Posts Tagged ‘public health’

Community ‘Feet on the Street,’ HRAs Improve Dual Eligibles’ Health

January 14th, 2014 by Jessica Fornarotto

A local approach — the integration of public health with managed care — is what a lot of states and CMS are starting to look for, explains Pamme Taylor, vice president of advocacy and community-based programs for WellCare Health Plans.

In HIN’s special report, Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes, Taylor describes some of WellCare’s efforts to connect its dually eligible population to health services, including making contact, identifying services for each member and assessing health status via health risk assessments (HRAs) that are part of these community services.

Question: What is WellCare’s strategy and practice for contacting dual eligible members and ensuring follow-through with recommended referrals to community support services?

Response: This question is two-fold; first, how do we reach the members and get them engaged? And second, how do we verify that services were rendered? For members, we have street teams that go out into the community investments. We also have community health workers on our interdisciplinary team. It’s their job to connect with our members on a face-to-face basis while also connecting them to community supports. It’s through that model that we heavily rely on engagement and connectivity, etc.

Our first line of outreach is through the phone; our second line is through the community health workers and the individuals that are ‘feet on the street.’ And then, how do we verify that services were rendered, and how is that data collected? We have a command center, which is the warehouse of all that information, and then the social service electronic health record (EHR), which bolts onto the member’s medical record. That process produces a provider roster that we then put into the hands of our field teams, who use that as part of relationship management, much like a provider relations representative would use in their engagement with the primary care physician (PCP). We meet with them on a regular basis to confirm that services were rendered, and review the successes.

The secondary piece to that is our case managers also reach out to the members that they have referred to services and activities. They verify through the members they received it and their level of satisfaction. So there’s two points of feedback: one from the provider themselves and one from the member.

Question: How do you identify community services to meet members’ needs?

Response: It’s similar to the United Way 2-1-1 directory. We did community health needs assessments, which identified a number of different needs. And using epidemiological information, we come at it in terms of identifying the need, and then determining the service model. Then we took it a step further and asked, ‘How do we define the services so it’s a blend between public health, social supports and managed care terminology?’

We use about 67 different categories of social supports. We turn that into research. We go ‘feet on the street’ to canvas the neighborhoods to make sure that we have all of the organizations represented. Then that’s put into a ‘pend’ status in our databases and it is vetted on a secondary level of review by our team of liaisons. Once it’s vetted and confirmed, it’s then put into the final database, which is used for searching by our case managers. It’s a combination of public health practice using both public health and managed care terminology.

There is no magic number of categories or organizations. No one’s ever systematically inventoried or catalogued the network of social services. That’s what we’re hoping to do — explain and quantify what organizations exist, then identify their service area, their reach, their service portfolio, and the volume of connectivity that the health plans have with these organizations for specific services. It’s an exciting time.

Question: What other components of the comprehensive health assessment are administered to the duals as they come on board?

Response: A number of different factors go into the HRA that’s completed. There are health factors, socioeconomic factors, living environment, and activities of daily living (ADL). What are their social needs, what are their social supports, etc.? There’s a whole number of different tiers of questions that we ask as part of the HRA. We use very specific tools that are either state-dictated or guidelines produced by the state or in partnership with CMS. It depends on which side of the equation that we’re being contracted for, and it depends on what’s already in existence.

Infographic: Top Public Health Risks

December 11th, 2013 by Jackie Lyons

Obesity and smoking are among the top public health risks, according to an infographic from MPHOnline.org. In fact, the infographic shows that obese adults cost $1,429 more per year in medical costs than healthy weight adults. In addition, smoking causes serious illness in approximately 8.6 million people.

This infographic also identifies other public health risks, accompanied by statistics and information regarding causes and at-risk populations.

Top Public Health Risks

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You may also be interested in this related resource: 2013 Healthcare Benchmarks: Health Coaching.

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

October 10th, 2013 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.

Infographic: Investment in Public Health Slipping

May 23rd, 2013 by Patricia Donovan

The public health systems in the United States are meant to be at the forefront of prevention, but state and federal investments are shrinking.

This infographic published on the Pew Charitable Trusts Web site illustrates how public funding levels vary from state to state. For example, in 2012, Alaska received the most public funding from the Centers for Disease Control and Prevention (CDC) and the Health Resources Services Administration (HRSA), while Indiana received the least.

Investment in Public Health Slipping

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You may also be interested in this related resource: Forces of Change: New Strategies for the Evolving Health Care Marketplace.

Infographic: The Cost of Obesity

May 15th, 2013 by Patricia Donovan

Designed to shed light on the national epidemic of obesity, this infographic from the School of Public Health & Health Services at George Washington University illustrates the financial impact of obesity on U.S. communities and the overall economy, preventive measures the nation can take to positively affect change at a national level, and three key programs that are getting results.

Cost of Obesity

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You may also be interested in this related resource: 2013 Healthcare Benchmarks: Health Coaching.

Infographic: The Rise of HIAs in the United States

April 24th, 2013 by Melanie Matthews

The major health issues that cause chronic health conditions — obesity, asthma, heart disease and diabetes and injuries — can be shaped by living and workforce conditions. To improve wellness, a growing number of cities and states are conducting health impact assessments.

Pew’s Health Impact Project’s infographic on the subject looks at the growing number of assessments and the areas they are assessing.

The Rise of HIAs in the United States

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You may also be interested in this related resource: Derryberry’s Educating for Health: A Foundation for Contemporary Health Education Practice.

Infographic: Funding Public Health

March 15th, 2013 by Patricia Donovan

Public health helps children grow up healthy and helps build strong communities. Public health saves lives and saves money. But it is often a challenge to describe public health and its impact in concrete terms, which is a critical step in building support for public health programs. This infographic from the American Public Health Association depicts the positive impact of public health and reinforces the importance of funding for public health programs at all levels.

public health

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You may also be interested in this related resource: Coalitions and Partnerships in Community Health.

7 High-Impact Ideas to Prioritize Prevention

February 22nd, 2013 by Jessica Fornarotto

Reimbursement for prevention efforts and employer engagement are among seven high-impact recommendations from the Trust for America’s Health (TFAH) to prioritize prevention and improve the health of Americans.

“A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years”, a new TFAH report, illustrates the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective.

The report outlines top policy approaches to respond to studies that show that more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented; and also that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.

The seven recommendations documented in the report are:

  1. Advance the nation’s public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities;
  2. Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
  3. Integrate community-based strategies into new healthcare models, such as by expanding ACOs into accountable care communities;
  4. Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs;
  5. Maintain the prevention and public health fund and expand the community transformation grant program so all Americans can benefit;
  6. Implement all recommendations for each of the 17 federal agency partners in the National Prevention Strategy; and
  7. Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs.

“A Healthier America” also features more than 15 case studies from across the country that show the report’s recommendations in action.

The report also includes recommendations for a series of 10 key public health issues: reversing the obesity epidemic; preventing tobacco use and exposure; encouraging healthy aging; improving the health of low-income and minority communities; strengthening healthy women and healthy babies; reducing environmental health threats; enhancing injury prevention; preventing and controlling infectious diseases; prioritizing health emergencies and bioterrorism preparedness; and fixing food safety.

Infographic: A Visualization Into the World of Public Health

October 3rd, 2012 by Melanie Matthews

The impact of public health is far-reaching, as illustrated by this infographic from mphprogramslist.com, which advocates for public health student education. It extends around the globe to increase life expectancy, improve quality of life, reduce and eliminate diseases and chronic conditions, prevent injuries and prepare for natural disasters.

++ Click to Enlarge Image ++
A Visualization into the World of Public Health [ VISUALIZATION ] |
Source:MPHprogramsList.com

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data. Click here to sign up today.