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New CareMore Chief Talks Expansion and Transformation

Analysis  |  By Philip Betbeze  
   April 28, 2016

Sachin Jain, MD, reveals new insights on the Anthem subsidiary's national expansion plans via the continuous adjustments needed to make care more efficient and effective for high-cost, high-need patients.

Sachin Jain became a fan of CareMore while he was at the Centers for Medicare & Medicaid Services during the first Obama administration. A little more than a year after being recruited from a lofty position at Merck, he's been named to lead CareMore.

A strategically and operationally independent subsidiary of Anthem, CareMore started out 25 years ago as an elder-focused physician practice in Southern California. Over time, the company morphed into a health plan serving seniors based on care protocols initially piloted at the physician practice.

Now its care management system has been integrated into pilot programs at Emory Healthcare in Atlanta, and in Medicaid-based partnerships in Memphis and Iowa.

Jain discovered CareMore while he helped launch the Center for Medicare and Medicaid Innovation at CMS. Jain served as a senior advisor to the CMS administrator. He also was a special assistant at the Office of the National Coordinator for Health Information Technology. At Merck, he was chief medical information and innovation officer before joining CareMore as CMO and COO in January 2015. Named president and CEO a week ago, Jain is succeeding longtime mentor Leeba Lessin, who will retire.

During an interview with HealthLeaders, Jain shared his mixed feelings about succeeding his mentor, the imminent release of a peer-reviewed study showing the effectiveness of CareMore's interventions, and his plans for the expansion of partnerships with acute care hospital partners pioneered by a program at Emory in Atlanta. He cautions: Nothing less than transformation of care delivery is required, and transformation requires full commitment.

HealthLeaders: Congratulations on the promotion. Were you expecting it so soon?

Jain: It's exciting. It's like following Michael Jordan. Leeba is an innovative thinker and I learned a lot working with her and it shaped me as a leader. You never expect anything like this. You just do your job and try to make a difference. Things worked out.

She had been here for nine years when she recruited me, and she was a huge part of why I came here, so I had very mixed feelings that she was handing the reins over to me. But I do get to take over what I think of as the marquee organization focused on high-cost, high-need patients in the country. What we have is simply a better way to manage those who are responsible for disproportionate amount of healthcare spending in this country.

HealthLeaders: When we last spoke, you were excited that CareMore could "model the future for healthcare." We talked about some projects with local hospitals and health systems that CareMore was doing outside California—in Memphis and Atlanta, specifically. What are some of the highlights so far of those programs?

Jain: Anthem is committed to leading in this space. That's why they acquired CareMore. It's been an engine to serve the Medicaid population through the partnerships with Amerigroup entities (health plans in states where Anthem does not have a Blue Cross license) as well as the partnership with Emory, which has been a positive demonstration on how our principles can be applied to settings other than traditional Medicare Advantage plans.

As of March 1, Emory's enrolled 13,511 shared savings patients in that geography. They now have a single operating model for all Medicare patients and Emory's primary care capacity has increased because the [jointly developed] CareMore centers mean primary care physicians are seeing fewer visits for chronic disease management, resulting in more time for acute visits. Star ratings for Emory-specific products have increased significantly and the hospital readmission rate for patients seeing CareMore-trained Emory extensivist physicians is 8.9%, which is fantastic.

[The national average was 17.5% in 2013 for all causes, and Emory will publish a paper this week coauthored by former Emory University chancellor Michael Johns III, MD, that will further detail some of the findings from the partnership. Johns is currently interim executive vice president for health affairs at Emory.]

HealthLeaders: Those are good numbers. What about new partnerships? Do you see further expansion of the model gaining traction?

Jain: I'm an execution-focused leader and evidence-based. We need to prove things out before we extend too far. Since we last spoke we've taken the model of care we're building in Memphis and partnering with Amerigroup to provide that model of care to patients in Des Moines.

There are about 7,500 patients in that market. We're also in discussions with a select number of large health systems who see CareMore as a possible on-ramp to value-based care. We've done this now for 25 years. We have deep expertise in these areas. The model results in better outcomes for patients and we're delivering on transferring capabilities to shorten the length of the on-ramp and the pain they experience when transitioning to value-based care. The Memphis and Iowa work is different.

The delivery partner is Amerigroup Medicaid managed care plans. In traditional markets, we partner with both the delivery system and the health plan. The other model variation is that we actually become the primary care providers for those patients. We're not wondering how to pay for what's right for these patients. We are responsible for our patients on average for nine years, so that enables us to make significant investments in their health and well-being over the long haul.

We're also working on modifying our care centers so they can function as open-access centers for any kind of urgent need with extended hours. That is difficult in many organizations.

HealthLeaders: At the most basic level, what will make these partnerships successful?

Jain: We're simply looking at the downstream acute healthcare utilization that we can reduce by providing services to our members. That's a different conversation altogether from traditional medicine.

From our perspective, the key component in the next several years of our 10-year relationship with Emory, for example, is to grow the numbers of patients we serve. Primarily the patients come to us through the sale of Emory-specific Medicare Advantage products.

HealthLeaders: You've said that CareMore is a delivery system first, and a method of paying for that delivery second. What do you mean by that?

Jain: There are so many vendors who operate in this space and all seem to do it the same way. They bring data dump trucks to you, they analyze for high-cost and high-need patients and they say those are the ones you need to work on. Go build some care management forums.

But we are soup to nuts. That's not a transformation approach people are used to because transforming what care looks like from the patient perspective is very difficult.

HealthLeaders: Why do you think so many organizations go that route?

Jain: Traditionally, you have physicians who are not worried about chronic disease management. They will send you to several specialists who will poorly coordinate your care. There will be little emphasis on exercise and no one's thinking about behavioral health.

They're victims of the system to a degree.

Our system is designed so all those pieces fit together. Another important piece is we have a lot of humility. This is hard work. We don't have 10 clients because we believe we need to create and demonstrate real value for our partners and the creation of real value requires real buy-in.

A lot of people say they want to transform, but there's often not the will to transform care delivery. Those are not the types of organizations we want to partner with.

HealthLeaders: Have you heard anything about how your partners are scaling their experience with CareMore to better and more efficiently care for other populations than Medicare and Medicaid?

Jain: This will happen over time as healthcare leaders recognize the value of total transformation as opposed to patches. The reality is that commercial populations have the same needs. The issue is appropriately identifying those patients and being open to partnerships.

HealthLeaders: What are your goals in the new role for the first 12 months?

Jain: Number one, I need to learn every facet of this organization. There's a lot that I don't know. I have that humility and my goal is to touch every department and understand the work with great depth.

The next piece of it is really clinical innovation. We need to focus on not standing pat, and on constantly working to build and scale new programs. For instance, we scaled a diabetes prevention program across our partners, in advance of CMS. We beat them to diabetes management.

We also have a brain health program that we're now implementing across our markets for patients with early dementia. We're also working on back pain programs, thoughtful introduction of digital health tools across our care model, and a pilot for after-hours care. I am also interested in recruiting spectacular new clinical leaders.

We'll be a who's who of individuals interested in transforming healthcare. As someone who didn't train in internal medicine too long ago, many people want to change the delivery system and don't have anywhere to go because most delivery systems are not transforming. So I want to be a magnet for the best physician talent who want to change healthcare delivery.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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