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AJAC Interviews Sachin H. Jain, MD, MBA, Chief Medical Officer, CareMore

Laura Joszt, MA
The American Journal of Accountable Care recently interviewed Dr Jain about his decision to join CareMore, CareMore's innovative care model, and his perspectives on US healthcare.
Sachin H. Jain, MD, MBA, recently joined Anthem’s CareMore Health System as its chief medical officer. CareMore is an innovative healthcare delivery system that originated in southern California but now extends to 7 states and cares for over 100,000 patients in the Medicare Advantage and Medicaid programs.

Dr Jain was previously chief medical information and innovation officer at Merck, Inc, a lecturer in healthcare policy at Harvard Medical School, and an attending physician at the Boston VA Medical Center. Previously, he was special assistant to the national coordinator for health information technology; senior advisor to CMS; and a member of the faculty at Harvard Business School. Dr Jain is also an editorial board member of
The American Journal of Managed Care.

The American Journal of Accountable Care recently interviewed Dr Jain about his decision to join CareMore, CareMore’s innovative care model, and his perspectives on US healthcare.

AJAC: What do you see as the biggest issues in American healthcare?
For years, there was a stark, unmistakable void in US healthcare: access to care and coverage. With the passage of the Affordable Care Act, we are quickly moving onto improving the delivery system. We are haunted by the huge gap between the potential of what we know we can deliver to patients and the reality of what they receive in practice. We know instinctively that we can do better, yet we struggle with how to do so.

AJAC: You recently joined CareMore as chief medical officer. How did you end up there?
A few years ago, while working as part of the team launching the Center for Medicare and Medicaid Innovation, I had the opportunity to get to know organizations in the vanguard of improving the value of care: namely, organizations that were successfully working to do more for patients with less. Among these was CareMore.

AJAC: How is patient care at CareMore different from patient care in other leading healthcare systems?
The value of a system like CareMore is perhaps best understood in contrast. When I was a physician in Boston, I had the pleasure of taking care of woman we will call Elizabeth Owens (name changed to protect patient privacy). Ms Owens was well known to most of the other physicians because she was sassy and had a sharp tongue—and spared no opportunity to use it.

Her hospitalizations were varied in their causes: one time it was cellulitis that progressed into a non-healing ulcer; another time it was hyperglycemia and congestive heart failure; and yet another time, it was blocked dialysis access.

Nothing we ever did seemed to work. She seemed to be in the hospital almost as often as we were. I will always remember another physician remarking to me about Ms Owens: we can cure her difficult medical problems, but we can’t fix her difficult life. This was the type of frustration and philosophizing that Ms Owens would prompt.

Now, over time, I was able to get to know and bond with Ms Owens and I came to understand that her problems were as much social as much as they were medical.

She was lonely and frustrated. She could never make her outpatient appointments because she had no one to bring her to them. She had a fundamentally poor understanding of her diseases, her therapies, and her care, and she was frustrated by a system that never seemed to give her what she needed to stay well—but was more than happy to hospitalize her when things became bad enough. Anyone who has spent time in the trenches of care delivery knows that patients like Ms Owens populate our nation’s healthcare system—patients whose needs are part medical, part social, and entirely unaddressed by our dominant models of care. Ms Owens had good insurance; she had access to America’s best hospitals and top-notch clinicians, yet somehow they were all ineffective.

At CareMore, Ms Owens might have had regular access to a nurse practitioner who could visit her home as the need arose. She would have regularly visited a community-based comprehensive care center with integrated disease management programs for the most common chronic diseases of the elderly. She might never have been admitted for heart failure because measurement of her weight by tele-weight scale would enable medication adjustments before her condition worsened. She might never have lost her dialysis access because of the regular maintenance and cleaning administered. She might not have missed her appointments because she would have been given transportation to and from. And she might not have suffered a non-healing ulcer because the wound care and prevention program would have aggressively managed it so that it did not become bad enough to require hospitalization.

And on the rare instance where she did need hospitalization, she would be treated by an extensivist physician who would not just see and manage her in the hospital, but also during her rehabilitation facility stay and subsequently in clinic to follow up. That physician would have time for her—because for producing understanding in a patient, there is no substitute like time.

The typical errors at hand-off—medication errors and discontinuities in her care plan—would be less frequent because care would be consistently delivered by a well-functioning, highly organized team that has built the institutional memory necessary to deliver high-quality care.

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