Community Site Presentation [1]
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Transcript of Community Site Presentation [1]
Why is Medicaid changing in OH?
HB 66/Budget Mandate: Transform Medicaid by expanding care management programs and stabilizing costs
Expanding the current full-risk program to all CFC consumers statewide
Applying care management to the ABD population through the most effective approach
ODJFS Average Medicaid Spending Per PersonPer Member Per Monthn
$-
$400
$800
$1,200
$1,600
$2,000
95 96 97 98 99 00 01 02 03
State Fiscal Year (SFY)
Ave
rage
per
mem
ber,
per m
onth
cos
ts
= Aged, Blind and Disabled
= Covered Families and Children
Why Managed Care?
Managed Care is Cost Effective Ensures Access to Providers Enhances Quality of Care Ensures Customer Satisfaction Plans offer Value Added Services
Disease Management/Case Management A 24-hour Personal Health Advisor Expanded Benefits & Incentive Programs
Who’s affected?
Covered Families and Children (CFC)Also known as Healthy Families and Healthy Start Children (up to age 19) Pregnant Women Families (Parents and Children) About 261,000 people in NE region
Aged, Blind and Disabled (ABD) Except for dual-eligibles, children under 20,
waiver, institutionalized and spend-down About 25,000 in NE Region
Members
Government Partners
Premium to WellCare
AdministrationNetwork and Medical
HospitalsAncillary
PhysiciansSpecialists
Case ManagementCustomer Services
Claims PaymentDisease Management
How do we partner with the State?
Who is WellCare Health Plan?
IL IN
NYCT
FL
GA
LA
Core Business Operational Strategy
Largest provider of managed care services exclusively focusing on Medicaid & Medicare
Over 2 Million Members Nationally
National Prescription Drug Plan Opportunity
One of the largest PDP plans in the Country
New Medicaid Opportunity – Ohio
Contract with ODJFS for CFC and ABD
Patient-focused with preventive care emphasis
MO
OHIO
What does WellCare offer?
-
,
Benefit Design
Network Structure
Preventive Care
Primary Care Model
AdditionalServices
Case/ Disease Mgmt
Mandatory Benefits
PCP, Specialists, Ancillary, Facilities
HealthCheck, Prenatal
Coordination of Care, Referrals
Therapies, Home Care, Surgery
RN’s coordinate care for members with chronic, high risk conditions
What are WellCare’s Extra Benefits?
No copays for any service Transportation (30 one-way, 15 round trip)
Medical appointment WIC Redetermination
Vision Annual exam (Kids and Adults) Up to 2 pairs eyeglasses each year Frame upgrade
Extra Benefits (continued)
Personal care items mailed to your home each month (Up to $10)
Pain relievers, vitamins, bandages, toothbrushes, etc.
No cost No prescription necessary You choose what you need
Extra Benefits (continued)
Personal Health Advisor 24-hour health advisor line
Care Management Programs for chronic diseases Nurses work with members to help coordinate
healthcare needs
Prenatal Rewards Program Prenatal Visits/Postpartum Visit Free Stroller
How Do Clients Enroll? Automated Health Systems (AHS)
Enrollment Vendor for ODJFS Choice
Eligible clients must call AHS to enroll FFS until member of WellCare
If No Choice Auto-assigned
Assignment Process History/Relationship with Provider (PCP/Hospital) Proximity to Provider
AHS Contact Information (800) 605-3040 TTY – (800) 292-3572
How Can WellCare Member Services Help?
Educator Educating members on benefits Educating on how to access services
Researcher Finding providers that meet cultural, demographic,
health care needs Assisting with claim issues
Facilitator Supporting transportation arrangements Capturing changes to demographic information Providing language services Capturing OTC orders
Coordinator Identifying transition and/or coordination of care needs Identifying candidates for disease/case management
Dedicated customer service team
Multi-lingual capacity
Superior responsiveness
Our Member Service Associates serve as advocates for our Members’ health care needs.
WellCare Member Benefits
How Do We Work Together? Opportunities for Education Health Fairs Community Events
Contact UsSusan TitteringtonOffice: (216) 378-7651Cell: (216) 255-1806
Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials
How Do We Work Together? Opportunities for Education Health Fairs Community Events
Contact UsLynn CharlesOffice: (216) 378-7820Cell: (216) 357-8901
Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials
How Do We Work Together? Opportunities for Education Health Fairs Community Events
Contact UsChristine ThwingOffice: (216) 378-7845Cell: (216) 357-8902
Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials
How Do We Work Together? Opportunities for Education Health Fairs Community Events
Contact UsTiffanie RiggsOffice: (216) 378-7818Cell: (216) 357-8904
Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials
How Do We Work Together? Opportunities for Education Health Fairs Community Events
Contact UsIvelisse RoigOffice: (216) 378-7522Cell: (216) 357-8905
Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials