WellCare Launches Fully-Integrated Clinical Platform to Improve Member Outcomes and Drive Efficiencies

Mar 08, 2016, 08:30 ET from WellCare Health Plans, Inc.

TAMPA, Fla., March 8, 2016 /PRNewswire/ -- WellCare Health Plans, Inc. (NYSE: WCG), a leading provider of managed care services for government-sponsored health care programs, announced today the launch of its new clinical platform designed to more effectively manage the needs of its members in the areas of utilization management, care and disease management, quality management, pharmacy, long-term care and behavioral health. The system is scheduled to be rolled out in phases over a two-year period and is expected to improve member outcomes by enabling holistic, real-time care coordination and increasing the effectiveness of WellCare clinicians and staff.

"This system is designed to be innovative and transform how we care for our members," said Michael Radu, WellCare's senior vice president of clinical operations and business development. "When it's fully operational, we expect to have a best-in-class clinical platform that will allow our care managers to access a more complete history of a member's care than ever before, whether it involves medical, behavioral health, pharmacy or social service supports. It will also enable us to better coordinate care with providers and help close care gaps, with the goal of improving health outcomes for our members."

WellCare partnered with Pegasystems, Inc., the software company empowering the world's leading enterprises with strategic business applications, to create the customized system. Once fully implemented, it is designed to:  

  • Provide WellCare clinicians and care managers with a complete and real-time view of a member's medical, behavioral health and pharmacy needs in a single system that will also be accessible to remote and field-based employees.
  • Integrate medical management programs and processes to improve administrative efficiency and quality.
  • Enhance the exchange of information to WellCare's provider and pharmacy networks. This approach will enable more effective processes, including hospital discharges, needed follow-up care, and medication adherence.

"This system is designed to improve the flow of information throughout our clinical space," said Dr. Traci Ferguson, chief medical director, medical management for WellCare. "It will allow us to have a much clearer picture of what a member needs for care. For example, we can do a great job of helping a member transition home from the hospital, but if they are going home to an unheated apartment or suffer from a lack of food, it will be difficult for them to continue to get better. The new clinical platform is designed to also identify these barriers to health."

Providers also are expected to see improvements, including increased and targeted communication to help them close member care gaps, a streamlined authorization process and improved access to individual care plans for better collaboration.

"The healthcare industry is becoming increasingly complex, and managed care organizations are faced with the challenge of working in disconnected environments with information spread across different aspects of their members' care plans," said Susan Taylor, Pegasystems' vice president and business line leader, healthcare. "By unifying its platform across all dimensions of care, WellCare expects a faster, easier and more cost-effective vehicle to provide care management to help its members live better, healthier lives, especially those most in need."

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. WellCare serves approximately 3.8 million members nationwide as of Dec. 31, 2015. 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.

Cautionary Statement Regarding Forward-Looking Statements This news release contains "forward-looking" statements that are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995. Statements that are predictive in nature, that depend upon or refer to future events or conditions, or that include words such as "expects," "anticipates," "intends," "plans," "believes," "estimates," and similar expressions are forward-looking statements. For example, statements regarding the timing of the implementation of the new clinical platform and its functionality contain forward-looking statements. Forward-looking statements involve known and unknown risks and uncertainties that may cause WellCare's actual future results to differ materially from those projected or contemplated in the forward-looking statements. These risks and uncertainties include, but are not limited to, WellCare's ability to fully implement the new clinical platform with the functionality needed to improve quality and cost-efficiency, the effectiveness of the new clinical platform in improving quality and cost-efficiency, potential cost overruns and timing delays regarding the implementation of the new clinical platform, WellCare's ability to comply with contractual data requirements and related laws and regulations; WellCare's ability to maintain, upgrade or enhance the new clinical platform to meet its operational needs, potential operational disruptions related to the implementation and performance of the new clinical platform, WellCare's ability to design the new clinical platform so it is secure from attack, damage, or unauthorized access, WellCare's ability to comply with laws and regulations regarding information security, including HIPAA, WellCare's reliance on its third party vendors, and WellCare's ability to comply with the terms of the Corporate Integrity Agreement. Given the risks and uncertainties inherent in forward-looking statements, any of WellCare's forward-looking statements could be incorrect and investors are cautioned not to place undue reliance on any of our forward-looking statements.

Additional information concerning these and other important risks and uncertainties can be found in the company's filings with the U.S. Securities and Exchange Commission ("SEC"), included under the captions "Forward-Looking Statements" and "Risk Factors" in the company's Annual Report on Form 10-K for the year ended December 31, 2015, and other filings by WellCare with the SEC, which contain discussions of WellCare's business and the various factors that may affect it. Subsequent events and developments may cause actual results to differ, perhaps materially, from WellCare's forward-looking statements. WellCare's forward-looking statements speak only as of the date on which the statements are made. WellCare undertakes no duty, and expressly disclaims any obligation, to update these forward-looking statements to reflect any future events, developments or otherwise.

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SOURCE WellCare Health Plans, Inc.