How WellCare Closed 4 Socially Based Care Gaps

Imagine, if you will, a family of six living in a 1,100-square foot home in rural United States. Mom and Dad work two part-time jobs, their daughter is 19 and pregnant for the second time; her 10-year-old twin brothers have developmental issues, and their grandmother has diabetes and early onset dementia. Finding ways to help this family access healthcare, food and even transportation is one of WellCare’s primary goals, explains Pamme Lyons Taylor, vice president of advocacy and community-based programs.

We found four specific gaps. The family relied heavily on a food bank for its nutrition and food assistance. The local food bank closed its doors because of lack of funding. Our community advocate — what we call our ‘front facing community team’ — worked with a local church who had just refurbished its kitchen, a grocery store looking to give back into the community, and a local trucking company that had refrigerated vans and wanted to give back and use its vans for a meaningful purpose. Essentially, that team recreated that food bank scenario. The trigger for this was the family, but the benefit of this was for the community.

Next, the family relied heavily on Low Income Home Energy Assistance Program (LIHEAP). This particular state instituted a lottery system because it could no longer provide services to the level of need in their local area. And the family did not qualify through the lottery system. So again, our local advocate found out and stepped in, creating a lookalike program with a community partner who was looking to give back into their community.

As far as the daughter is concerned, while we did connect the daughter into prenatal care through her primary care physician, she didn’t have a lot of support within her peer group. So we worked with an OB-GYN, a provider in the local area, and created a teen-focused healthcare program. We then connected the daughter into that program with peers of the same gestation and at the same age group. This helped the daughter learn how to go through prenatal care and learn the benefits of prenatal services. She had a healthy delivery and learned what to do post-delivery to receive the necessary first year of life support for her newborn son.

Transportation was also an issue: among them, because the family had only one car. We worked with a local United Way and a local bank to create a subsidized loan program so the family could tap into it and get a second car. I’ll talk about the health outcomes that are associated with this activity later on, but I wanted to explain that our community support program really focuses on closing care gaps that are socially based. That’s not traditional within a managed care company; it’s what sets this program apart. It’s the integration of public health with managed care. It’s what a lot of states and CMS are really starting to look for.

Source: Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes
Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes

Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes details the WellCare approach to duals’ care coordination — a healthy mix of public health and social support in which a team of advocates works the front lines of the community, cataloging and pooling resources with a common goal — the reopening of a local food bank, for example.

This entry was posted in Alternative Healthcare Coverage, dual eligibles, Elderly Care and tagged , , , . Bookmark the permalink.
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