Founded in 1993, CareMore Health (CareMore) is an integrated health plan and care delivery system with over $1.4 billion in revenue that serves over 150,000 Medicare and Medicaid patients across 8 states. The company’s comprehensive approach to clinical care – known in the industry as the CareMore Model – utilizes primary care providers, case managers, extensivists, and CareMore Care Centers to improve health outcomes and quality of life for their patients. According to a New York Times feature on this model, CareMore patients, in 2015, had 20% fewer hospitalizations and 23% fewer hospital days than their Medicare fee-for-service counterparts with similar health conditions[1].

The Pulse team had the privilege of sitting down with Dr. Sachin Jain, CareMore’s President and one of the 2018 Wharton Health Care Business Conference keynote speakers, to better understand his team’s approach to patient engagement. Full of passion for his employees and the patients they serve, Jain gives us a glimpse into CareMore’s culture and philosophy by constantly focusing the conversation on the need to care for patients for caring’s sake. Jain is unapologetic about his focus on people in an industry that’s buzzing with excitement around digital health and the next “Uber for healthcare.” Below are our takeaways:

Emphasis on healthcare technology and patient engagement results from patients not receiving the actual care they need; we should focus on delivering that care. When asked about CareMore’s usage of data analytics tools to better care for patients, Jain responds, “we are using data analytics tools to identify patients with specific needs, but in this era of big data, the best computer is still the human mind. Because we touch our patients often – sometimes once a month, sometimes once a week – it gives us the opportunity to know, in real time, whether someone is doing well in comparison to last week. We see signs that do not show up in data signals. Many people today do not have the patience for this kind of talk because there isn’t an app or an easily scalable solution. But at the end of the day, a clinician laying eyes on a patient enables magic to happen. Many patients do not get their needed frequency of clinical interactions, and our industry’s focus on using clinical data tools is an outgrowth of the fact that we are not doing things to actually take care of patients.”

When asked about building digital tools to engage patients, especially Baby Boomers, Jain emphasizes his previous point, “For most people who are sick, they are not interested in being engaged. They are interested in being cared for by a system that knows what to do during a health crisis. Much thinking around consumerism in healthcare is deeply flawed because it assumes that every patient wants to be a consumer and shop like it’s Black Friday for every aspect of their healthcare experience. In reality, those of us who are sick, who have been sick, or have loved ones who are sick know that the thing we want the most from the healthcare system is that when we access it, the right thing happens. The consumer engagement movement in healthcare has been an outgrowth of the fact that many times the right things don’t happen for people, and they feel like they need to be engaged. I think we are getting confused. The optimal state is that we anticipate people’s needs and deliver solutions to address those needs 100% of the time with great effectiveness.”

While healthcare technology is a great facilitator for delivering healthcare services, it cannot make up for a poor patient-clinician interaction. Thus, CareMore has a high bar for its technology partners. According to Jain, people are “the magic in healthcare delivery.” Thus, for Jain, while technology is a great facilitator, it can’t replace human interaction. He explains, “healthcare is one human interaction at a time…, and the best technology cannot make up for a poor interaction that patients have with a clinician. That’s why we are unapologetic about saying that we only hire the best clinicians…, who are competent, thoughtful, sophisticated, and patient-centered.” Jain’s team does not allow itself to be distracted by shiny, new technology platforms; instead, CareMore is focused on delivering, with both coordination and compassion, “phenomenal preventative care and extraordinary chronic disease management.”

Nevertheless, CareMore does recognize certain technological advances’ potential to help deliver top-notch care. In fact, CareMore has a dedicated digital health team that constantly surveys the healthcare technology landscape, and it is one of the first healthcare partners of Lyft (read about the partnership’s impact here[2]). Healthcare start-ups wishing to partner with CareMore must demonstrate abilities to truly make a difference – whether it’s avoiding unnecessary hospitalizations or preventing a CKD (chronic kidney disease) patient from needing dialysis treatments. CareMore sets a high bar for start-ups because according to Jain, “most technology solutions are built for 80% of the patients who account for 20% of the cost, while we are caring for 20% of the patients accounting for 80% of the cost.”

CareMore earns its long-term relationships with patients by investing in them. When asked about whether the private sector is capable of establishing long-term relationships with its patients, especially given that it has to balance patient turnover with long-term patient investment, Jain was not hesitant at all to say yes. For instance, according to Jain, CareMore has the lowest voluntary disenrollment rate in the country and a net promoter score of 94 (out of 100) in the Memphis market. He states, “Our patients are incredibly loyal. When you meet CareMore patients, they are passionate about the CareMore Care Centers that provide social activities, the transportation that they receive through our partnership with Lyft, and the Togetherness Program that delivers intervention for the loneliness of our patients…Some policy makers think we should require patients to choose an insurance policy for 3-year or 5-year periods so actuarially, health insurers are encouraged to think about investing in patients for the long term. We believe that patients can perceive that investment and vote with their feet. Lifelong relationships are something that you earn, and we feel that we have earned those lifelong relationships.” In fact, when pushed to discuss analysis of CareMore’s churn rate, Jain emphasizes that his team “never talks about investment in health as it relates to churn rate.”

With that level of patient loyalty, it’s no wonder that CareMore has scored an average of 4-4.5 (out of 5) Stars for 100% of its Medicare Advantage plans across multiple markets[3]. Medicare Star Ratings are a good indication of a plan’s relationship with its members as CMS bases its ratings on five categories, three of which focus on member experience.

Physician burn-out and changing expectations around healthcare delivery are the biggest disruptors to the healthcare industry. Jain discusses two biggest disruptors to the healthcare industry. First, he is concerned that there are “fewer and fewer physicians who actually want to take care of patients.” Second, patients are going to want “healthcare delivered in different ways and in different sites,” such as by non-clinical individuals supported by doctors or at patient homes. However, Jain is not worried these trends’ impact on CareMore’s ability to attract and retain the appropriate workforce because “it has built a model that is sustainable, where people want to practice and do the right things.” To better understand CareMore’s approach to attracting talent, please read Jain’s August 17, 2017 editorial on this very topic in Forbes[4].

[1] https://www.nytimes.com/2017/09/28/upshot/the-high-price-of-failing-americas-costliest-patients.html?mwrsm=Email

[2] https://www.advisory.com/international/research/global-forum-for-health-care-innovators/the-forum/2017/08/caremore-lyft

[3] https://www.businesswire.com/news/home/20161014005536/en/CareMore-Health-System-Achieves-Substantial-Increase-Medicare

[4] https://www.forbes.com/sites/sachinjain/2017/08/27/the-key-ingredient-of-great-healthcare-delivery-remains-unchanged-its-the-people/#69fb52056169