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U.S. healthcare is broken. Sachin Jain and colleagues want to help transform it

By | October 12th, 2016 | Blog | Add A Comment

 

Sachin Jain: “I’ve always been drawn to problems related to our failure to effectively apply the knowledge that we already have. Healthcare is full of those problems.”

 

Classic content: One in a series of interviews with Modern Healthcare’s Top 25 Minority Executives in Healthcare for 2016.

 

In his mid-30s, the laundry list of accomplishments that Sachin Jain, MD, MBA, has already achieved stretches like the curriculum vitae of an executive twice his age. As a medical student at Harvard, he and some friends started a medical clinic for the homeless. He eventually became a lecturer for Harvard Medical School and was a physician for Brigham and Women’s Hospital and the Veterans Affairs Boston Healthcare System. He and a friend founded a new medical journal that is growing by leaps and bounds.

 

He was a senior advisor to Don Berwick at CMS and has been a leading advocate for quality and safety. He was the chief medical information and innovation officer at Merck, the pharmaceutical giant. Now, he’s the president of CareMore Health System, an innovative blend of payer and provider that’s owned by Anthem.

 

So what exactly drives this guy?

 

“On some levels, it’s outrage,” Jain says candidly. “Healthcare could be better and should be better. I’ve always been drawn to problems related to our failure to effectively apply the knowledge that we already have. Healthcare is full of those problems.”

 

The mission aspect of healthcare comes naturally to Jain. His father, Subhash Jain, MD, founded the pain management service at Memorial Sloan Kettering Cancer Center. One of his aunts, Shanti Jain, MD, went against the grain in her native India by opting not to marry. She devoted her life to rural healthcare in India, going places other clinicians were loathe to go.

 

“She was somebody who saw problems in the world and came up with solutions,” says Jain of the woman who was an early pen pal of his as he grew up in New Jersey. “It wasn’t just about healthcare. She went to one community and saw the kids didn’t have a good education, so she built a school. She saw that the sanitation system was an obstacle to good healthcare so she started fixing the tatters of the sanitation system there.”

 

When Jain’s aunt died of ovarian cancer, her sister, Kanti Jain, MD, who was a diabetes researcher at Cornell University, moved to India to take over the work. Jain says he himself toyed with the idea of moving to Asia as well but decided against it, although he has volunteered with the medical mission there.

 

“Somewhere along the way, as the first person in my family to be born in the U.S., I became American and decided that America was my home,” he says with a chuckle. “And, frankly, I also had this realization that there are lots of people suffering from healthcare injustices right in our own back yard.”

 

With a background that includes mentors like Berwick, David Blumenthal (now head of the Commonwealth Fund) and Michael Porter (author and economist at Harvard Business School), Jain says he feels he has found an ideal outlet at CareMore for his passion around quality and safety. The organization actually was founded as a physician group by California gastroenterologist Sheldon Zinberg, MD, who created an innovative way to care for chronically ill elderly patients.

 

 

The idea is to be omnipresent via extensivists, who provide continuity of care, as well as home care to help prevent readmissions, whether that means supplying car rides to the doctor’s office or even delivering a refrigerator to keep insulin cold. It morphed into a health plan, focused on Medicare patients, and is now is a $1.2 billion enterprise that has more than 100,000 members in eight states and manages care for Medicaid patients in Memphis and Des Moines as well.

 

The results have been impressive:

 

• CareMore’s patients are hospitalized 20 percent less than the industry average, even though its population tends to be sicker than the average Medicare patient. (If one adjusts for the health of the patients, the admission rate is 40 percent less.) • Its Congestive Heart Failure program participants on average experience 43 percent fewer hospital admissions than the average Medicare patient with CHF. • For patients with end stage renal disease, there are 45 percent fewer admissions.

 

And its members pay lower costs as well.

 

Jain admits that the CareMore model won’t fit every situation. “The CareMore model is disruptive and transformative, so we have to be very thoughtful about how and where we integrate and pilot it,” he says. “But I do think there are a number of opportunities to take the work that we’ve done successfully serving Medicare patients to serve similar patients in commercial and Medicaid populations.”

 

It’s also making its presence felt in academic medicine circles. Leaders at Emory Healthcare in Atlanta recently chose CareMore to help them transform their care model for Medicare Advantage patients. It’s a provider-payer relationship that Jain says he is excited about.

 

“The leaders at Emory were visionary in their thinking that a California-based managed-care company could be a transformation partner,” Jain says. “They were able to think beyond the stereotypes of the payer industry and get into the guts of what CareMore actually does – and how it might be relevant in their setting.”

 

A year after joining CareMore as chief operating officer and chief medical officer, Jain was promoted to president in April 2016. With that distinction, he joins a growing list of physicians who are at the helm of healthcare organizations. He continues to see patients on a limited basis, and says he knows why physicians are willing to take on a bigger role.

 

“For the first time, you have a generation of physicians who are seeing that the system is broken,” Jain says. “They believe they can and should lead change, and that their insights as physicians can drive better care.

 

“We want to deliver better healthcare. We want to bring back the joy of work to actually delivering healthcare. There are few better jobs in the world than being a physician or a nurse where you get to take care of patients and be a part of their lives in that intimate way. There’s nothing quite like it.”

 

 

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