CareMore’s Role in Changing the Healthcare Landscape: An Interview with Ali Khan

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What was your background prior to coming to CareMore, and how did you end up at CareMore?

 I had a little bit of a circuitous path to get to CareMore. I actually went to college for investigative journalism, focusing on social issues. While I loved journalism, I eventually became frustrated by seeing social problems that I couldn’t directly impact. Ultimately, this led me to pursue medical and public policy degrees – as I saw medicine and policy as powerful tools for social change.

 After medical school, I wanted to go to ground and get my hands dirty by putting into action the principles I had studied. I started my career at Iora Health, an innovative primary care system based out of Boston. Iora was a fantastic experience, and I got to help the company expand and open new markets as well as adapt to the early changes Medicare Advantage brought.

 After Iora, I knew I wanted to continue working in the integrated payor / provider space. However, I preferred the culture and more nimble model of smaller companies – which eventually led me to CareMore. I was immediately drawn to the company’s innovative approach and complete alignment of incentives. Generally, CareMore acts as the integrated payor and care delivery team, either directly or through capitated arrangements. This alignment lets the company set up systems that most of American healthcare simply cannot. In particular, CareMore has the ability to offer three resources most of our healthcare system can’t – time, resources, and follow through. We have the time to work directly with patients to better explain care options and pathways. We can deliver resources to our patients that normally wouldn’t be available in fee for service medicine. And we follow through to make sure that all of our patients are receiving the best care possible for them. With this innovative approach and ability to help so many patients, it was hard for me to say no to a role at CareMore!

 

You’ve had a few different roles at CareMore, can you describe what those have been?

My first role at CareMore was as Regional Medical Officer in Santa Clara and San Jose, where I managed an internal P&L with 9,000 patients. My role was to manage our health plan, clinics and patient care – all while doing right by our patients and offering high quality, consistent care. I managed teams of people across multiple disciplines, from behavioral health to nurses to primary care.

After a few years of growing and improving our business in California, I accepted a role in Clinical Product Design and Implementation. In this role, I focus on three things – taking local innovations and scaling them nationally, launching new markets, and internal incubation of innovative concepts. One example of this would be taking a principle we used in San Jose – stratifying patients into distinct cohorts and creating different operational goals for each cohort – and expanding it to markets outside of San Jose. This was a concept that we had a lot of success with in San Jose, and it ended up being quite successful in other geographies as well. In this new role, I can take many of the learnings I had as Regional Medical Officer and affect change on an even larger scale than before.

Your new role sounds fascinating – do you find it difficult to scale local programs nationally?

Being aware of the needs of each local market is definitely one of the biggest challenges of my new role. CareMore’s business model can vary be different in each geography, and the healthcare needs of each market can be incredibly different. In some markets, social determinants are the biggest factor influencing healthcare in the region, in others it might be utilization or even state policies.

We always strive to be thoughtful about what makes sense for the market and what makes sense for CareMore. We do this through a combination of research – including physician and patient interviews in addition to traditional secondary research – and working with local partners, who inevitably know the market better than we do when we first enter. In this way, we can adjust and customize our business model to make sure we provide the highest quality care possible to our patients.

 

What other challenges have you and the company seen driving change in healthcare?

Recruiting care providers and patients in each region we operate can be challenging. Our model is quite different from the way healthcare has operated in the US for some time, and these differences can require a lot of education to explain. Of course, many physicians and care providers are intrinsically excited about this model – but many more don’t know anything about CareMore. We try very hard to be a thought leader in the industry and increase our channel engagement to get the word out about our company and model. This thought leadership, combined with a vision about how to manage people and teams that is authentic and humble, has allowed us to recruit smart people and do great work – but it takes a lot of time and effort.

Converting patients can be difficult as well. We try to target our marketing effort towards patients that we think would most benefit from our care model. In addition to this, we spend a lot of our time designing benefits plans that would be most attractive to these types of patients. And while we do market towards patients, we also have incredibly high standards for our customer service – which we think gets people to vote with their feet and stay with us over time.

 

What are CareMore’s most important growth drivers in the near future?

We expect three large factors to contribute to our growth in the short term. First, we want to continue to take advantage of the growth in managed Medicaid plans. These have seen dramatic growth recently, and new markets here should continue to drive growth for us. Second, we want to continue to grow deeper in the markets where we currently operate. This includes both growing the patient population for our legacy plans, as well as growing in payor agnostic ways in markets where we currently operate. We believe we have the ability to help patients on other health plans, so we want to focus there to grow in our existing markets. The third area of growth for us is our unique partnerships in the healthcare landscape. We have had the good fortune to partner with large and well-known providers in the US, assisting them with preparing for risk as our healthcare system transitions away from fee for service medicine. In addition, through CareMore@Home we have been able to partner with providers to offer intensive management of home health for our patients. This has allowed to be faster and more nimble in some markets, while offering incredible value to our patients.

 

Lastly, it seems culture is important as a part of CareMore’s success – how has the company created and maintained a successful culture as it’s grown?

Culture has been extremely important for us, and we have tried to be very thoughtful and intentional about how we build and maintain the best culture for our organization. We try to think about this at all points in an employee’s journey with CareMore. First, we’re thoughtful about how to interview and select the right people for our organization. We look for people that take on risk, with intellectual curiosity, and that are energized by working with other people. From there, we have made substantive investments in our professional development and longitudinal cultural development for the time that people are with our organization. We have also institutionalized the idea of being focused on greater goals for the organization, which includes features like individuals not having bonuses tied to their own performance, but rather to the performance of their team. We have been iterating on these choices for 25 years, and we continue to refine and improve how we set up our teams to function at a high level.

And at the end of the day, we make sure the whole organization is focused on the same question – how can we provide great medical care? Since we’ve grown so much, we operate in geographies with a lot of variability. Being thoughtful about our organization’s culture and making sure everyone is striving for the same end goal has helped us maintain the spirit that has made us successful so far.