Innovating care delivery with ‘radical common sense’: An interview with CareMore CEO Sachin Jain

Value-based payments. Consumerism. Digital transformation. With all the sweeping changes health care CEOs face today, it can be easy to get lost in the jargon, hype and hope. But some improvements are more efficient, not to mention scalable, when simply going back to the basics.

And that is as true in care delivery as anywhere else, according to CareMore CEO Sachin Jain, MD. Prior to taking over as chief executive at CareMore, which is a subsidiary of Anthem, Jain held prominent positions at Merck, served at the Office of the National Coordinator for Health IT and the Centers for Medicare and Medicaid Services, among others.

Health Evolution Editor-in-Chief Tom Sullivan spoke with Jain about expanding care setting boundaries, managing high-cost complex patients, and why in the next five to 10 years health care CEOs are going to have to make some hard decisions to do the right things.

Health Evolution: It’s been a busy stretch for CareMore with the Welltower and SCAN Health initiatives. What’s the vision for those arrangements? What has happened so far?

Jain: CareMore and our sister company Aspire, which I also run, are really focused on taking care of the complex and frail patients differently. It flies in the face of the American egalitarian health care ideal that all patients should be treated equally. My view is that all patients should be treated with the care that they need. We’re trying to grow access to high-quality, integrated care.

Our model is really, really focused on just staying very close to the patients. CareMore and Aspire are working to bring care into the home — that’s where people want it, where they’re comfortable and have access to the people they love, their things, their pets. We’re trying to push the bounds of how care is delivered.

Health Evolution: How? What will those expanded boundaries ultimately look like?

Jain: Most care is delivered in hospitals and clinics, and that experience is not a good one. We’re trying to create a clinical experience that delights patients instead of frustrating them. I’ve never known a patient who had a restful night of sleep in the hospital, exactly when they need it most. We’re quietly running one of the largest hospital-at-home programs in the country.

Health Evolution: How big is the program? How many patients? What has CareMore achieved to date that other CEOs might not know about?

Jain: Many of the patients we serve have multiple chronic conditions, such as COPD, and just getting to and from medical appointments is a massive burden for them. We’ve partnered with Lyft and Uber around member transport. That’s the second-best thing; the best is when you don’t have to come in for clinical care at all. We have 200 patients. Many wouldn’t meet criteria for inpatient, but they’re either close or at high risk for readmission. So we deliver IV medications in-home, for example, as well as daily visits to ensure patients are getting the care and services they need. In Connecticut, we have a home based-medical group for dual-eligibles, and we’re extending that. People think of us a Medicare Advantage entity, but we’re now in Medicare, commercial markets, Medicaid. We’re in 12 states across all lines of business.

Health Evolution: We hear a lot about the challenge and opportunity of managing high-cost complex patients. What’s the reality check? Where is it working and where is it not?

Jain: The industry has really believed it can optimize the management of high-cost, high-need complex patients through technology and there are certain places, such as predictive analytics, where tech can work. But the key thing is that the intervention is a caring human, who can build a relationship with the patient, the family, to support and motivate them to actually get better. We’re too often looking for simple, scalable answers where what we really need to be doing is scaling a culture of high quality, high touch compassionate care for patients and families.

Health Evolution: Whether talking about more empathic care or a better patient experience, what will it take to get to wider practices of high-quality, high-touch care?

Jain: It’s going back to the basics and doing what needs to be done to serve patients. Our industry is overrun by jargon these days, we talk about value-based care, consumerism, digital transformation. Ultimately, I like to go back to basics and fundamentals and think about the care we want for ourselves and loved ones when they become ill. That leads to different answers than the industry is getting right now.

I love to use the phrase “radical common sense,” it’s a tongue–in–cheek attack at a lot of the conversation happening, for example, making sure before you prescribe insulin that the person can store it at a proper temperature.

Health Evolution: When you think strategically about 3-5 years into the future, what are your top priorities today? 

Jain: There are three pillars to this stool. One is aligning around the fact that most people think we have to spend a lot of effort to figure out where we need to go but when you’re really honest we all know where we need to go. The second is when you know where you need to go, there are tradeoffs. We talk about things like they’re win-win but the reality is a lot of things are win-loss. When you know where you need to go and accept the tradeoffs, the third pillar is executing and making those tradeoffs to get to the better state of where we need to be.

One of my bibles is Ben Horowitz’s book The Hard Thing About Hard Things, and in the next five to 10 years, with the inflation of healthcare spending, we’re going to need to do some hard things. The opportunity to innovate and create transformative care for patients is going to be hard. We have to do the right thing and we have to have business models that align around the right things. I think people hide too much behind policy as a disabler — we actually have a lot of policy to do the right things in the current framework.