wellcare health plans, inc. kathy warner, chief operating officer for sc and tammie burnette,...
DESCRIPTION
WellCare Health Plans, Inc. Kathy Warner, Chief Operating Officer for SC and Tammie Burnette, Community Relations Representative. WellCare Health Plans, Inc. Company Snapshot. Medicaid, Medicare Advantage & Medicare Part D PDP. Medicare Advantage & Medicare Part D PDP. - PowerPoint PPT PresentationTRANSCRIPT
WellCare Health Plans, Inc.
Kathy Warner, Chief Operating Officer for SC and
Tammie Burnette, Community Relations Representative
2Data as of March 31, 2013
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 pharmaciesServing 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• The WellCare Community Foundation• Advocacy Programs• Creation of Public-Private Partnerships
Significant contributor to the national economy• 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
Company Snapshot
Medicare Advantage & Medicare Part D PDPMedicaid & Medicare Part D PDP Medicare Part D PDP (49 states & D.C.)
Medicaid, Medicare Advantage & Medicare Part D PDP
3Data as of March 31, 2013
VisionTo be the leader in government-sponsored health care programs in partnership with the members, providers, government customers and communities we serve.
Mission• Enhance our members' health and quality of life
• Partner with providers and government customers to provide quality, cost-effective health care solutions
• Create a rewarding and enriching environment for our associates
Core Values• Partnership
• Integrity
• Accountability
• Teamwork
WellCare Health Plans, Inc.
4Data as of March 31, 2013
At WellCare, our members are our reason for being.
We work each day toenhance our members’
health and quality of life.
Our Mission to Serve
Emphasis on lower income populations and 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
5Data as of March 31, 2013
Company History & Growth 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 2013Medicaid and Medicare Advantage Plans
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
7Data as of March 31, 2013
• 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 low-income, 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
What We Do
Reduce Cost and Improve Quality and Accessfor Government Health Programs by:
WellCare
Medicaid
Dual-Eligible
Members
MedicareAdvantage
Prescription
Drug Plans
Managed Long Term
Care
8Data as of March 31, 2013
Medicaid Presence
• 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
Approximately 1.7 million members across 9 states
9Data as of March 31, 2013
Medicare Advantage Presence
• 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
Approximately 256,000 members across 14 states
10Data as of March 31, 2013
Prescription Drug Plans Presence
• 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
Approximately 757,000 members across 49 states and D.C.
11Data as of March 31, 2013
WellCare’s Integrated Care Model
Members&
Caregivers
Primary Care
Specialists
Case Management
Mental HealthPharmacy ManagementDisease Management
Home and Community-based Care
Therapy
Transportation
Optical
Community-Based Social Services
• 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
Integrated Care Management and Coordination of Care can:
12Data as of March 31, 2013
Focused Giving
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.
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.
Some of our partners include:
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
13
Free Community Programs
• 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
14
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.
16
Contact Information
• Kathy Warner Phone: 803-724-1393Email: [email protected]
• Tammie BurnettePhone: 803-404-0653Email: [email protected]
17
Questions?