Alyssa Lane
Caremore Health, formerly known as Carelon Health, is an integrated healthcare plan and delivery system for Medicare and Medicaid patients. Founded in 1992 by doctors Sheldon Zinberg and John Edelston, Caremore was established to provide proactive and personalised care to patients, with a focus on improving the quality of care and better serving high-risk, chronically ill patients. Caremore has since expanded its services to nine states and serves 125,000 patients, offering convenient primary care services available in-person or virtually.
| Characteristics | Values |
|---|---|
| Name | Carelon Health (formerly CareMore) |
| Type | Integrated health plan and care delivery system |
| Founders | Sheldon Zinberg and Johnn Edelston |
| Year founded | 1992 |
| Focus | Elderly, high-risk patients with chronic conditions |
| Number of patients served | 125,000 |
| Number of states served | 9 |
| Annual revenue | $1.2 billion |
| Parent company | Elevance Health |
| Partner | Emory Health System |
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What You'll Learn
Medicare and Medicaid patients
CareMore Health (formerly Carelon Health) is a healthcare provider that serves members with original Medicare, Medicare Advantage, Medicaid, or group and private insurance plans. The company was founded by doctors who wanted to provide personalized and proactive care.
CareMore Health offers convenient primary care services available when and where patients need them—whether that's in a doctor's office, at a care center, virtually, or at home. The company's mission is to help people become the healthiest they can be by delivering personalized, whole-person care. This means that they provide support for patients who need help staying healthy, as well as those with chronic conditions that require more assistance.
CareMore Health's model of care is people-first and value-based, aiming to produce the best patient outcomes by treating the whole person. Their dedicated and compassionate care teams provide the preventive and supportive care that patients need most. CareMore strives to help patients manage and improve their health, reduce the symptoms and effects of ongoing health problems, and live healthier lives.
In October 2021, SCAN Health Plan expanded its relationship with CareMore Health by adding its providers to its Medicare Advantage plan networks in Arizona and Nevada. As a result, SCAN members in these two states gained access to 3,350 CareMore providers when SCAN launched in Arizona and Nevada on January 1, 2022. SCAN Health Plan is one of the nation's foremost not-for-profit Medicare Advantage plans, serving more than 220,000 members in California.
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Chronic disease management
Carelon Health, formerly CareMore, is an integrated health plan and care delivery system for Medicare and Medicaid patients. The company was founded in 1992 by doctors Sheldon Zinberg and John Edelston, with the goal of reorganizing the healthcare delivery system to proactively integrate and improve the quality of care.
CareMore has since expanded its services and, in 2015, partnered with Emory Health System to redesign its clinical delivery infrastructure and better manage chronic disease. This partnership has resulted in notable improvements in care quality, including a reduced 30-day hospital readmission rate.
CareMore's approach to chronic disease management is comprehensive and proactive. They offer 14 different disease management programs that provide personalized, whole-person care to patients with chronic conditions. These programs focus on prevention and upstream interventions, integrating mental health and social factors to improve overall health. CareMore's disease management programs have shown strong outcomes in Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, End-Stage Renal Disease, and Diabetes management. Their comprehensive approach has led to reduced hospital admissions, lower amputation rates, and improved patient outcomes.
The Care Center, a key component of CareMore's chronic disease management strategy, aims to be a one-stop shop for care services. It offers a range of primary care medical services, including podiatry, mental health services, diabetes management, wound management, and hypertension management programs. By providing accessible and convenient care, the Care Center reduces travel time, lowers the likelihood of missed appointments, and streamlines care services.
In addition to their disease management programs and Care Centers, CareMore also prioritizes accessibility and patient support. They partnered with Lyft in 2016 to provide free rides for patients to the Care Center, further removing barriers to accessing healthcare. CareMore's dedication to improving patient well-being and providing compassionate care extends beyond traditional medical services, integrating factors such as food, housing, and transportation to promote whole-person health.
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High-risk, chronically ill patients
Carelon Health, formerly CareMore, is an integrated health plan and care delivery system for Medicare and Medicaid patients. The company was founded in 1992 by Sheldon Zinberg and John Edelston with the goal of reorganizing the healthcare delivery system to proactively integrate and improve the quality of care.
CareMore initially focused on providing care for the elderly and high-risk patients. Over the years, the company has expanded its services and now offers specialized programs for patients with chronic conditions such as diabetes, heart failure, chronic obstructive pulmonary disease (COPD), and kidney disease.
CareMore's model of care is based on the concept of "whole-person care," which aims to address all aspects of a patient's needs. They provide convenient primary care services that are available in various settings, including in-person at a doctor's office or care center, virtually, or even at the patient's home. The company also has a strong focus on prevention, early intervention, and improving patient outcomes while reducing the cost of care.
One of the key features of CareMore is its dedication to forming trusting relationships with members. Their clinical teams often serve as the first point of contact for patients' urgent medical needs and concerns. This personalized approach to care has led to improved engagement and treatment plan adherence, helping patients stay medically stable and healthy.
In addition to their clinical services, CareMore has also partnered with ride-sharing companies like Lyft to provide free rides for patients to their care centers, further increasing accessibility and convenience for their patients.
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Proactive disease management
Carelon Health, formerly CareMore, is a health insurance company that provides integrated healthcare experiences for Medicare and Medicaid patients. The company was founded in 1992 by doctors Sheldon Zinberg and John Edelston with the goal of reorganizing the healthcare delivery system to proactively integrate and improve the quality of care.
CareMore's approach to proactive disease management is centred around its Care Centers, which offer a range of primary care medical services, including podiatry, mental health services, diabetes management, wound management, and hypertension management programs. The goal of these Care Centers is to provide a one-stop shop for care services, reducing travel time and the likelihood of missing appointments.
After a comprehensive medical evaluation, patients with chronic conditions are enrolled in one of Carelon Health's 14 different disease management programs. These programs focus on prevention, early intervention, and member well-being. Carelon Health's interdisciplinary care team periodically monitors disease-specific metrics to determine whether a patient requires more intensive management. This proactive approach to chronic disease management is designed to minimize the probability of an acute episode of care.
CareMore has seen strong outcomes in its disease management programs for Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, End-Stage Renal Disease, and Diabetes. For example, CareMore's diabetic amputation rate is 67% lower than the average. In addition to its disease management programs, CareMore has also formed partnerships with other healthcare systems, such as Emory Health System, to redesign clinical delivery infrastructure and improve care quality.
Overall, Carelon Health's proactive disease management approach is focused on providing personalized, whole-person care that improves patient well-being and contributes to their longevity. By integrating care across the healthcare system, they aim to make complex condition management easier and more accessible for their patients.
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Primary care services
Caremore, now known as Carelon Health, is a healthcare provider that offers comprehensive and coordinated care, with a focus on Medicare beneficiaries. The company provides primary care services that are personalised, comprehensive, and coordinated. Carelon Health's primary care services are available to those who want to maintain or improve their health, as well as those with serious, complex, or chronic conditions. This includes conditions such as arthritis, diabetes, cancer, heart disease, high blood pressure, and chronic kidney disease.
Carelon Health takes a whole-person care approach, addressing not only the physical symptoms of a patient but also their social, environmental, and behavioural health. The company's primary care services are designed to be patient-centred and proactive, with a focus on improving patient outcomes. This involves the coordination of primary care doctors, specialists, and care managers working together. Carelon Health also provides telehealth services, allowing patients to consult with healthcare professionals remotely.
One of the key features of Carelon Health's primary care is the relationship between the healthcare providers and the patients. The doctors and nurses at Carelon Health take the time to listen and develop friendly and familiar relationships with their patients. This compassionate approach has led to improved patient experiences and increased patient satisfaction.
Carelon Health's model of care has resulted in reduced costs and improved outcomes, particularly for elderly patients. The company provides direct care for its frailest elderly patients and has developed an integrated patient care delivery system. This system includes hospital-based physicians, nurse practitioners who manage specific chronic conditions, and nurse care managers who handle remote home monitoring data and build trusting relationships with patients.
Carelon Health's primary care services are currently available in Arizona, California, Iowa, Nevada, North Carolina, Tennessee, and Texas. To access their primary care services, individuals need to be enrolled in a health plan that includes Carelon Health, such as a Medicare or Medicaid plan, or a group or private insurance plan in certain states.
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Frequently asked questions
Caremore, now known as Carelon Health, is an integrated health plan and care delivery system for Medicare and Medicaid patients. It was founded in 1992 by Sheldon Zinberg and John Edelston.
Caremore was founded by doctors who wanted to provide personalized and proactive care. Its mission is to help people become the healthiest they can be by delivering whole-person care. Caremore works to improve the quality of care and make healthcare more accessible and integrated.
Caremore caters to patients who need help staying healthy or have chronic conditions that need more support. It specifically targets high-risk, chronically ill patients and has a focus on elderly patients.
