The healthcare system in the United States is hopelessly fragmented. While most physicians now have an Electronic Health Record system, each system operates in a silo without sharing information. Even with a medical delivery system as comprehensive as CareMax’s, patients still occasionally receive care at hospitals and outside specialists, leading to primary care physicians having an incomplete picture of patients’ healthcare. Even worse, the cognitive load that a physician must undergo during an office visit – keeping on top of the myriad quality guidelines and coding requirements – becomes a distraction from focusing on the patient and leads to physician burnout.
Knowing this solution was untenable, CareMax’s Chief Executive Officer Carlos de Solo, challenged his Chief Strategy Officer, Ben Quirk, to develop a solution. “We surveyed the market and found that most products were written for the middle – not groups constantly innovating like CareMax,” explained Quirk. “As a result, we developed our own solution.”
The CareOptimize solution gathers data from across the healthcare continuum, including labs, claims, hospital, specialty, pharmacy and home medical equipment data. The data are then run through CareOptimize’s proprietary artificial intelligence rules and CareMax’s best practice guidelines to deliver actionable data at point of care. “Ensuring our physicians had a one-stop shop with carefully curated data at point of care was critical,” remarked de Solo. “Having another portal or plug in was going to distract the physician. We needed a seamless solution.”
The results are self-evident in CareMax’s clinical outcomes when compared with traditional Medicare:
Realizing that the CareOptimize technology had the ability to transform care outside of CareMax, de Solo and Quirk began offering the solution to other providers. The system is now used in 32 states serving 2.4 million patients and more than 20,000 providers. “For the past three years, all providers who actively participated in the Merit-Based Incentive Program received exceptional performance scores,” said Quirk. “The CareOptimize software is a serious game changer in our ability to rapidly deploy to new markets and quickly improve patient care,” explained de Solo. CareMax is now geared for national expansion in 2021, including to Orlando, Atlanta, Baton Rouge and New Orleans.
Founded in 2011, CareMax Medical Centers is a network of value-based clinics in South Florida primarily serving Medicare beneficiaries through high-touch enhanced services. Each of the 13 CareMax centers offers comprehensive care to its members by combining primary care, specialists, dental care, pain management, social services, health education, diagnostics, home health and pharmacy under one roof with transportation to get members to their appointments. CareMax has found proactively fulfilling members’ medical, mental and social needs — what CareMax calls “whole person health” — leads to improved patient health and lower costs to the healthcare system. Five-Star quality CareMax centers use a combination of best practices, technology and social determinants to achieve better healthcare outcomes for senior members in the community. The results: 130% year-over-year growth, the opening of three new medical centers in the next six months, and high-quality scores as evidenced by three contracted health plans receiving a 5-Star quality rating as awarded by the Centers for Medicare and Medicaid Services.
Founded in 2015, CareOptimize provides technology and practice transformation services to ease the switch to value-based care. After gathering data from across the healthcare continuum, CareOptimize’s artificial intelligence and best practice rules engine identifies care opportunities. These opportunities are shown at point of care in any Electronic Health Record system as well as a web portal from care managers between visits. Modules include Coding for identifying undocumented diseases, Quality for measuring progress against national quality benchmarks, Engagement for tracking and care managing patients between visits, Referrals for helping providers find other specialists who practice value-based care, and Operations which tracks key performance indicators. Launching in 2021 is a patient facing application for members to become engaged in their own care.