Greg Whisman is the Chief Medical Officer of CareMore Health, a venerable prepaid medical group caring for seniors. It’s been part of Anthem/Elevance for many years but this year spun off as part of a larger PE backed group called Millennium. We really got into the what and the how of primary care for seniors and, yes, we delved deep into the future of primary care. This is a topic that will never die on THCB and getting a real expert to opine on it was really valuable. This is a great conversation–Matthew Holt

This was such a great discussion I wanted to publish the transcript. The way I do that is to copy the Youtube generated transcript and drop it into Claude to smooth it over. I then read it and if I think it’s made an error, dip back into the video and listen to what actually happened and make a correction. This is all code therefore for me saying I think this transcript is pretty accurate but it might have a bunch of AI and human generated mistakes.

THCB Spotlight: Primary Care and the Future of Senior Healthcare

A Conversation with Greg Whisman, Chief Medical Officer, CareMore

Matthew Holt: Hi, I’m Matthew Holt with another THCB Spotlight, and we’re going to delve into one of my favorite topics — primary care. I have with me Greg Whisman. Greg is the Chief Medical Officer of CareMore, which is part of the big Elevance organization, but is pretty well known from its days long ago as being a sort of independent medical group managing seniors as part of Medicare Advantage. We’ll get into a lot more about what that means. Greg has quite the background — he was actually a primary care doctor for many years himself in Ohio, and has worked in various places within the larger Anthem/Elevance organization. Greg, you’ve been Chief Medical Officer of CareMore for about three years now, is that right?

Greg Whisman: Well, really about a year and a half. I’ve been with the organization just over two years.

Matthew Holt: Good to get it right! So let’s start at the beginning. Those of us who’ve been in this world for a long time know that CareMore has been around for a long time, starting off in Southern California, and then after it was purchased by Wellpoint — now Elevance — its role in delivering care as well as financing care for seniors has become a bigger deal, as has Medicare Advantage overall. Can you give a quick thumbnail of where CareMore was and what it represents now within the world of Elevance?

Greg Whisman: Well, I think you hit on something really germane. There was large expansion into some East Coast markets as well as the Southwest, and over the last two years we’ve really consolidated our operations into several key markets to focus on what makes CareMore great. We’re in California, Arizona, Nevada, Tennessee, and currently have a smaller presence in Iowa, North Carolina, and Texas. Our core model is really in the Southwest — Nevada, Arizona, and California — where we are taking full risk on Medicare lives. We’ve got some commercial lives baked in there, and of course a lot of dual special needs type plans.

Matthew Holt: Does that mean you’re essentially a medical group owned by a big health plan, but you’re also taking risk from other Medicare Advantage plans? Is that correct?

Greg Whisman: That is correct. We actually went through a process this year under a private equity company with two other large healthcare organizations — Millennium Physician Group in the Southeast and Apris, which does a lot of employer-based healthcare. In that new entity, Elevance is a minority stakeholder.

Matthew Holt: So now you are kind of independent of that, right?

Greg Whisman: Exactly.

Matthew Holt: That makes a lot of sense. So Apris was the entity that had various pieces including a bit of Castlight, and had something to do with JP Morgan Health, and you mentioned Millennium Physicians. There’s a bunch of stuff in there, and a separate private equity fund group funding that as well.

Greg Whisman: We’re all under one entity called Mosaic Health, from CDNR, which has a large track record in healthcare mergers, acquisitions, and startups. They partnered with Elevance Health to develop Mosaic Health, and we’re really on a trajectory to bring together value-based healthcare across not only MA but commercial, and fold in our Medicaid lives. For instance, Millennium Physician Group has a really successful MSSP Medicare ACO in the Southeast. We’re trying to figure out what that strategy looks like — how do we put these complementary pieces together in a way that strategically makes sense while giving us economies of scale.

Matthew Holt: Okay. And we can probably have a separate conversation about the role of private equity in healthcare — I’ve just been looking at the Steward bankruptcy, which is interesting. But let’s go back to CareMore. As a medical group providing actual care for seniors, what are the key things that an at-risk organization like yours needs to do? Over the years, folks like Rushika Fernandopulle and Sachin Jain, who had your job at CareMore at one point, have talked about managing loneliness, social determinants of health, coaching — what do you think the latest thinking is on what you need to do to manage the care and health of seniors?

Greg Whisman: Well, I think we all know this. One of the illnesses of the healthcare system at large is that you go in to see your doctor, and the average time before you’re cut off is 30 seconds, and the average visit is somewhere around seven minutes. So much of what determines how a patient does — how they avoid the ER, how they stay out of the hospital — happens outside those seven minutes. That barely gives you enough time to ask about their family, their plans, their goals of care, reconcile their medications, and fill out the medical record. Where we’re different is we allow ourselves much longer times, smaller panel sizes, and in-depth care — both for our own clinicians and our network partners. We wrap care around that patient. We’ve got social work to help with social determinants of health — poor socioeconomic status, getting them Meals on Wheels, arranging transportation. We’ve got case management looking at patients who’ve been in facilities multiple times, helping with transitional care. You’re really wrapping a team-based model around that patient to pick them up between discrete visits, and making sure they have appropriate access — same-day access is available. We have an internal telehealth service, a team of nurse practitioners available 24/7. If you need someone, you get on and talk to a CareMore nurse practitioner for a virtual visit in our own electronic medical record, which can tee things up for social work, case management, or get them back with their primary care doctor. We’re really trying to pick that patient up across the continuum rather than in the discrete minefield that is primary care throughout most of the country. For an elderly population, that’s critical — not just the relationship, but making sure they can bring in their daughter, their son, their spouse to understand what’s going on. They’ve got complex medical needs, far more than you’re going to accomplish in a traditional primary care setting.

Matthew Holt: I’ve heard from various players — Rushika Fernandopulle, the Park brothers now doing this at Devoted Health — about a coaching angle. How do you find someone who doesn’t have an MD but has the time to help people work through issues like, how should a diabetic be shopping? And there’s also the management of very complex chronically ill people, with more house calls, virtual hospital at home, remote monitoring. Can you give me a flavor of where you’re going on both those fronts?

Greg Whisman: It all starts with our recruitment. We prioritize clinicians who have their board certification, who have made this their career, but we’re also looking for emotional intelligence and the ability to connect with people — qualities that come across in an interview, that indicate they can develop a genuine relationship and kinship with a patient. We’re putting those people in the field, going into people’s homes, and in our clinics, to make sure people know that’s their home for care. A lot of our docs are mid-career — they have some experience in the healthcare ecosystem, whether inpatient or ambulatory, so they’ve got a depth of chronic disease management. But really we’re looking for that next-level nurse practitioner or doctor who is genuinely able to connect with the patient and ensure that the patient knows this is the place that will care for them throughout their journey. When you find those people, they stand out.

Matthew Holt: You need the right kind of person — and not necessarily what medical school has been producing, which is probably not at the top of the list of what medical school is focused on, empathetic as many doctors are. Though you do have to find your orthopedic surgeon somewhere. What else in terms of systems are you deploying that are a bit different?

Greg Whisman: I like to use the phrase ‘whole continuum care’ rather than just patient-centric or whole-person care. We’re able to deploy providers into the home for acute and transitional situations — and this isn’t just sending a home health person out. This is our nurse practitioner who might be seeing patients in the clinic that day or the next day. If you’re institutionalized, we’re sending them into your facility. We bring the same electronic medical record we use in the clinic into your house, and we couple that with advanced population health analytics on risk stratification — who’s at risk to fall, who’s at risk for readmission. We’re bringing that intelligence and technology into the field with the right team and wraparound resources. We also still do utilization management — the certification techniques. So we’re able to capture the patient the second they hit the door of a hospital. Whereas many provider groups are blind to a patient once they’re in the four walls of the hospital until they’re discharged, we are managing that care and alerting our case management teams to work hand-in-hand with the facility. Whether it’s new walkers, wheelchairs, hospital beds, or making sure medications are delivered on time — we are managing each of those spaces without the blind spots.

Matthew Holt: That sounds great, and to be honest that sounds like a continuation of what CareMore and many of those other California groups have been working toward since the ’90s. Let me ask you about results. With this full-risk approach — where you’re at risk for the drugs, hospital care, specialty care, as well as the primary care you’re delivering — how much more are you spending on primary care and how much are you saving, and what kind of results are you seeing compared to other people in Medicare or Medicare Advantage?

Greg Whisman: When I look at it, I look at a couple of things. One is star ratings — critically important in the Medicare Advantage space. They drive revenue but also speak to the caliber of your care. We’re a four-star player, creeping on four and a half stars, with strong organizational infrastructure driving improved quality of care. Two, we use a lot of the Milliman benchmarks for a well-managed population — even though our population traditionally has lower socioeconomic means, multiple chronic conditions, and sometimes limited healthcare literacy or activation. What we’re seeing is that we are managing close to, and in some circumstances right on the precipice of, a Milliman well-managed commercial population. You’re noticing readmission rates for this really disproportionately complex population hovering around where you would expect a commercial population to be. Our admissions per thousand — when we look at our claims — we are admitting as if we don’t have institutionalized special needs plans and a whole bunch of D-SNPs. We do. So the investment in managing the really complex patient is allowing us to perform at a level you’d expect of a healthier, more commercial-age population. That’s really a testament to the comprehensiveness of the model and the investment in infrastructure we’ve had.

Matthew Holt: Can you give me some rough ballpark numbers — how much more are you spending on primary care than typical, and how much are you saving because of that?

Greg Whisman: That’s a great question, Matt, and I’m probably the worst in our organization to answer it because I’m so focused on the clinical model. I will say we have a significant investment and we’re really leveraged to take care of an even larger population. Our medical overhead right now is still being worked through following this consolidation. We’re leaning into our core business model to get it as efficient and fluid as possible, and we’ve had this large private equity investment. I’d be remiss to throw out a figure.

Matthew Holt: Let me ask a different question. Forget CareMore, forget the new organization, forget the history. When I look at the numbers — Humana puts this out every year among others — about a quarter to a third of people in Medicare Advantage are in an organization like yours, and the rest are in some kind of looser risk-sharing arrangement or straight fee-for-service. Then of course half the population is in fee-for-service, and a bunch of those are in MSSPs and ACOs, which can vary from the person not even knowing they’re in an ACO to being pretty tightly managed. Why is it that — and I’d say many people in this business say we spend roughly double what the typical system does on primary care and save somewhere between 20 to 30% overall — why has this model been so hard to spread? It’s not a secret. We’ve had Kaiser since 1937. Why hasn’t everyone got one?

Greg Whisman: Great question. I think there are a few trends worth noting. First, I spent time as a CMO of a Medicare ACO and we could have doubled our attributed lives at any time just by getting patients to come in one more time that year — doubled it from about 36,000 to 70,000 lives. There are a lot of patients out there who enroll at annual enrollment, they see the free benefits or zero-dollar co-pays, and they switch plans a lot. When they switch plans, sometimes the provider’s in, sometimes they’re out. They’re reticent to jump into one of these organizations. It’s a little intimidating — I’ve selected this plan and now I can only see this group of doctors or nurse practitioners. For the average senior dealing with a lot of information thrown at them in a short amount of time, that can be overwhelming. They get attracted to a couple of benefits. The other thing is, a lot of people don’t have a great sense of the healthcare ecosystem — what’s a premium, what’s a deductible, how many meds am I on, who do I go to for my meds. It is so fractured out there. The average senior is looking at the benefits. The health plans are looking at overall costs in the MA space.

So the senior might just be looking at: they’re going to give me free termite service and I get free meds and a grocery card, and that wins at the point of purchase. By the time you’re a couple months in, you start to see some shifting in that population. Going that extra mile to a CareMore, an Archwell, a Centerwell, a ChenMed — any of these advanced primary care models — it’s tricky. 

On the health plan side, it’s risk. They have to set it up in the right place. We’re delegated for utilization management on the West Coast, but east of the Mississippi, delegation isn’t as common. And then getting patients to jump through those hoops. I’ll also say — when I helped implement some ChenMed practices in a previous life — you have to pick where you put those practices, in areas of town where you have the chronicity of illness, the people who need it most. Some of these advanced primary care models are sending vans out to pick up patients just to get them to their provider within a small catchment area. Each model is subtly different, but as we continue to have baby boomers aging in every day, these models can really be a great resource — especially for those with multiple medical conditions.

Matthew Holt: I want to push a bit harder on this, because we’ve known this for a while. And yes, you have to persuade patients, and it’s not easy — but on the other hand, if it’s so much better and cheaper, wouldn’t the plans holding the risk be more interested in pushing it harder? Why do you think that hasn’t happened?

Greg Whisman: My experience having been a regional chief medical officer for Anthem/Elevance is that we did push a lot of our value-based partners in deals and membership growth — the CareMoreS, Oak Streets, ChenMeds — we wanted to push membership to them and partner with them. Where it gets a little murky is that as a clinic we are multi-payer. We are not going to solely see one plan’s patients, not solely manage one payer. So they get into managing multiple risk-based arrangements while trying to push volume. And of course if you’re sitting on the health plan side, you want to disproportionately get your members in there because you’re going to save on overall membership. It’s a yin and a yang. But you can’t get around the fact that we’re conservatively 25,000 family medicine doctors short in the community right now. It’s hard — I still see patients virtually quite a bit and I hear from people who just can’t find someone, or they face a six-month wait. There are probably too few of these advanced primary care clinics for the patients that even want to get into one of these models. We’ve made it unnecessarily complicated.

Matthew Holt: I want to have a philosophical conversation about this, because I think I have the solution — but we’ll get there in a second. One thing before that: there’s always somebody somewhere who’s done something really well and I always wonder why it hasn’t spread. I’m going to pick one you probably know — Bob Matthews, who works with the Primed Clinics in Dayton, Ohio, and gives these lectures about how they’ve figured out — with his company Medisync and Primed — how to get all of their patients, including those in the poorer parts of Dayton, with their blood pressure at target. Kaiser is at 70% and California as a whole is at 50%, or whatever the numbers are. Years ago my friend John Mattison, who was a Kaiser leader for a long time, said to me: ‘The great thing about American healthcare is we know what to do. We just don’t know how to do it.’ If we take something like high blood pressure management — something we know how to do — why has that not spread at scale? Why do we have such poor chronic care numbers across the board as a nation? Why haven’t we figured this out?

Greg Whisman: There are probably a couple of reasons. One, we know the meds. We know medications that can make a big difference. But there are so many other things that go into managing high blood pressure, diabetes, congestive heart failure. The reason chronic disease is booming is partly significant societal decisions we’ve made — high fructose corn syrup, a lot of what’s in our foods. Do you know anybody that drinks just one Diet Coke a day? Or just one Mountain Dew a day? It doesn’t happen. And those are influenced by societal things — you take your smoke break, you chug a Dew four times a day. We make a lot of decisions that are counterproductive to the medications clinicians are trying to prescribe. Good techniques exist — the DASH diet works really well for blood pressure, and coupled with an antihypertensive you can get great control. It’s that extra education, being a partner with the patient, not a shepherd, really talking to them and being in it with them. But it is a two-way street. We’ve had food stamps for years that have enabled Cheetos and cheese puffs — things counterproductive to chronic disease management for people who haven’t been instructed about what those foods do to their health. We know a lot on the medication front, though I will say we don’t know enough about the interactions and downsides because of the way some of our journals and science have been corrupted by pharmaceutical interests. I think it’s about a more holistic approach to the patient, and we’re running into trouble because we haven’t been able to have honest dialogues about life choices, medications, and what it takes to manage chronic disease. And we don’t train our clinicians to have that dialogue.

Matthew Holt: The obvious step from where I sit in Silicon Valley would be to say: we use information, now AI, to communicate with patients and help them. What do you think is the solution, and what are you planning at CareMore and in the broader organization to use technology? I mean, it’s all very well to say it’s all the fault of Big Food — and they do play a role, right, and Fast Food Nation said all this 30 years ago, how the New Jersey flavor labs made Cheetos so delicious — but very little has changed. Whatever RFK says he’s doing, how do you think we’re going to use the new AI tools to combat this? What are you planning from a patient perspective?

Greg Whisman: I think it gives patients incredible power. I remember sitting across from patients who were bringing in Dr. Google, holding up one article based on some niche disease. AI gives a patient the power to comb through all that and say: here are my symptoms, here’s my age, what’s my risk profile look like? It makes them a more informed consumer to decide whether to start a medication or move forward. So first, you’ve now empowered and educated patients in a way we didn’t see 20 years ago — we just saw the latest Google search or Medline headline. Second, on the clinician side, AI allows two cool things. It allows clinicians to comb through the noise and stay abreast of the most recent information. AI can take large amounts of data and distill it — I can ask for a three-page summary of all the data out on X, Y, or Z, and get it in 15 seconds. You can get an independent assessment of the risks, what things you’re willing to accept before taking a medicine or a vaccination or a particular test. Third, for the healthcare system generally — can you imagine the research that a pharmaceutical company or biomedical researcher can do if they can synthesize all knowledge and research to date and quickly identify the next hypothesis to test? It really enables those brilliant folks to take that next step. For CareMore specifically, we’re going to start embedding AI to help with clinician burnout and work-life balance — synthesizing templates, streamlining inbox management so there’s less take-home work. They’re going to be able to use it to review lab results, pick up abnormals and trends. We’re also going to use it in our utilization management programs — not to rely on AI to make a determination, because that’s a bridge too far, but to help inform and make sure we’re not missing a key component that forces someone through an appeals process and delays care. We’re leaning into it with the implementation of our new EHR to streamline clinician experience and work-life balance.

Matthew Holt: That’s super interesting, and there’s a lot of optimism about using AI on the clinician side. I’ve had Rob Pearl on the show before — another ex-Kaiser senior physician leader — talking about using AI to monitor chronically ill people all the time and get to exceptions. At what pace do you think we’re going to be able to do the things you’re talking about to combat all the problems we’ve discussed?

Greg Whisman: The remote patient monitoring piece — how we monitor people when they’re not in front of us — AI can be a great resource for that. But if you’re getting feeds on every patient, you can imagine overwhelming the provider. Though the data fields are fairly discrete: blood pressure is X over Y, weight is this today. It’s very discrete. But have you tried to drive down the street and hit the button to tell your car where to go and gotten listings for places 600 miles away? We see the robots fighting in China at $700,000 apiece, but people think we’ll be out of work next year because of AI. We’re years away from that level of capability. But if we can start to incrementally chip away — getting the most clinically relevant information in front of the provider at the right time, helping providers distill the safest treatment regimens — when we look back 10 years from now, we are going to have made a lot of headway. It’s going to be more incremental. There may be some crazy breakthrough technology out there, but right now we’re building data centers as fast as we can, and I just don’t know that it’s going to keep up with Hollywood’s vision of what AI will be.

Matthew Holt: Well, don’t forget Hollywood’s version is the one that kills us all. Terminator 2 is my favorite example. So let me close with my solution to fix everything. I think there are thousands of people like me and you who like the idea of giving all the risk and all the management capability to primary care doctors and letting them figure it out for their appropriate age groups. We made this arbitrary line — over 65 gets this, under 65 gets that — and we’ve put a lot of pressure on those risk groups. For that reason, and many others, building the systems and the muscle memory of how to do this right has been problematic. Not to mention it’s also been wrapped up in stock market growth, and we’ve seen companies come and go because of other financial issues. 

So here’s what I think we should do that fixes the whole thing: I think we should actually get rid of primary care risk. We should just give primary care doctors more money. And there is an obvious flaw to this, which I’ll address, but I think we basically give everybody in America a couple of thousand dollars per head — obviously age-adjusted and risk-adjusted — and you say to every primary care doctor: we’re going to give you a panel of 500 to 600 people. Not the 2,000 to 2,500 people many are facing today. You’d basically run a concierge practice and be able to take a lot more money. If you do the math, 600 people at $2,000 a head is about $1.2 million. A primary care doctor can pay themselves half a million, do better than they do today, better than most surgeons. And they could use the rest to run programs. But that’s all the money they get — they wouldn’t be responsible in my view for managing the risk of what happens afterwards. Somebody else would be responsible for that, with some kind of global cap budget to make sure nothing too crazy happens. I think just doing that, and trusting the professional responsibility of doctors — and by the way it wouldn’t just be doctors; some would be nurse practitioners because we don’t have enough primary care doctors; some would be converted internists, maybe converted emergency room docs — I’ve heard so many ER docs say half of their patients should just be getting primary care. Say someone lacerates their finger the concierge doc goes around to fix it instead of the person going to the ER. 

There are people who have no primary care doctor, are uncontrolled, and end up in the hospital with diabetes or asthma because no one was paying attention to preventive care. If you put the responsibility of proper primary care onto lots of doctors, assign people to them, and say: you’re basically going to get a wonderful concierge doctor paid for by the government — in my view, you wouldn’t have to give those primary care docs the burden of managing what happens afterwards, managing the downstream risk. That has been one of the big constraining factors. Now, obviously the politics are intense — I’d have to change the whole healthcare system, probably get rid of health plans and a lot of other things. But from a vision standpoint, do you think that if you had enough primary care doctors operating with modern technology and nurse practitioners, just giving people really good quantitative primary care would fix a lot of what’s going on in American healthcare?

Greg Whisman: I do. I think your model is very interesting — almost like I’m hoping CMMI is listening and wants to do a test.

Matthew Holt: And let me just tell you where it comes from. My friend Jeff Goldsmith — great healthcare futurist — said: ‘Look, we’ve basically put all this stuff in because we distrust doctors. And that’s wrong. We shouldn’t have made them record everything they do, all the risk stuff. How do you get rid of that and just let doctors be doctors? Wouldn’t they do a good job if you just let them alone?’

Greg Whisman: You’d have very meaningful results. You’d have less physician burnout. But when you look at the medical boards, and you look toward Washington — who creates a lot of the regulations — they tend not to have an MD or DO behind their name. But I’ll tell you, you tap on something really rich there. You pay doctors to be good doctors, you pay them so they feel valued for the lengthy education — they spend the bulk of their 20s in a book or in a hospital. There’s an opportunity cost that comes with that. And you let them get out and practice their craft. They love it. I’ve got a friend — I used to deliver newspapers to their parents — they’re a general surgeon and they told me: ‘I wanted to be a primary care doctor, but how do you make ends meet? It’s always been on the low end of the payment scale.’ And they ended up being one of the busiest surgeons in town partly because they have the bedside manner. I started thinking about that. 

When I paid all my medical school bills, they were a pittance compared to what students are coming out with now. And the projections for the family medicine and primary care deficit in this country are daunting. Even with NPs and APPs working alongside a primary care clinician, we’ve got to do something really disruptive to solve this problem or we’re going to be in trouble. I like your idea. It’s disruptive. It’s different. I’ve had an idea of a five-year loan payback for anyone that goes into family medicine and ambulatory care. We fund medical residencies out of CMS, but you have to incent. We’ve got to invest in this or we’re in trouble. Ten years from now, we’re going to have 50,000 fewer primary care clinicians and a whole bunch of people walking around with catastrophic episodes of uncontrolled care, and the system is going to continue to go bankrupt. Hopefully somebody’s listening and willing to make real seismic changes. There are a lot of students out there who’d be interested in primary care, but they put in all this time and think: well, I’ll make double if I just do one extra year of residency, why wouldn’t I? And I talk to all these primary care docs who are filling out forms and risk-adjusting and doing every quality measure known to man, then going home and doing all their EHR work. I can see why that doesn’t appeal to a 20-something who thinks: that’s crazy, I’d rather work standard hours or shift work. We’ve got to fix that or we’re going to be in trouble.

Matthew Holt: And I’d add to that: we spend so much on waste motion. Within a risk-based organization it’s rather different, but in straight claims and billing — the number of people in a typical fee-for-service primary care practice or even specialty practice who are just doing billing and administrative work, which is really waste motion. I think we could get rid of a lot of that. I’m not oblivious to the fact that if I say this will save us a ton of money in specialty and hospital care, there are some people — specialists and hospitals — who might object. And if you look at what has happened outside organizations like yours, most hospital systems today have bought up primary care doctors with the goal of generating referrals into the hospital as soon as possible. We’re really still stuck in that fee-for-service model.

Greg Whisman: Exactly right. It’s up to the limits of antitrust, really — they want the downstream referrals. Not doing anything untoward; it makes sense financially. And they make it really easy: we’ll give you a concierge number for every pre-cert you need, or to schedule with our hospital. But I don’t know that it’s getting to the point where we’re truly servicing our population. And we didn’t even touch on the third-payer problem — spending someone else’s money. But yeah, it’s a challenge.

Matthew Holt: Right. And I think there are people in the direct primary care movement who believe in this, but they’re largely looking for either the consumer or the employer to pay for it. And I think the biggest problem is that there has to be somebody else paying for the expensive care of expensive people. The average per-capita healthcare spend — and I know it’s much higher in the senior population — is around $14,000. You can’t tell me the government, which is spending 60 to 70% of the healthcare dollar anyway, can’t afford $2,000 per head. A lot of the people I’m talking about don’t even have a primary care doctor now. I know it would be a big change, but I can’t believe you couldn’t sell it with enough marketing dollars, because it’s just better than what most people experience. 

Greg Whisman: I always go back to: how many hospital admissions do you have to save to account for the $2,000 per patient for 600 patients? It turns out not to be that many if the model really delivers the benefit. Everyone will point to a couple of bad outcomes that bankrupt it here or there — maybe it’s in a difficult community, or you have a couple of catastrophic cases that don’t have goals of care established and languish on ventilators. But I’m sure there’s a way to reinsure that catastrophic coverage and keep people whole. There’s too much money floating around the system right now to not foster innovation to get there.

Matthew Holt: I agree, and I think we both just agreed that the current way that most fee-for-service medicine works in America is not helping — it’s not getting at the underlying problems on the societal side or the patient management side, and we know it’s not working. 

Greg, we’ve talked for a long time and I really appreciate you getting into this. It’s been super fascinating. I hope you’ll come back and talk to me again. There are a lot of things I’ve done over time, with tech and with various plans, and this may upset some of your previous employers; my plan would probably put health plans out of business, and might require nationalizing hospitals and putting a global budget on doctors, which might upset a lot of your former classmates. But I think if we don’t figure out how to get people into primary care — which is going to involve paying them more by definition and moving some doctors who are now in other specialties into becoming primary care doctors — and we don’t figure out how to manage the primary care of the growing number of elderly with chronic illness that we’re going to have, the healthcare system is going to continue to get worse rather than better. I think at least we’re agreed on that. Exactly how we do it, we’ll have to figure out.

Greg Whisman: Absolutely. Well, look, I really enjoyed talking with you. Happy to come back anytime and chat with you.

Matthew Holt: Thanks so much. I’ve been speaking with Greg Whisman, Chief Medical Officer of CareMore. Greg, thanks very much for your time.