WellCare - SC Office of Rural Health

Report
WellCare Health Plans, Inc.
Kathy Warner, Chief Operating Officer for SC
and
Tammie Burnette, Community Relations
Representative
Company Snapshot
WellCare Health Plans, Inc.
Founded in 1985 in Tampa, Fla.
• Approximately 2.7 million members nationwide
• More than 210,700 contracted health care providers
• More than 66,300 contracted pharmacies
Serving approximately 1.7 million Medicaid members,
including:
• Aged, Blind and Disabled (ABD)
• Children’s Health Insurance Plan (CHIP)
• Family Health Plus (FHP)
• Supplemental Security Income (SSI)
• Temporary Assistance for Needy Families (TANF)
Serving Medicare members, including:
• Approximately 256,000 Medicare Advantage members
• Approximately 757,000 Prescription Drug Plan members
Serving the full spectrum of member needs
• Dual-eligible populations (Medicare and Medicaid)
• Managed Long Term Care
Spearheading efforts to sustain the social safety net
Medicaid, Medicare Advantage & Medicare Part D PDP
Medicare Advantage & Medicare Part D PDP
Medicaid & Medicare Part D PDP
Medicare Part D PDP (49 states & D.C.)
• The WellCare Community Foundation
• Advocacy Programs
• Creation of Public-Private Partnerships
Significant contributor to the national economy
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Data as of March 31, 2013
A FORTUNE 500 company
Ranked #18 in the nation on the Barron’s 500
More than 4,900 associates nationwide
Offices in all states where the company provides managed
care
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WellCare Health Plans, Inc.
Vision
To be the leader in government-sponsored health care programs in partnership with the
members, providers, government customers and communities we serve.
Mission
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Enhance our members' health and quality of life
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Partner with providers and government customers to provide quality, cost-effective
health care solutions
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Create a rewarding and enriching environment for our associates
Core Values
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Partnership
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Integrity
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Accountability
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Teamwork
Data as of March 31, 2013
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Our Mission to Serve
Emphasis on lower income
populations and value-focused benefit
design
At WellCare, our members
are our reason for being.
We work each day to
enhance our members’
health and quality of life.
Communication among members and
providers to improve outcomes
Focus on preventive care including
regular doctor visits
Community-based solutions to close
gaps in the social safety net
Data as of March 31, 2013
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Company History & Growth
Medicaid and Medicare Advantage Plans
Data as of March 31, 2013
State
Began
Operations
Florida
1985
Connecticut
1998
New York
1998
Illinois
2004
Louisiana
2004
Georgia
2006
Missouri
2007
Ohio
2007
New Jersey
2008
Texas
2008
Hawaii
2009
Kentucky
2011
California
2012
Arizona
2013
South Carolina
2013
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WellCare of SC Timeline
• Purchased United Health Care Community Plan 2/1/2013
• Transition of Services with United 2/1 through 8/31/2013
“Business as Usual”
• Member Notices around 7/25/2013
• Provider Notices around 7/25/2013
• Provider and Member in-services and education month of
August
• Go Live and operate Medicaid plan as WellCare of South
Carolina
• Transition of Carolina Medical Homes Membership
Projected for 12/1/2013
What We Do
Reduce Cost and Improve Quality and Access
for Government Health Programs by:
•
Providing managed care services
targeted to government-sponsored
health care programs, focusing on
Medicaid, Medicare and Prescription
Drug Plans
•
Serving a variety of people including
families; children; and the aged, blind
and disabled; includes a focus on lowincome, dual-eligible populations
•
Improving quality of care, increasing
health care access and improving
outcomes for members
•
Relieving providers of administrative
work and hassles
•
Providing cost savings for government
customers and taxpayers
Data as of March 31, 2013
Medicaid
Managed
Long Term
Care
DualEligible
Members
WellCare
Prescription
Drug Plans
Medicare
Advantage
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Medicaid Presence
Approximately 1.7 million members across 9 states
• Presence in 5 of the 10 largest states
• Broad range of eligibility groups
• Capabilities to integrate medical, pharmacy and
behavioral services
• Coordination with Medicare benefit a strength
Data as of March 31, 2013
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Medicare Advantage Presence
Approximately 256,000 members across 14 states
Data as of March 31, 2013
•
Serving 204 counties, encompassing more than 15
million Medicare-eligible residents
•
Offering Dual Special Needs Plans in nearly all counties
•
Complementary to Medicaid and stand-alone PDP
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Prescription Drug Plans Presence
Approximately 757,000 members across 49 states and D.C.
Data as of March 31, 2013
•
Focused on value-conscious beneficiaries
•
A leader in generic utilization
•
More than 75% of our members have selected our
plans (as opposed to being auto-assigned)
•
Pharmacy data, purchase volume and infrastructure
benefit Medicaid and Medicare Advantage plans
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WellCare’s Integrated Care Model
Pharmacy
Management
Disease
Management
Home and
Communitybased Care
Mental Health
Case
Management
Therapy
Specialists
Transportation
Members
&
Primary Care
Optical
Caregivers
Community-Based Social Services
Integrated Care Management and Coordination of Care can:
• Enhance quality of life for members and family caregivers • Provide value to state customers and members
• Significantly decrease inpatient readmissions • Reduce over-utilization across multiple segments
• Reduce non-emergency ground transportation costs • Reduce inpatient bed days
Data as of March 31, 2013
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Focused Giving
WellCare strives to enhance the health, well-being, safety and quality of life for the disabled, economically
disadvantaged and medically underserved, and the communities in which they live.
The WellCare Community Foundation works
with a number of organizations to improve
outcomes for our members and lower the
overall cost of health care, including:
•
Big Brothers and Big Sisters
•
The Family Café
•
The Greater New Orleans Foundation
•
The Judeo Christian Health Clinic
•
The National Association of Area Agencies
on Aging
•
Nathaniel’s Hope
Data as of March 31, 2013
The weCare WellCare Gives Back program
encourages employee volunteerism, specifically in
low-income, underserved and aged populations.
In 2012, employees donated more than 1,500
hours to community partners through the weCare
WellCare Gives Back program.
Some of our partners include:
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Free Community Programs
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Eating Healthy on a Budget
A is for Asthma
Lead Away
Know Your Number (Healthy Heart Presentation)
Heart Disease and Stroke (Healthy Heart Presentation)
Nutrition and the Heart (Healthy Heart Presentation)
Diabetes and the Heart (Healthy Heart Presentation)
Tobacco and the Heart (Healthy Heart Presentation)
Exercise Presentation combined with Stress Management
Presentation (Healthy Heart Presentation)
Fitness Day/ Night (family friendly line dancing)
Sugar Presentation
Portion Distortion Presentation
Sodium Presentation
Fitness activities for kids
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Local Community Partnerships
• Attend and participate in
community meetings
• Volunteer for community projects
• Provide education for the
community agency clients
• We not only want to help to
provide affordable healthcare for
our Medicaid population, but we
also want to help make the
communities be healthier.
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Helpful Website for Us
• https://www.wellcare.com
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Contact Information
• Kathy Warner
Phone: 803-724-1393
Email: [email protected]
• Tammie Burnette
Phone: 803-404-0653
Email: [email protected]
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Questions?
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