Innovations in Reducing Cost & Improving Quality of Health Care Donald S. Furman, M.D. ~ Chief Medical Advisor CAREMORE “It’s what we do”.

2 Opening Slide  Edward Deming  “Improve constantly”  “Build quality into the product”  Peter Drucker  “Knowledge has to be improved, challenged and increased constantly, or it vanishes”  “ the best way to predict the future is to create it”

3 CAREMORE 20 percent of the Senior Population utilizes percent of the cost.

4 CAREMORE Five Chronic Diseases' make up the vast majority of the percent.

5 CAREMORE percent of health care spending in the United States is waste.

6 Chronic Diseases’ can be managed, but usually are not.

7 CAREMORE CareMore began in 1993 as a Medical Group with enrolled Medicare beneficiaries. It became CareMore Health plan when it obtained a CMS contract in 2001 and began offering a chronic care Special Needs Plan (CSNP) in  Since inception, CareMore recognized that chronically ill and frail seniors received uncoordinated, often inadequate, and unnecessarily costly care from the existing “system.”  CareMore has become a healthcare management system that coordinates and integrates care for chronically ill and frail seniors. It has organized a system to effectively care for those 20 percent. CareMore recognized that the present legacy healthcare system does not work.

8 CAREMORE Medical, Social, Psychological, Functional, Pharmaceutical CARE ACROSS DISCIPLINES FRAIL CARE MANAGEMENT

9 CAREMORE Care Across Sites  Hospital  Medical Office  Home  SNF  ALF  Custodial  Under a Bridge FRAIL CARE MANAGEMENT

10 CAREMORE  78% fewer amputations in Medicare diabetics than the national average OUTCOMES

11 CAREMORE  percent fewer hospital admissions than the Medicare average OUTCOMES ESRD

12  percent all cause hospital readmission rate at 30 days  National average in Medicare is 20%  We believe we are on the way to doing much better CAREMORE READMISSIONS

13 CAREMORE  Average HbA 1c for those patients attending the clinic is 7.01  LDL – 100  Effective control of Hypertension with wireless remote BP monitoring  Requirement for all diabetics with HbA 1c eight times to be evaluated in the diabetes clinic DIABETES

14 CAREMORE  No hemorrhagic complications in the last 5 years ANTICOAGULATION CONTROL

15 CAREMORE  Clinical review and customized/supervised strength and fitness programs have led to 89% decrease in falls and 80% decrease in fractures as compared to national CDC study  Health plan benefits are clinically directed so OTC’s like Calcium and Vitamin D are free OUTCOMES FALLS & FRACTURES

16 CAREMORE  No barriers to care  Coordinated with the rest of the system  Care broaden to SNF’s custodial home and the home  Families included  Third decrease psychiatric in admissions; 50% decrease in psychiatric hospital length of stay OUTCOMES MENTAL HEALTH

17 CAREMORE  Extremely low disenrollment rate  High levels of provider satisfaction  Very low MLR  Benefits are usually best in the markets in which we participate

18 CAREMORE  Comprehensive, Coordinated, Longitudinal care for the 20% of the members who are frail  Constant clinical vigilance and predictive modeling to identify those in the 80% who may be becoming frail  Wellness and preventative maintenance of the 80% who are not frail; supported by infrastructure and technology to prevent any gaps in needed service

19 CAREMORE CAREMORE INTEGRATED PATIENT CARE DELIVERY SYSTEM A Cohesive Center of Gravity Diabetes and Wound Care Program Dietary/Nutritio n Counseling House Call Team Strength and Balance Training First Fall Program Effective Specialists On-Site Diagnostic Lab Community Resources 24-Hour Care Management Smoking Cessation Program Senior Patients Case Manager/ NP Extensivist Clinical Care Centers (CCC) PCP CHF Program CKD Management COPD Management Hypertension Management Mental Health Program Transportation Services Clinical Pharmacy Program Provider Portal ESRD Management Co-Morbidity Management Crisis Intervention Team Nifty After 50 Palliative Care Team Hospice Clinical IT Anticoagulation Program Pre-Op Clearance Hospital Wireless Blood Pressure Monitoring Healthy Start Program

20 CAREMORE  CAREMORE SERVES 30,000 MEMBERS THROUGH 11 CARE CENTERS IN LOS ANGELES AND ORANGE COUNTY CALIFORNIA  ON AN AVERAGE BUSINESS DAY, CAREMORE… *Proprietary  Provides more than 900 rides to patients to and from points of care *Prepaid  Makes or receives 3,385 phone calls arranging for care *No outsourcing  Sees 40 new members to assess health and establish personal care plans.  Provides more than 950 hours of homemaker services for the frail  Visits 27 homes to provide care or social support  Engages 4 families in end-of-life/hospice planning  Makes 235 follow up calls to patients in care programs  Provides 191 strength training sessions  Makes 90 care visits to patients residing in nursing homes/assisted living  Reads 567 blood pressures from monitors in the homes of hypertensive patients  Reads 369 weights from monitors in the homes of chronic heart failure patients  Sees 413 patients in our Care Centers for follow up and chronic care management CAREMORE A DAY IN THE LIFE

21 CAREMORE

22 CAREMORE  Critical to success  Allows for rapid innovation  Allows for alignment PREPAYMENT

23 CAREMORE  Decrease total cost of care  Improve quality  High patient and system satisfaction NATIONAL IMPERITIVE

24 CAREMORE  Rapid rate of hypothesis generation, testing and implementation  Continuous care model and performance improvement

25 CAREMORE  We can bend the cost curve in the Medicare population; payment reform is a critical driver in order to make this happen nationally  Medicare FFS System will not be the vehicle to signify decrease cost/increase quality COMMENTS