Lessons From CareMore: A Stepping Stone to Stronger Primary Care of Frail Elderly Patients

ABSTRACT

CareMore, a Medicare Advantage insurance plan originating in southern California, provides direct care for its frailest elderly patients and has developed an integrated patient care delivery system designed to surround patients with care. The system is based on extensivists, hospital-based physicians who also see patients for 1 or more follow-up outpatient visits; a cadre of nurse practitioners who manage specific chronic conditions by protocol; and a corps of nurse care managers who manage banks of remote home monitoring data and develop trusting relationships with patients. Early data from this system suggest better outcomes at lower costs: patients experience 42% fewer hospital admissions than the national average, an amputation rate among diabetic patients that is 60% lower than the national average, and a 4% pressure ulcer rate in institutionalized patients compared with a 13% rate for the entire state of California. Per member per month spending is less than expected under a CMS model for similar risk patients. For patients in the intermediate risk category, the actual cost is $1000 versus an expected cost of $1500. For the highrisk group, the actual cost is $2250 versus an expected $3500.