Innovations in Reducing Cost & Improving Quality of Health Care

1. 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 70-80 percent of the cost.

4. CAREMORE Five Chronic Diseases' make up the vast majority of the 70-80 percent.

5. CAREMORE 30-40 percent of health care spending in the United States is waste.

6. CAREMORE 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 2006. • 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. FRAIL CARE MANAGEMENT CAREMORE CARE ACROSS DISCIPLINES Medical, Social, Psychological, Functional, Pharmaceutical

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

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

11. CAREMORE OUTCOMES ESRD • 25-30 percent fewer hospital admissions than the Medicare average

12. CAREMORE READMISSIONS • 13-14 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

13. CAREMORE DIABETES • Average HbA1cfor those patients attending the clinic is 7.01 • LDL – 100 • Effective control of Hypertension with wireless remote BP monitoring • Requirement for all diabetics with HbA1c eight times to be evaluated in the diabetes clinic

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

15. CAREMORE OUTCOMES FALLS & FRACTURES • 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

16. CAREMORE OUTCOMES MENTAL HEALTH • 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

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

20. CAREMORE CAREMORE A DAY IN THE LIFE • 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

21. CAREMORE

22. CAREMORE PREPAYMENT • Critical to success • Allows for rapid innovation • Allows for alignment

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

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

25. CAREMORE COMMENTS • 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