WellPoint Inc.’s Cerritos, Calif.-based subsidiary CareMore and Atlanta-based Emory Healthcare say they will team up to expand CareMore’s model of care management for Medicare Advantage patients in Georgia.
The move comes against the backdrop of further administration efforts to reduce government spending on Medicare Advantage and bring those costs more in line with traditional fee-for-service Medicare. Between this and the 2 percent cut to Medicare Advantage mandated by sequestration, the need to better manage the care of Medicare Advantage patients, especially those that are chronically ill or frail, is critical. According to the Agency of Healthcare Quality Research, 5 percent of seniors (those 65 years or older) account for 34 percent of all healthcare spending on seniors.
By partnering with a large established healthcare system like Emory, CareMore can expand into Georgia much faster than if it built its health plan from the ground up. Meanwhile, Emory benefits by being able to move into Medicare and manage both value-based reimbursement models and risk-based payment arrangements.
According to Wellpoint, CareMore currently serves nearly 70,000 seniors in California, Arizona and Nevada. It is a patient-centered care management model that emphasizes patient education, preventive care, mental healthcare and communication/coordination between providers with the goal of reducing costs by keeping plan members healthier overall. Wellpoint’s website notes that for Medicare Advantage plan members in the CareMore model, they have seen:
- 14 percent hospital readmission rates vs. 18 percent for traditional Medicare
- 56 percent reduction in the three-month hospital readmission rate for members with congestive heart failure
- Amputation rates that are 60 percent lower than the national average
- 40 percent reduction in stroke risk for hypertensive patients
- 40 percent lower hospitalizations for people with end stage renal disease vs. the national average
“CareMore has demonstrated the ability to replicate its results in different regions throughout the country. With our CareMore collaboration, we are eager to deliver those benefits to our patients, as well,” noted Richard Gitomer, M.D., president and chief quality officer of the Emory Healthcare Network, in a press release.
Emory Healthcare is the largest and most comprehensive health system in Georgia. In fiscal year 2013, it had $2.6 billion in annual net revenue and provided $80.3 million in charity care. Three years ago, it established the Emory Healthcare Network, which is a clinically integrated network of six hospitals and 200 provider locations. Currently, the network includes roughly 1,800 physicians in more than 70 specialties, including 237 primary care physicians.