Episode #56 – Customized Care for an Aging Population with Sachin Jain MD

There are numerous reasons to focus on caring for our aging population.  First, it’s the right thing to do.  Second, the utilization of care and medical costs in the older population with more complex and chronic medical conditions are tremendous.  For example, the budget for Medicare jumped $300 billion between 2007 and 2017.  In fact, Medicare costs are the 2nd largest federal expenditure, next to social security.  Third, these costs are continuing to rise. It’s predicted that per capita Medicare expenditures will rise at least 4.6% annually for the next decade.  At present there are over 60 million people enrolled in Medicare with an estimated 10,000 more enrolling each day.  It’s an unsustainable situation, from a cost perspective.  Finally, we know that there are significant opportunities for improvement – in care, outcomes, and cost.

Our guest today represents an organization that is addressing this issue in new and better ways.  Sachin Jain is the CEO of CareMore. Founded in 1993, CareMore is a prepaid integrated delivery system and health plan that provides medical care to approximately 150,000 Medicare & Medicaid patients in over 40 clinics across nearly a dozen states.

Dr. Jain brings a remarkable background to leading CareMore. He received an MD, an MBA, and his residency training in Internal Medicine, all within the Harvard system.  He has held a number of positions at the Centers for Medicare & Medicaid Services (CMS) and CMMI (the CMS innovation division).   He has also published over 100 peer reviewed journal articles.

Some of the major points that Dr. Jain will share in this episode include:

• Why we need to move away from a generic primary care model to more customized models of care, such as for the older patient with complex chronic conditions.

• The various approaches that CareMore takes to address the Social Determinants of Health such as transportation, nutrition, physical fitness and care in patients homes.

• How CareMore reorganized the physical infrastructure of their clinics to address the issue of Social Isolation and Loneliness – what has been termed “an epidemic in plain sight”.

• Their industry leading “Togetherness Program” as well as other programs that also address social isolation and loneliness.

• CareMore’s method for reducing hospitalizations and readmissions, and how they markedly reduce healthcare costs through their focus on transitions of care.

Throughout this interview, Dr. Jain shares CareMore’s compelling story – what makes their model profoundly different from and better than the generic primary care medical home model. One other theme I found encouraging is the attention CareMore pays to the professional development and sustainment of its providers and staff.  The thinking that providers should have an ‘owner’ vs. ‘employee’ mentality speaks to one of the major crises of healthcare today – provider and staff burnout.  As Sachin states, if we’re going to save healthcare, we’re going to have to really support the people who are actually providing care.

There are numerous lessons to be gleaned from this interview – from CareMore’s focused segmented approach, to their highly coordinated care model, to their focus on social determinants of health and social connectivity, to their attention to sustaining the professionalism and engagement of their providers.  Dr. Jain and his colleagues at CareMore refer to it all as “Radical Common Sense”.  And, that’s exactly what it is!

As always, I hope you get as much out of this interview as I have.

Zeev Neuwirth, MD