Integrated Care: The Real Deal

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by Jason Brandt (@jasondmg3)

What if there were a coordinated healthcare system in which teams of caregivers focused on sharing information and insights about their mutual patients and preventing health issues before they became critical?

Is it a utopian dream or perhaps the mission statement of an advocacy group? No its the original vision developed two decades ago by the founder of CareMore, a Cerritos, California-based company that serves more than 50,000 Medicare Advantage patients throughout the Southwest. The companys 26 “care centers are vastly different from a traditional medical practice, and may offer lessons for achieving greater patient compliance.

CareMores model is based on the application of an old systems-management principle first developed at Bell Labs in the 1930s and refined by the management guru W. Edwards Deming in the 1950s: You can fix a problem at step one for $1, or fix it at step 10 for $30.

Most U.S. healthcare is repair-centric, not prevention-centric big health events occur in the lives of patients, and the system is geared to try and fix them. But what would happen if we prevented the big events in the first place?

This “upstream intervention approach as opposed to treating “downstream outcomes means CareMores overall member costs are 18 percent below the industry average.

What does it look like? Consider these examples:

  • A woman with a history of congestive heart failure notices shes put on three pounds in 24 hours a sign of possible fluid in her lungs. CareMore noticed too, because her scale wirelessly communicated with the clinic.
  • A diabetic who cut his foot and was referred to CareMore had a nurse practitioner clean and dress his wound and then check on it every two days until they were certain the risk of infection had passed. Had the patient not been able to drive or catch a bus, CareMore would have sent a car.

If that sounds like a luxury take on traditional healthcare, its actually just the opposite. CareMore found that, among elderly patients, as many as one-third fail to show up for their doctor appointments because they lack the network of friends and family or even basic fiscal resources to make the trip. So this massive area of fundamental noncompliance getting to a doctor before a small problem turned into a big one was often replaced with just calling 911 when they got sick.

Against that backdrop, providing transportation for these patients was very cost effective.

The problem of noncompliance isnt limited to missed appointments. Patients leave prescriptions unfilled, medicines untaken, exercise-and-diet regimens unfollowed, and symptoms unnoticed and unreported.

CareMores largest innovation may be in deciding that noncompliance istheir issue, not the patients. And the numbers show that it works: their hospitalization rate is 24 percent below average; hospital stays 38 percent shorter; and amputation rate among diabetics 60 percent lower than average.

Others are watching: In August, CareMore was acquired by WellPoint, which serves 70 million people nationwide directly or through subsidiaries, and has plans to expand the CareMore model.

Of course, its easy to draw a distinction between broad-based preventative care and pharma, and the CareMore example may not translate perfectly to the world of pharma marketing and patient communication if for no other reason than pharma is not in a primary-caregiver role. But there is now significant evidence that making compliance our issue rather than the patients pays long-term benefits, both in terms of cost and patient outcomes.

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One Response to Integrated Care: The Real Deal

  1. Carmen Gonzalez says:

    Jason,
    Thanks for highlighting a good example of healthcare improvement, where the emphasis is on preventive care rather than emergency care. Let’s hope that Wellpoint doesn’t mess up a good model—I remain skeptical. CareMore has a very patient-focused approach, one that is not typically shared by health insurance companies.