CareMore Delivers Value for Members with Chronic and Complex Conditions


Chronic and Complex Conditions | CareMore Health

Beth is a 72-year-old Type II diabetic who needs help monitoring her blood sugar and taking her insulin on schedule. She also needs guidance on diet and eating healthy.

Ben, 81, suffers from congestive heart failure. Breathing is labored. Walking to the kitchen leaves him exhausted. He has a steady cough due to fluid retention and he needs help daily with his compression stockings and his many medications.

Ramona, 78, has late-stage kidney disease. Between dialysis appointments, she needs help with household chores, buying groceries and trips to the pharmacist. Her high blood pressure is a concern and needs to be checked daily.

Each of these patients has a complex, chronic condition that restricts their activity, affects their quality of life, and requires frequent and costly medical treatment. In addition to their primary diagnosis, they have related conditions to manage – such as insomnia, muscle soreness or high blood pressure. Every day they make difficult decisions on how to manage their fixed income: Pay their health care bills or spend on necessities of daily living like food and rent.

Without needed care, their health will deteriorate into a spiral of acute illness, repeated hospitalizations and uncontrolled expense.

Traditional health care often inadequate

Traditional healthcare often fails these patients. The system is designed for brief episodes of care, with little planning or coordination. Access to the system is confusing, so patients appear at the hospital emergency room – the most expensive setting. They are discharged with little or no support, so their condition worsens, resulting in a return trip to the hospital.

Providers working on a fee-for-service basis have little incentive to cooperate with peers or think beyond the crisis of the hour. Specialists see only their piece of the medical puzzle. Mental, emotional and social issues are overlooked, while community resources like social workers are not consulted.

Special Needs Plans close gaps in care

CareMore is a pioneer in the treatment of patients with complex and chronic diseases. With 25+ years of experience, CareMore is unrivaled in our understanding and treatment of chronic conditions. Many Medicare Advantage plans designated as Special Needs Plans (SNP) offer CareMore as the care delivery system.

Our clients are some of today’s most progressive health plans that recognize their patients need specialized care that is different from traditional models. The CareMore model is a true system of care. We replace fragmented services with a multidisciplinary clinical team that delivers care where and when the patient needs our support.

CareMore is a physician-led organization, managed by doctors and clinicians committed to treating chronic conditions. Our approach draws on clinical data and evidence-based medicine.  However our patient experience is high-touch and personal. CareMore serves as the patient’s primary care team, offering local support across medical disciplines. We provide treatment planning, care coordination and patient monitoring between appointments, bringing disease management expertise and clinical resources to meet the patient’s special health needs.

Managing risk, controlling costs, improving outcomes

CareMore’s expertise in risk assessment and risk management adds value to health plans. We identify risk, stratify patients and engage them through focused interventions, care coordination, patient education and proactive disease management. For health plans, we capture the true health risk burden of patients and properly code them so plans are reimbursed for their risk.

Healthy Start is a key first step to member engagement and better health. All new patients are offered a Healthy Start appointment, comprised of a head-to-toe assessment, review of medications, health status and personal health goals. Members are introduced to their CareMore team and community resources. Members also receive an annual follow-up visit, called Healthy Journey.

Surveys show that 94% of members report a good experience with Healthy Start. The program is essential for member engagement, as they build a relationship with their clinician and commit to their treatment plan. Healthy Start also enhances health plan loyalty and re-enrollment since members want to continue the progress they’ve made with CareMore.

Continue learning in Part II of this article