Through a 2015 pilot program, Integra ServiceConnect®, a community-based healthcare support company, assisted WellCare of New York in locating more than 300 members with complex physical and/or behavioral health needs in targeted geographic areas. Integra's community health workers were able to find members who did not have current addresses or phone numbers on file by visiting their last known addresses, talking to neighbors, searching the Internet and visiting homeless shelters, food pantries and other social service agencies. They also assisted with helping members access the appropriate level of care and engage with a primary care physician.
WellCare's care managers step in to create individual, collaborative care plans to address members' needs and close any gaps in care. They also connect members with community organizations that can assist with any unmet basic needs – such as food, housing, transportation or other social services – that can limit their ability to prioritize their health.
These 2015 efforts resulted in cost reductions associated with avoidable hospitalizations and emergency room visits, as well as decreases in the monthly cost of caring for members in this population. These savings enable WellCare of New York to invest in additional resources and programs that can help members live better, healthier lives.
The pilot program helped people like Bronx resident Olga Burgos. She is 69 and suffers from pain related to rheumatoid arthritis. The pain gets out of control, she said, and prompted frequent trips to urgent care. The pain also caused her to miss doctor's appointments.
Integra community health worker Angela Wong visited Burgos at her apartment to help her get the care she needed. She made medical appointments for Burgos and accompanied her to many of them to help her clearly communicate with the doctor about the pain. Wong also arranged for a home health aide to assist Burgos with daily activities and scheduled recommended preventive screenings such a mammogram and colonoscopy.
"Sometimes it's a bit rough," Burgos said recently. "Yesterday I couldn't even get up."
She appreciates the extra support from WellCare. "They're helping me get what I need," she said. "I gotta keep going."
WellCare is now extending its partnership with Integra to increase member engagement targets and eventually serve WellCare's entire 16-county Medicaid coverage area, which includes Albany, Bronx, Dutchess, Erie, Kings, Nassau, New York, Niagara, Orange, Queens, Rensselaer, Rockland, Schenectady, Schuyler, Steuben and Ulster.
"WellCare is at the forefront of an important movement among health plans that understand the important role that social determinants play in impacting their members' health and is proactively working to address them," said Michael Yuhas, Integra's founder and chairman. "We are pleased that WellCare has expressed the confidence in Integra to allow us to work with more of their most vulnerable, hard-to-engage members."
As of June 30, 2016, WellCare serves approximately 122,000 Medicaid members, 42,000 Medicare Advantage members, 55,000 Medicare Prescription Drug Plan members and 7,000 Managed Long Term Care members in New York.
About WellCare Health Plans, Inc.
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. The company serves approximately 3.8 million members nationwide as of June 30, 2016. For more information about WellCare, please visit the company's website at www.wellcare.com or view the company's videos at https://www.youtube.com/user/WellCareHealthPlan.
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SOURCE WellCare Health Plans, Inc.