WellCare Works Community ‘Front Lines’ to Close Social Care Gaps for Dual Eligibles

Thursday, October 10th, 2013
This post was written by Patricia Donovan

Healthcare is local — and therefore, care needs to be local and community-based, says WellCare Health Plan.

The mission behind WellCare’s HealthConnections model is simple: when you do something good for the community, you do something good for your members — and vice versa.

This philosophy is also rooted in fact: according to joint research by the Robert Wood Johnson Foundation and the University of Wisconsin School of Public Health, 80 percent of what affects health outcomes occurs outside doctors’ offices.

That’s why so much of the work done by WellCare Health Plan, a managed care organization (MCO) that serves only government programs, is devoted to connecting its members with sorely needed community-based services — a healthy mix of public health and social support. Its team of advocates works the front lines of the community, pooling resources with a common goal — the reopening a local food bank, for example.

HealthConnections even labors to sustain the services when necessary, with a combination of grants and community support, explained Pamme Taylor, WellCare’s vice president of advocacy and community-based programs, during an October 2013 webinar on Closing Care Gaps and Engaging Dually Eligible Members in Self-Management.

The HealthConnections model, with an interdisciplinary care team as its foundation, is not a traditional MCO approach, she continues. HealthConnections kicks off its arrival in a new area with a hard look at community data, cataloging need and available services. The resulting database is accessible by WellCare caseworkers, who match the services to the vulnerable populations it serves, including the dually eligible (individuals qualifying for both Medicaid and Medicare).

Equipped with both the individual’s electronic medical record and a social services record, the caseworkers have a global view of their members’ health and social needs.

The HealthConnections model started in Kentucky in November 2011 with a baseline of about 2,500 entities. By the time the pilot ended in 2012, the robust social services database contained almost 14,000 unique agencies representing about 200,00 programs and services across the region — most of which are owned by minorities, women or the disabled. Approximately three-quarters of the compiled services are federally funded, which leaves the system financially vulnerable, Ms. Taylor noted.

HealthConnections identified and filled more than 175 specific gaps, and launched more than 10 community-based health initiatives.

To illustrate how HealthConnections helps to close socially based care gaps, Ms. Taylor used the example of a typical family of six living in rural United States:

Mom and dad both now work two part-time jobs. In 2008, dad was an executive at a company but lost his job because of the economic crisis. To make ends meet, they’re now working two part-time jobs. Living with them in 1,100 square feet are three children and a grandmother. The daughter is 19 years old and pregnant for the second time. The two twin boys, ten years old, are very enthusiastic children; one is developmentally delayed and the other one has emotional outbursts. The grandmother just recently moved in with the family, and she has been diagnosed with diabetes and has been noncompliant with her treatment. She also has early onset dementia.

HealthConnections was able to connect everyone in this family to various social service supports, but there were still gaps, she notes. For example, looking at the daughter alone, HealthConnections put social supports in place to ensure the young woman had a healthy pregnancy and delivery. The assistance didn’t end there. “She also hadn’t graduated high school, so we helped connect her to a program where she got her GED. She is now fully employed and she’s considering college,” Ms. Taylor said.

During the webinar, Ms. Taylor also described the five key roles of the community health worker and addressed the challenges of identifying and communicating with dual eligibles.

Pamme Taylor talks more about WellCare’s “healthcare is local” philosophy in this HealthSounds podcast.

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