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

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.

Pamme Taylor

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 of 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 2nd webinar on Closing Care Gaps and Engaging Dually Eligible Members in Self-Management.

In case you missed this webinar, you still have a chance to watch this highly-rated program.

Register to view the conference today or order your training DVD or CD:
http://store.hin.com/product.asp?itemid=4715

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.

During the 45-minute program, Taylor also described the five key roles of the community health worker and addressed the challenges of identifying and communicating with dual eligibles

You can "attend" this program right in your office and learn how WellCare connects with primary care physicians and specialists to assess member needs; uses PCPs and specialists to identify cultural and ethnic preferences to improve member engagement; developed a referral tracking system embedded in the electronic health record for case managers to link members to available services; and expanded the referral tracking system data inputs to create a truly population health-focused platform. Taylor also shares the impact of these initiatives on emergency room utilization, quality scores and gaps in care.

It’s so convenient! Invite your staff members to watch the conference. We will send you a DVD or CD-ROM of the conference proceedings or a link to our web site with a username and password. You can log in and view the program right from your computer — any time of the day or night, whenever convenient for you and your colleagues — and benefit from the archived recording of the conference, including the Q&A period.

You'll get to listen to the question and answer session to hear WellCare’s strategy and implemented practice for contacting dual-eligible members and ensuring follow through with recommended referrals to community support services, how to overcome barriers relating to reaching members via the phone or email, or to those who don’t keep appointments with their primary care providers, identifying community services that can meet the needs of members and monitoring and evaluating these services on an ongoing basis, the components of WellCare's health assessment for dual eligibles and details on WellCare's "soft landing" strategy for new members who are dually eligible.

To register for the on-demand re-broadcast, download an .MP3 file or order the training DVD or CD-ROM of Closing Care Gaps and Engaging Dually Eligible Members in Self-Management, please visit:
http://store.hin.com/product.asp?itemid=4715

I hope you find it useful.

Cordially,

Melanie Matthews
Executive Vice President
The Healthcare Intelligence Network

P.S. -- You may also be interested in these resources on dual eligibles: