Community Impact Model Mackie Hicks

WellCare Health Plans, Inc.

Company  Snapshot  

2 All numbers are as of June 30, 2017

Founded in 1985 in Tampa, Fla.: •  Serving 4.4 million members nationwide •  407,000 contracted health care providers •  68,000 contracted pharmacies

Serving 2.8 million Medicaid members in 11 states: •  Aged, Blind and Disabled (ABD) •  Children’s Health Insurance Program (CHIP) •  Family Health Plus (FHP) •  Supplemental Security Income (SSI) •  Temporary Assistance for Needy Families (TANF)

Serving Medicare members in 17 states: •  484,000 Medicare Advantage members •  1.1 million Prescription Drug Plan (PDP) members Serving the full spectrum of member needs: •  Dual-eligible populations (Medicare and Medicaid) •  Managed Long Term Care (MLTC)

Spearheading efforts to sustain the social safety net: •  The WellCare Community Foundation •  WellCare Associate Volunteer Efforts (WAVE) •  Community-based social service programs

Significant contributor to the national economy: •  8,800 associates nationwide •  Offices in all states where the company provides

managed care •  Ranked #195 on the FORTUNE 500

WellCare Health Plans, Inc.

At WellCare, our members are our reason for being.

We help those eligible for

government-sponsored health care plans live better, healthier lives.

Emphasis on value-focused benefit design

Community-based solutions to close gaps in the social safety net

Focus on preventive care including regular doctor visits

Communication among members and providers to improve outcomes

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Structure for Joint Accountability

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Center for CommUnity Impact

CommUnity Operations

CommUnity Assistance Line (x2 locations)

CommUnity Connections (x11 markets)

CommUnity Innovation

Business Development

Support

Workforce Innovation &

Caregiver Services

CommUnity Impact

Campaigns

CommUnity Analytics

CommUnity Command

Center

Reporting, Evaluation & Research

CommUnity Impact Model

CommUnity Impact Model Overview

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Here’s How It Works •  Tracking Social Service Access & Use: WellCare

links members and families to social services and tracks each time services are used or not

•  Community Engagement: Using the social service data, WellCare:

o  Identifies when services are needed but not available and then mobilizes resources to (re)create the needed service;

o  Forms community planning councils to expand innovative community-based programs or introduce new programs;

o  Establishes CommUnity Contracts to assess impact and pilot new payment models with community partners.

•  Evaluation: These activities generate the data on which we evaluate the impact of social services in three ways:

o  Improving health outcomes and increasing access to care

o  Reducing avoidable costs by removing social barriers o  Evaluating system effectiveness leading to social

innovation

Overview •  Four distinct elements

1.  Web-based platform with automated tools

2.  Peer engagement for greater activation 3.  Data-informed community investing 4.  Rigorous academic evaluation

CommUnity Impact Model Overview

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National Key Data Points •  Social Services Catalogued: 190,000+

•  Social Service Referrals: 47,000 people/145,300 services

o  14.7% - Medication Assistance o  13.0% - Food Pantry o  10.8% - Medical Transportation o  10.2% - Utility Assistance o  8.3% - Financial Assistance

•  CommUnity Activities: 32,795

o  25,909 – Community engagement programs

o  6,886 – Evidence-based health and wellness

•  Total Social Service Accessed: 31%

•  Network Gaps Filled: 3,950 o  16.5% - Medical Transportation o  10.9% - Utility Assistance o  8.9% - Low Cost Dental Care o  8.0% - Financial Assistance o  6.7% - Housing Assistance

Data as of 9/17

CommUnity Impact Model Overview

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Outcomes •  Improve Access & Outcomes

Members with a social barrier removed are: o  6.9x more likely to have a better Adult Body Mass Index score o  2.8x more likely to have a better medication assessment score o  2.3x more likely to have a better Colorectal Cancer screen

o  1.7x more likely to schedule and go to their Annual PCP visit

•  Reduce Cost Removing a social barrier led to an aggregated savings of $450 per-social-service-accessed from reduced: o  Inpatient Spending (53%) o  Emergency Room Use (17%) o  Emergency Department Spending (26%)

•  CommUnity Innovation The healthcare savings from removing social barriers is re-invested back into the community through 650+ investments designed to increase data sharing capabilities or sustain critical social services.

Data as of 9/17

CommUnity Assistance Line/ Liaison Team

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CommUnity Liaison Program

Team of peer-support coordinators hired through workforce innovation programs to find and catalogue community-based programs and services. •  Annual cost: $11,500 per Liaison •  Team represents many diverse cultures

including individuals with disabilities, seniors, caregivers, students, veterans/military families, etc.

•  Less than $500 a year per person for any special accommodations

•  More than 75% of CommUnity Liaisons transitioned to full-time employment

•  First-hand experience in navigating social services and/or have “lived” experience

CommUnity Assistance Line: •  Launched in September 2014 •  Respond to 5,600+ calls per month •  Referred nearly 35,600 people to 113,500+

services •  Average three referrals per person with 31%

access rate

Data as of 9/17

Social Service Contracting

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A total of more than 650 contracts equaling nearly $3M annually designed to a) teach community partners how to contract with a managed care company for the delivery

of social services across populations and b) evaluate their impact on health outcomes.

•  Initiating the relationship •  Not more than $2,500 •  No PHI exchanged

Hyper Local Resource Grants

•  Testing the exchange of Information •  Not more than $6,000 •  No PHI exchanged

Community Health Initiatives

•  Data sharing agreement with delivery of services •  Average contract between $6,000 - $50,000 •  PHI exchanged in encounter report

Community Health Investment

Pilots Data as of 9/17

CommUnity Command Center

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