CareMore: Improving Outcomes and Controlling Health Care Spending for High-Needs Patients

Martha Hostetter
Sarah Klein
Douglas McCarthy
Case Example
March 2017

This resource is a case study of CareMore, a Medicare Advantage plan and medical provider based in Cerritos, California, that serves 130,000 enrollees in Medicare and Medicaid managed care plans across six states.

  • CareMore’s business model is to identify high-risk patients and surround them with coordinated services. It invests capitated payments from Medicare in prevention and early intervention programs for all members, and provides supplemental benefits such as patient education programs and transportation to its Care Centers.
  • CareMore partners with independent primary care physicians in its networks to refer high-risk patients to its Care Centers, where multidisciplinary teams deliver and coordinate care.
  • CareMore members are much less likely to be hospitalized than Medicare fee-for-service beneficiaries. From 2011 to 2015, unadjusted all-cause 30-day readmission rates among all CareMore members fell from 16.1 to 13.9 percent.
  • Under the banner of Anthem, Inc., which acquired CareMore in 2011, the model is expanding to Medicaid beneficiaries in Tennessee and Iowa.
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