Community Impact Model. Mackie Hicks

Transcription

1 Cmmunity Impact Mdel Mackie Hicks

2 WellCare Health Plans, Inc. Cmpany Snapsht Funded in 1985 in Tampa, Fla.: Serving 4.4 millin members natinwide 407,000 cntracted health care prviders 68,000 cntracted pharmacies Serving 2.8 millin Medicaid members in 11 states: Aged, Blind and Disabled (ABD) Children s Health Insurance Prgram (CHIP) Family Health Plus (FHP) Supplemental Security Incme (SSI) Temprary Assistance fr Needy Families (TANF) Serving Medicare members in 17 states: 484,000 Medicare Advantage members 1.1 millin Prescriptin Drug Plan (PDP) members Serving the full spectrum f member needs: Dual-eligible ppulatins (Medicare and Medicaid) Managed Lng Term Care (MLTC) Spearheading effrts t sustain the scial safety net: The WellCare Cmmunity Fundatin WellCare Assciate Vlunteer Effrts (WAVE) Cmmunity-based scial service prgrams Significant cntributr t the natinal ecnmy: 8,800 assciates natinwide Offices in all states where the cmpany prvides managed care Ranked #195 n the FORTUNE 500 All numbers are as f June 30,

3 WellCare Health Plans, Inc. Emphasis n value-fcused benefit design At WellCare, ur members are ur reasn fr being. We help thse eligible fr gvernment-spnsred health care plans live better, healthier lives. Cmmunicatin amng members and prviders t imprve utcmes Fcus n preventive care including regular dctr visits Cmmunity-based slutins t clse gaps in the scial safety net 3

4 Structure fr Jint Accuntability Center fr CmmUnity Impact CmmUnity Operatins CmmUnity Innvatin CmmUnity Analytics CmmUnity Assistance Line (x2 lcatins) CmmUnity Cnnectins (x11 markets) Business Develpment Supprt Wrkfrce Innvatin & Caregiver Services CmmUnity Impact Campaigns CmmUnity Cmmand Center Reprting, Evaluatin & Research CmmUnity Impact Mdel 4

5 CmmUnity Impact Mdel Overview Overview Fur distinct elements 1. Web-based platfrm with autmated tls 2. Peer engagement fr greater activatin 3. Data-infrmed cmmunity investing 4. Rigrus academic evaluatin Here s Hw It Wrks Tracking Scial Service Access & Use: WellCare links members and families t scial services and tracks each time services are used r nt Cmmunity Engagement: Using the scial service data, WellCare: Identifies when services are needed but nt available and then mbilizes resurces t (re)create the needed service; Frms cmmunity planning cuncils t expand innvative cmmunity-based prgrams r intrduce new prgrams; Establishes CmmUnity Cntracts t assess impact and pilt new payment mdels with cmmunity partners. Evaluatin: These activities generate the data n which we evaluate the impact f scial services in three ways: Imprving health utcmes and increasing access t care Reducing avidable csts by remving scial barriers Evaluating system effectiveness leading t scial innvatin 5

6 CmmUnity Impact Mdel Overview Natinal Key Data Pints Scial Services Catalgued: 190,000 + Scial Service Referrals: 47,000 peple/145,300 services 14.7% - Medicatin Assistance 13.0% - Fd Pantry 10.8% - Medical Transprtatin 10.2% - Utility Assistance 8.3% - Financial Assistance CmmUnity Activities: 32,795 25,909 Cmmunity engagement prgrams 6,886 Evidence-based health and wellness Ttal Scial Service Accessed: 31% Netwrk Gaps Filled: 3, % - Medical Transprtatin 10.9% - Utility Assistance 8.9% - Lw Cst Dental Care 8.0% - Financial Assistance 6.7% - Husing Assistance Data as f 9/17 6

7 CmmUnity Impact Mdel Overview Imprve Access & Outcmes Members with a scial barrier remved are: Outcmes 6.9x mre likely t have a better Adult Bdy Mass Index scre 2.8x mre likely t have a better medicatin assessment scre 2.3x mre likely t have a better Clrectal Cancer screen 1.7x mre likely t schedule and g t their Annual PCP visit Reduce Cst Remving a scial barrier led t an aggregated savings f $450 per-scial-service-accessed frm reduced: Inpatient Spending (53%) Emergency Rm Use (17%) Emergency Department Spending (26%) CmmUnity Innvatin The healthcare savings frm remving scial barriers is re-invested back int the cmmunity thrugh investments designed t increase data sharing capabilities r sustain critical scial services. Data as f 9/17 7

8 CmmUnity Assistance Line/ Liaisn Team CmmUnity Liaisn Prgram Team f peer-supprt crdinatrs hired thrugh wrkfrce innvatin prgrams t find and catalgue cmmunity-based prgrams and services. Annual cst: $11,500 per Liaisn Team represents many diverse cultures including individuals with disabilities, senirs, caregivers, students, veterans/ military families, etc. Less than $500 a year per persn fr any special accmmdatins Mre than 75% f CmmUnity Liaisns transitined t full-time emplyment First-hand experience in navigating scial services and/r have lived experience CmmUnity Assistance Line: Launched in September 2014 Respnd t 5,600 + calls per mnth Referred nearly 35,600 peple t 113,500 + services Average three referrals per persn with 31% access rate Data as f 9/17 8

9 Scial Service Cntracting A ttal f mre than 650 cntracts equaling nearly $3M annually designed t a) teach cmmunity partners hw t cntract with a managed care cmpany fr the delivery f scial services acrss ppulatins and b) evaluate their impact n health utcmes. Hyper Lcal Resurce Grants Initiating the relatinship Nt mre than $2,500 N PHI exchanged Cmmunity Health Initiatives Testing the exchange f Infrmatin Nt mre than $6,000 N PHI exchanged Cmmunity Health Investment Pilts Data sharing agreement with delivery f services Average cntract between $6,000 - $50,000 PHI exchanged in encunter reprt Data as f 9/17 9

10 CmmUnity Cmmand Center 10