4-Step Data-Driven Care Model Targets Dual Eligibles

The philosophy that healthcare is local—and therefore, care needs to be local and community-based—drives WellCare Health Plans’s efforts to connect its dually eligible population to health services. Here Pamme Lyons Taylor, WellCare’s vice president of advocacy and community-based programs, explains its four-step approach to developing a network for its population, including drilling down as far as zip codes for appropriate community supports.

What do we do through the HealthConnections model? When we first take a look at a new place that we’re going to be working in, when we look at what’s happening in a given region or county, we start with the data first. We look at a myriad of community sources; we take a very population-focused, public health approach and we pull epidemiological information. We pull community statistics; we take a look at existing community health need assessments. We look at the census and referral patterns, and if that doesn’t exist, we go in and do research. That includes stakeholder outreach and talking with people who live in the local area to ask, ‘What’s really happening in your community?’

Then we compile all that information and develop the most appropriate interventions or support that the community needs. And it is very, very local. The detail that we get into in each county is down to the zip code level, but then we summarize that to the state level and across our entire footprint. As the research comes in, it’s informing how we develop things, but as we develop things, it informs what other questions we need to ask. Then as we deploy, there are things we learn in the deployment process that tell us we need to go back and do further refinement. All the while, we’re thinking about how we’re going to evaluate ourselves on the back end.

This is the ‘so what’ of it all. Remember, I said we go in and do research on the front end, using all sorts of different tools, techniques, research methods and databases. It all feeds through a centralized repository and goes into one single warehouse that we can then all feed into, pull data from and refine, refine, refine. We catalogue those social services, much like the United Way 2-1-1. We catalogue what’s available and put that into a database. We then put that database into the hands of our caseworkers so they can create a social service electronic health record (EHR). That then bolts onto the member’s electronic medical record (EMR). And the two together give us a picture of what’s happening with that member, their caregivers, and to the extent possible, the entire family.

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 Disease Management, dual eligibles, Improving Community Care, Improving Patient Care and tagged , , . Bookmark the permalink.
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