Evercare History

The pioneering spirit of Evercare's founders, who thought that health care for people with more complex needs could be done better, was a driving force in the company's growth. However, Evercare's approach to health care had expansion potential beyond nursing home care that was fueled by the inclusion of Medicare Advantage Special Needs Plans in the Medicare Modernization Act of 2003 (MMA).

In the late 1990s and at the turn of the millennium, Evercare worked with Medicare and the federal government to understand how Medicare could offer care that was more accessible to more people. People with complex medical conditions, long-term illnesses or disabilities – who also are the most costly to Medicare and Medicaid – require more closely coordinated care. Moreover, the resources they need exist in different places, are often difficult to find, and require higher out-of-pocket costs. And, nobody ensures that all these elements are working together the way they should.

Recognizing this gap, the MMA also created Special Needs Plans (SNP), using Evercare's approach to care as a primary model. SNPs are Medicare Advantage plans that have a special mandate to focus solely on Medicare beneficiaries with the most serious and complex health care needs. They serve Medicare beneficiaries in three categories:

• People living in a long-term care facility;
• People with both Medicare and Medicaid, also known as "dual eligibles";
• People with severe or disabling chronic conditions, like heart disease or diabetes, who live in the community (at home, with a family member, or in other settings like assisted living facilities or retirement communities).

SNPs allow health plans to provide enhanced care management and coordination of care from a variety of health service providers, as well as other benefits and services that Original Medicare does not cover.

Evercare's success was not limited to the U.S. In 2002, the British National Health Service (NHS) took notice of Evercare, awarding it a contract to provide hands-on case management support to nine Primary Care Trusts and to help identify models that improve health care delivery to at-risk elderly populations.