The philosophy that healthcare is local and therefore, care needs to be local and community-based forms the core of WellCare’s efforts to connect its dually eligible population to health services, explains Pamme Taylor, WellCare’s vice president of advocacy and community-based programs. The Tampa-based healthcare company takes a culturally competent approach to assessing duals’ unique personal circumstances, ensuring their “soft landing” into WellCare’s care coordination system.
Care managers at the heart of WellCare’s multidisciplinary team, conducting a comprehensive needs assessment with each Medicare-Medicaid beneficiary and driving the resulting care plan, ensuring duals’ complex care needs are met at the most appropriate time and level.
Lauded for its care coordination service, Monarch had to overcome a few challenges when retrofitting the Naylor Transition of Care (TOC) model for the ACO among them insufficient patient access, patient skepticism and resource limitations. By focusing on readmissions reductions and four disease management conditions ESRD, COPD, CHF and diabetes and creating a care coordination team that included the newly created care navigator, case managers, and pharmacist, the organization has improved patient compliance, reduced negative drug interactions and hospital days and improved patients access to community services.
During Medicare Pioneer ACO Year One: Lessons from a Top-Performer, a September 18th webinar at 1:30 pm Eastern, Colin LeClair, executive director of ACO for Monarch HealthCare, shared first year lessons from its Medicare Pioneer ACO experience, how it evolved in year two and the impact on its organization’s participation in other accountable care organizations.