CareMore Corporate Brochure

“The
EXTRAORDINARY is
within reach.”
+ Provide focused and innovative healthcare
approaches to the complex problems of aging.
+ Serve our members by prolonging
active and independent life.
+ Serve caregivers and family by providing
support, education, and access to services.
+
Protect precious financial resources of seniors
and the Medicare Program through innovative
methods of managing chronic disease, frailty,
and end of life.
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+ HEALTHCARE DELIVERY
Healthcare Services
+ Disease Management Programs
- Diabetes
- ESRD and Chronic Kidney Failure
- Hypertension and Congestive Heart Failure
- COPD
+ Coordinated Care Management
+ Frail End of Life
- Hospice Care
- Palliative Care
- CareMore Intervention Team
- Home Care
Health Benefits
+ MA-PD Plan(s)
+ Special Needs Plan(s)
- Chronic Conditions
- Dual Eligibles
- Institutionalized Beneficiaries
Enterprise Services
+ Health Plan Management Support
+ Medical Data Collection
& Risk Monitoring
+ Physician Practice
Management & Support
2
+ Technology
- Transactional Capabilities
“
40% of patients with chronic conditions…saw on average
11 doctors in seven practices; the upper quartile of this
group saw 16 or more different doctors in nine or more
practices…from a clinical perspective, 16 or 11 or even
7 different doctors treating a patient is no way to deliver
high quality care…
Patients with chronic conditions do not need more
doctors, they need a few who cooperate.
Patients are best served when they have at most a few
physicians who work together well…doctors should
be paid in a steady manner to provide high-quality
care in a “medical home” to their own patients, within
a structure that integrates the judicious input of a few
other physicians with whom they regularly work. Doctors
should find it intuitive and appealing to take care of the
whole patient, not for atomized services.
“
”
— Richard Bach in the Wall Street Journal
June 2007
Patients with “medical homes” better manage chronic
diseases and maintain basic preventive care. In addition,
“medical homes” eliminate racial and ethnic health care
disparities.
”
— Commonwealth Fund Study
July 2007
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+ THE CURRENT MODEL
FOR CARE IS FLAWED.
For the Complex Conditions of Aging,
the Current System Performs Poorly. We
Intend on Fixing It.
+ The existing segmented health care delivery model is
fragmented, bloated and inefficient.
+ Patients with serious conditions see an average of
11 different doctors, resulting in lack of coordination of
care, and therefore become victims of the system.
+ This leads to poorly managed, redundant care, which in
turn increases cost and death rate. In fact, 20% of the
frail population generates 60% of the health care cost.
+ Healthcare costs in the last year of life increase 7-fold.
+ 80% of seniors wish to die at home – less than 5% actually do.
+ The current model causes low compliance with
chronic care management protocols.
The Results
+ Chronic conditions progress more rapidly
due to poor management.
+ Precious family and public (Medicare) resources are wasted,
thus endangering funds available for future generations.
+ Patients and families experience unnecessary hardship
associated with loss of independence, psychological
and emotional stress, and financial loss.
4
HOW
CareMore
+ KEYS TO SUCCESS
Proactive Intervention:
integration and coordination of care
is not voluntary
Intimacy of Contact:
managing complexity requires constant
knowledge of the condition
Speed of Action:
resources must be available and
mobile to adequately intervene.
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DOES IT
+ CareMore CLINICAL MODEL
Frail & Chronically Ill Population
+ CareMore Extensivist
- CareMore Care Centers
- Case Managers
- Member Services
- Primary Care Physicians
- Specialists
Intensive management of frail and chronically ill members
(approximately 20% of members) that account for 60% of
medical costs.
Non-Frail Population
+ Primary Care Physicians
- CareMore Care Centers
- Continuous Frailty Assessment Tools
- Extensivity of Coverage Area
- Member Services
- Provider Relations
Close monitoring of non-frail members to proactively identify
at-risk members and aggressively manage chronic
conditions to prolong the onset of frailty.
20% of the members account
for 60% of the cost.
9
+ CareMore Integrates around
The Needs of the Frail & Chronically Ill
Program for all Frail
Programs for Chronic Conditions
+ Strength & Training Program
+ Diabetes
- Comprehensive medical assessment
- Wound Care management and supplies
- Routine foot care
- Diabetes Health Planner
- Shape Up. Levels Down.™
Exercise and Strength Training
- Nutrition
+ Home Care
+ Mental Health Program
+ Social Services
+ Podiatry
+ Hospice
+ Palliative Care
+ Wellness Programs
CareMore’s structure does not permit
the disaggregated care of body parts or
isolated diagnoses
+ ESRD
- Comprehensive medical assessment
- Personalized care plan
- On-going evaluation of dialysis treatments
- Enhanced Nutritional Training
+ COPD
- Comprehensive pulmonary medical assessment
- Specialized breathing test
- Self-management skills training
- Pulmonary rehabilitation
- Stop Smoking Program
+ Hypertension & CHF
- Comprehensive medical assessment
- Personalized care plan
- Electronic Blood Pressure Monitor
- Enhanced Nutritional Training
- Exercise and Strength Training Program
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+ Improved
Member outcomes
Electronic Blood Pressure Monitoring
+ 150 Patients studied over 9 months
+ 50% Showed a significant decrease in systolic blood pressure (more than 10 mms mercury)
+ Improved
Utilization
CareMore 2004
3.2
CareMore 2005
3.1
CareMore 2006
CareMore 2007
Mental Health Program
3.36
3.46
5.5
Industry Average
+ 50% Decrease in mental health hospitalization
+ 50% Decrease in length of stay
Bed Day Length of Stay
+ Length of stay between 2003 - 2007 was 2.3 - 3.3 less days (No ESRD) vs. industry average
+ Bed days between 2004 - 2007 was 940 - 1,085
(No ESRD) vs. industry average of 1450
+ Bed Days
Per Thousand
CareMore 2004
CareMore 2005
965
940
CareMore 2006
1076
CareMore 2007
1085
Industry Average
1450
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available
ResourceS
+
+
+
+
Care Centers
Information Technology
Marketing And Advertising
Capital
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+ Care Centers A Newly Defined
Medical and social home
Community Focus
+ Located in the heart of the neighborhood
Care Centers
Social Environment
+ Designed with seniors in mind
Clinical
+ Disease Management
+ Foot Center
+ Healthy Start
+ Pre-Op
+ Fall Prevention
+ Wellness Programs
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+ INFORMATION
Technology
Member
+ Claims TAPs & Document Management
+ Flexible Warehouse With Analytics &
Dashboard Engine, Utilization and Clinical Data
+ High Reliability Data Center
Provider
+ Robust Integrated Applications
+ State-of-the-art Clinical Systems EMR & EPM
+ System Integration Experience
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POSTAGE WILL BE PAID BY ADDRESSEE
FIRST-CLASS MAIL
PERMIT NO 244
DOWNEY CA
EXPECT MORE. GET MORE!
BUSINESS REPLY MAIL
NO POSTAGE
NECESSARY
IF MAILED
IN THE
UNITED STATES
+ Marketing and Advertising
PRESORT
STANDARD
U.S. POSTAGE
PAID
ARTESIA, CA
PERMIT #24
What could be more important
than your
future?
Being
Be
part of theirs.
255 N. White Road
San Jose, CA 95127
YOU’VE COMPARED CANDIDATES,
Why not medicare plans?
12900 Park Plaza Dr., #150
Cerritos, CA 90703
Print/Direct Mail
Enclosed: 8 comparisons your current plan may not want you to make.
FIRST CLASS
PRESORTED
U.S. POSTAGE
PAID
SANTA ANA, CA
PERMIT # 450
IT’S MORE THAN JUST
A MEDICARE BENEFIT
IT’S $900 BACK
Project Name: Last Chance Mailer Anaheim
Month: December 2008
Drop: 2
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CareMore Health Plan is a managed
care and special needs plan
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Se Habla Español
Television
Maria Antonieta De Las Nieves
Spanish Actress & Comedian
CAREMORE
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How we
Measure
+ OUR GOAL
Prolong active independent life
+ Decreased dependence on institutions
+ Increased ability to perform Activities of Daily Living (ADL)
+ Reduce burden on loved ones / caregivers
Protection of assets
+ Innovative methods of managing chronic disease, frailty and end of life
+ Coordinated support and access to services
18
E
SA
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AC
SF
TI
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IT
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HIG
HQ
U
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+ EVERYBODY Wins
M
KE
AR
Members Win
NE
EST BE FITS
TB
+ Better benefits, high member satisfaction
G
W
RO
Physicians Win
T PRODUCER
COS
TH
+ Improved capacity and income
CMS Wins
+ Beneficiary satisfaction, improved and
SA
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AC
SF
TI
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IT
RSH
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W
LO
MEMB
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efficient health delivery and higher bid subsidy
CareMore Wins
+ Sustainable profitability, Growth engine
21
ION
HIG
HQ
U
AL
+ Improved member satisfaction
“
What I love about CareMore is their great interest in
taking care of me. Whether it’s a medical or personal need, something I don’t understand – one phone call
and I get it explained to me.
”
“
– Phil, Member Since 2006
A recommendation for CareMore from me will
always be there. How can I not be grateful or tell
others about CareMore?
– Gilbert, Member Since 2005
”
Overall Member Satisfaction 97%
22
+ Physician Satisfaction
“
Dr. John Hernandez
As a physician, I feel that CareMore provides comprehensive care.
It is a unique health plan that has a primary focus of providing excellence
in medical care. Its global approach in medicine reduces morbidity and
mortality. I believe CareMore is setting the standard of care in this
era of managed care.
”
“
Dr. Arturo Lopez
CareMore has always lived up to its name. Their priority is the patient.
They not only provide the best service, but they give physicians the
autonomy and full support needed to run our practices. I am honored
to be a part of CareMore.
”
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