV (210k Commercial HMO) Richmond, VA Delegated Medicare Advantage Provider Atlanta, GA Provider Collaboration (Emory) Tucson, AZ Delegated Medicare Advantage Provider Dallas/Ft Worth ( 18) Medicaid Care Delivery Memphis, TN Medicaid Care Delivery = Medicare Advantage Star Rating in 2017

14 Lessons We Have Learned

15 Lessons Relentless care redesign is enabled by capitation Foot Care Dentistry Integration Lyft Partnership Togetherness Program

16 Lessons Sick patients are not consumers Health care should anticipate and deliver on people s needs. Sick people should not have to shop for the care they need. People should not pay out of pocket for things they need.

17 Lessons Culture is the hardest thing to scale

18 ? Questions

CareMore Special Needs Plans Model of Care. Annual Evaluation 2015 Performance

CareMore Special Needs Plans Model of Care Annual Evaluation 2015 Performance The Special Needs Plans (SNPs) Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit