HCSC’s Community Behavioral Health Links Essential to Duals Care Coordination

Relationships with community organizations that support mental health as well as recovery from addiction are essential to care coordination of Medicare-Medicaid beneficiaries, notes Julie Faulhaber, vice president of enterprise Medicaid at Health Care Service Corporation (HCSC). These collaborations enable HCSC to address the needs of duals as “a whole sick person, and not just as a diagnosis,” she explains, noting that duals often suffer from depression along with some physical disability. HCSC also has its own integrated team with behavioral health expertise.

Julie Faulhaber shared her organization’s approach to designing a care coordination model for dual eligibles and initial findings from these new programs during a March 12, 2014 webinar Moving Beyond the Medical Care Coordination Model for Dual Eligibles, a 45-minute program sponsored by The Healthcare Intelligence Network.


Length: 4:06 minutes

Deconstructing Health Reform: 3 Reasons Medicare and Pioneer ACOs May Not Survive

Given changing reimbursement incentives and collaborative models for physicians and hospitals, Greg Mertz, managing director of Physician Strategies Group, LLC, discusses why the Congressional proposal “Better Care, Lower Cost Act” of 2014 is financially more attractive to providers than ACO models and whether he thinks it will be passed. He also deconstructs CMS’ recently reported financial results for such health reform delivery initiatives as Medicare ACOs, Pioneer ACOs, and the Physician Group Practice demonstration, and weighs in on which, if any, model he considers the most sustainable.

Greg Mertz helped healthcare organizations assess which value-based healthcare delivery model is right for their organization during Physician Alignment: Which Model Is Right for You?, a February 19th, 2014 workshop at 1:30 p.m. Eastern.


Length: 5:58 minutes

Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management

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.

Ms. Taylor shared Wellcare’s strategies for meeting members’ needs with community-based partnerships and engaging duals in self-management of their care during an October 2, 2013 webinar, Dual Eligibles: Closing Care Gaps and Engaging Members in Self-Management.


Length: 7:16 minutes