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WellCare Health Plans has created a large database that lists community organizations that provide services to WellCare’s regions.
Case managers nationwide use their experience and skills to find creative solutions to their patients’ medical obstacles and problems. But what if finding precisely the right answer was as simple as putting a word in a search engine?
That’s essentially what is happening with WellCare Health Plans of Tampa, FL, and the company’s HealthConnections program.
“HealthConnections is the connection between the synchronization of services across social, clinical, and behavioral health services,” says Pamme Taylor, vice president for advocacy and community-based programs for WellCare, an insurance company.
“This model embeds social service delivery right smack dab in the middle of care management,” Taylor says.
“We’ve created a database with social services that spans 32 different states and 150,000 social service partners and 73 categories of services,” Taylor says. “They span adoption, advocacy, all the way to youth support services.”
The program has connected about 16,000 people to 50,000 services since 2011, she says.
WellCare’s program covers Medicaid and Medicare populations with about 16,000 people enrolled in case management. HealthConnections helps enrollees with issues that might affect their medical care indirectly, such as housing, transportation, food, and other needs, she explains.
For example, a member might not be able to leave the house due to lack of a good wheelchair.
“Recently, I went to evaluate a person to make sure they had an appropriate wheelchair,” says Kendra St. Vincent, RN, CCM, senior field service coordinator for WellCare Kentucky.
“Basically, the person’s wheelchair didn’t have an appropriate leg rest and it wasn’t able to recline,” St. Vincent says. “The patient needed it to be functional to leave the house.”
Using HealthConnections, St. Vincent found a better wheelchair and was able to have it delivered to the member’s home.
HealthConnections, which is continuously updated, has included many community services for urban areas, but rural services sometimes are lacking, Taylor notes.
“We found in rural communities that there is a general lack of services across many different categories, and social services is one of them,” she says. “Trying to find multiple services in rural areas is extraordinarily difficult.”
As a result, WellCare created HealthConnections Council with local teams that bring different people together to create a new service and fill a gap, she explains.
“Those are called community health investment programs, where we take savings from our model and reinvest the money in the community in the social services gap,” Taylor says.
For instance, WellCare has worked with local transportation providers to put bus routes in a loop, so a person could get on the bus, go to a doctor’s visit, and then go to a pharmacy and grocery store before heading home, she says.
“An evaluation of the change demonstrated its impact on health outcomes, reducing avoidable ER visits, so absolutely, it was worth the effort,” Taylor adds.
Part of Taylor’s passion for the HealthConnections program comes from her personal experience and understanding of how difficult it can be for people to manage their health when they have basic living needs that are unmet. “I’m a former Medicaid recipient, a part of the foster care system,” she says.
“When you’re worried about whether or not you have a roof over your head or have food that day, then you’re not worried about what your future will be,” Taylor explains.
Sometimes, even an experienced care manager can be shocked by how seemingly minor bumps in life’s road can sideline families.
For example, St. Vincent recalls visiting the home of a non-English-speaking WellCare member. When she walked into the rental home, she could see that the kitchen sink, which didn’t have a garbage disposal, was stopped up from food and was unusable. The family had been washing dishes in the tub and carrying buckets of water from the tub to the backyard. This had been going on for three months.
“I called the landlord for them, and the landlord said it was their responsibility to fix the sink,” St. Vincent says.
Using HealthConnections, St. Vincent found a community church that donated funds to fix the sink. After a plumber replaced the elbow of the sink’s pipes, St. Vincent educated the family on how to avoid putting food refuse down the sink. She also taught them how to change a light bulb because they were refugees from an area that didn’t have plumbing or electricity.
Sometimes, transportation barriers for members is not as simple as finding a community organization that provides rides to doctor’s appointments. This is where the extensive database and the ability to ask for help through a database query can be helpful. For instance, one homebound member in a wheelchair had multiple health issues, including obesity, diabetes, heart failure, and hypertension, but he couldn’t always get to the doctor, recalls Charles Talbert, regional communication manager for WellCare Kentucky.
“During the winter months, his driveway was impassable, so the care manager took it upon herself to contact a local paving company,” Talbert says. “The paving company was so moved by the care manager reaching out that the company donated 100 tons of gravel to get the driveway passable.”
Once the driveway was made passable, the transportation company could pick up the patient to go to doctors’ appointments.
“We have a laundry list of gaps in these types of care,” Talbert says. “When people are confronted with a stopped-up drain and driveway, this is where a care manager comes in and moves heaven and earth to get the help the person needs.”