Podcast with Grace Bell (WG ’17) | CareMore

The hot take: A consistent mentor in the Wharton HCM community, Grace Bell is has long been at the forefront of managed care. From her time in implementation consulting, to the New York City Department of Health and now to Specialty Operations at CareMore, Grace builds solutions for high needs patients across the spectrum. In this episode we dive into CareMore, her roles and Grace’s take on the managed care landscape.

Grace’s career path before and after CareMore (0:00 -5:15 ):

• Philly native, interned at UPENN Health System during college at Case Western + years of research in electronic health records
• After college: Huron Consulting in clinical operations and change management implementation
• New York City Department of Health, implementing EHRs in small private practices primarily for non-english speaking clinics
• Interned at Rittenhouse Ventures during MBA
• Joined CareMore after graduating from Wharton

Brief overview of CareMore (5:43-10:25):

• CareMore founded in 1993 as a risk-bearing provider group until 2006, at which point it was purchased by a PE group and also became a health plan
• Anthem insurance acquired CareMore — now CareMore is an independent subsidiary and again a delegated provider group
• Chains of clinics focused on disease managements with strong behavioral health and specialty components, along with mobile delivery solutions
• Patients is primarily Medicare and Medicaid, with commercial initiatives coming soon in 2019
• CareMore is a care delivery arm of health plans, for high-risk patients

Trends in Managed Care (10:25–15:20):

• This may finally be the time for managed care, as opposed to the 90s when we first tried, because now we assign a dollar value to care delivery and quantify quality
• CareMore is full risk, which allows for the entity to think holistically about the patients
• ACOs and IPAs are only at risks for certain aspects
• Need deep integration between the plan and provider for joint benefit design to be successful

Evolution of Grace’s roles at CareMore (15:45–25:20):

• June K. emailed Sachin Jain (CareMore CEO) on a Tuesday, Grace was out in LA interviewing that Friday
• Had the opportunity to run Specialty Operations — strategy and ops across specialty care (cover ~10 different specialities)
• CareMore: “Leverage the specialists to create a confident generalists”
• PCPs and disease management Nurse Practitioners have strong connections and easy access to specialists
• Example of an ongoing project #1: Chronic Kidney Disease education platform, partnered with the National Kidney Foundation, for patients, generalists, dietitians and nephrologists
• Example of an ongoing project #2: Behavioral Health is largest specialty employed at CareMore, both therapy and psychiatry. Making every member of care delivery team comfortable and equipped to engage with questions.

CareMore initiatives for Seniors (28:00–31:00):

• “Togetherness Program” is CareMore tackling the senior loneliness epidemic: supported by volunteers within the company, patient talks with a paired employee, once a week. Helps with referrals, long term check ins, socialization…shown marked improvement in health outcomes.

Hiring MBAs at CareMore (31:00–33:00):

• Hiring two Wharton MBAs in 2018, Grace came on in 2017, looking to hire more!
• Have central offices in Southern CA and NYC
• Newly acquired Aspire Health, palliative care company based in Nashville, TN which will be hiring
• Regional sites in: AZ, CA, CO, CT, District of Columbia, IA, NV, TN, TX, NY…CareMore will be in 12 states very soon
• Roles: Strategic or Operational are good fit for MBAs

Two themes Grace has seen in her conversations with students (33:00–35:00):

• People want to learn more about Managed Care, how CareMore works and why Primary Care matters
• How to make the transition from being in a 3rd party role (consulting, VC, etc) to an actual operational role…“near the thing but not actually doing the thing”…this can be challenging and you need the find the right fit