Caremore

CareMore, a subsidiary of Anthem Inc., is an integrated health plan and care delivery system for Medicare and Medicaid patients. The company was founded in 1993 by Sheldon Zinberg as a small, Southern California regional medical group. Today, CareMore serves 100,000 patients across 8 states with annual revenues of $1.2B. CareMore's President and CEO is Sachin H. Jain.

The company has developed a care model designed to target high-risk, chronically ill patients through focused care coordination, patient education, and proactive disease management. This model has resulted in costs 18% below industry average, while tangibly increasing quality: hospital admissions are 42% below national average, average length of stay is 32% below traditional Medicare FFS, and diabetic amputation rates are 67% below traditional FFS. These results have led some health policy experts to point to CareMore as one of the most innovative models to reform Medicare. However, CareMore has also been criticized as a one-off success story that will not be able to scale beyond its core markets.

CareMore Health System was founded by Dr. Sheldon Zinberg in 1991 in an effort to reorganize the healthcare delivery system to proactively manage health and improve quality in high risk populations. The company’s website highlights that the name “CareMore” was selected as a representation of its philosophy and mission-driven nature. By 1993, the group had grown to include 28 offices in the greater Los Angeles area. CareMore restructured in 1997 as a privately managed Medicare health plan, shifting its focus to primarily elderly, high risk patients. In 2003, it formalized this focus, becoming a Medicare Advantage (MA) plan. As an MA plan, CareMore embraced full capitation reimbursement, aligning its financial incentives with favorable patient outcomes.

In 2006, JP Morgan’s CCMP Capital acquired CareMore, refining and expanding the plan’s model of care. CareMore introduced a number of Special Needs Plans in 2007 that were aimed at high-cost, high-need patients with chronic diseases. By 2010, CareMore had expanded to Northern California, Arizona, and Nevada. Serving over 50,000 patients, CareMore was acquired by WellPoint – now Anthem – in 2011 for $800 million. Between 2011 and 2016, CareMore diversified its care delivery services by providing care to Medicaid and Dual-Eligible patients in CA, NV, TN, OH, and IA.

CareMore’s clinical model is designed to improve coordination across care settings and proactively manage patients with high-risk, chronic conditions. The company does this through three primary mechanisms: the CareMore Care Center, CareMore’s chronic care management programs, and the CareMore Extensivist.

CareMore operates neighborhood-based care centers that act as supplementary extensions of the patient's primary care physician offices. The goal of the Care Center is to provide a one-stop shop for care services, reducing travel time, likelihood of missing an appointment and duplication of efforts. Each Center provides a range of primary care medical services as well as podiatry, mental health services, diabetes management, wound management, hypertension management programs, and prevention services. In 2016, CareMore announced a partnership with the ride-sharing application Lyft to provide free rides for patients to the Care Center and further increase accessibility.

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