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Posted by Sarah Brown on 10 Nov '14

What we can learn from a simple idea

{img_title} I first read about CareMore in the book  Demand (Slywotzky & Weber, 2011, p. 76) and was blown away by the inspirational story of how an American healthcare provider offering state funded care was providing ‘good’ health care which changes lives and saves the state money. The simple common sense routines which are focused on the patient as a person work and save almost 20% on overall costs. Like any good strategy they focused on market needs.

“If you put people before profit, you will profit” Zinberg, CareMore

Looking at the market Sheldon Zinberg in the late 80’s identified an aging population with lots of specialists dealing with individual bits of their care but no coordinated care or simple support to prevent problems. He was prompted to look at the market because of pressures on finances and if that was so then how much more so is it true now. The unmet need identified was for coordinated person-centred care ranging from preventative measures to acute care. It took him several years to develop the service which initially was not just for the elderly but then became focused on this sector because of financial constraints.

What developed is not rocket science but does meet clearly unmet needs. CareMore works with the elderly. It identified unmet needs often just be watching. For example up to a third of old people failed to show for appointments not through wickedness but lack of transport so they provide free transport to get people to appointments. They considered nonmedical problems which are not addressed in medical school. Someone who is frail gets a house check to remove dangerous rugs that might cause a fall and then monthly gets toe nails cut to reduce dangers of tripping as well as access to exercise sessions to increase muscle strength and stability. They provide talking pill boxes to remind people to take pills, they give people with congestive heart failure scales linked to the surgery and get them to weigh themselves daily so that they get early warning of problems with the heart which are indicated by sudden weight gain. In the first six months of using the scales hospital readmissions for congestive heart failure fell by over half.

A subject close to my heart is their focus on diabetes. For example, instead of leaving wounds or treating in an ad hoc way they set up a wound clinic staffed with nurses caring for the small cuts and providing regular monitoring to prevent the deterioration that can be the start of a problem leading to gangrene and amputation. The result-a reduction of more than 60% in amputations. The whole focus is on early stage treatment and diligent follow up.

A diabetic being cared for by CareMore initially has a comprehensive medical assessment, is monitored across a range of areas monthly with plan adjustments as necessary, gets nutrition and exercise support, wound care management and supplies and routine foot care to avoid unnecessary amputations.

Each patient has someone responsible for overseeing all aspects of their health and coordinating the potentially many specialists and the patient background. The focus is on the sickest 15% who cause 70% of the costs and the aim is to avoid hospital stays down by a quarter and readmissions down by a third. When in hospital CareMore patient stays are almost 40% shorter than the norm.
CareMore in meeting an unmet need is improving the quality of life for older people, reducing costs, making more profit and increasing the job satisfaction of the medical professionals it is working with. Zinberg had to convince the private medical community in the US and to prove what he said: “If you put people before profit, you will profit”

By apparently doing more and things not traditionally done by doctors it has saved money with its costs being 18% below the industry average.