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Making Total Cost of Care Contracting Work

By Philip Betbeze  
   December 03, 2015

Unique, but becoming less so
Jain calls CareMore unique in healthcare, which he says is what it needs in a time of transition.

"Here, we have the freedom to think broadly not only about healthcare delivery, but also the payment models and organizational structure to enable that," he says. "My passions, in order, are clinical medicine, policy, and business and management, and very few organizations allow you to do all three simultaneously and manage the intersection of those things with equal vigor."

He says focusing on seniors was a good starting point because that's where the majority of healthcare's cost is. As a site of integrated delivery and payment, he says organizations like CareMore are geared toward the prevention of catastrophic outcomes that many seniors are forced to deal with because a broken healthcare system doesn't help them with health—it focuses on procedures. For example, payers are funding a large portion of dialysis services because so little was done when patients were showing signs of hypertension or diabetes.

"There's a huge gap in people's understanding the interconnectedness of care..."

"How do we prevent them from getting to that place where they ever need dialysis?" he says.

"That's exciting. And then, how to expand these principles to other populations."

CareMore spreads those principles by partnering with other organizations and demonstrating the scalability of its basic structure, which hinges on a prevention benefit for patients that includes not only extended office hours, wellness programs, and patient monitoring, but also educating patients about a continuum that depends on interchange of information and putting them in participatory programs to help improve their health preconditions—hopefully preventing interventions that are more invasive and expensive.

"There's a huge gap in people's understanding the interconnectedness of care. Effective healthcare delivery is not the individual pieces; it's the sum of the parts," Jain says. "Our patients understand they're in a system of care, so, for example, if they are hospitalized outside our continuum, we repatriate patients to one of our hospitals; our settings. It's the system that produces world-class outcomes, not the individual parts of it."

Philip Betbeze is the senior leadership editor at HealthLeaders.

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