Wellcare Community Impact Model

Multistate

WellCare Health Plans, Inc. is a national managed care health plan, primarily serving Medicare, Medicaid and Dual Eligible populations across the U.S. In 2011, Wellcare launched its Community Impact Model (also known as HealthConnections) to better understand patients' need for and use of social service providers, in addition to the associated benefits. The model includes four components which aim to reduce social barriers to healthcare access, reduce overall healthcare costs and build an effective social support network for its members. They include: (1) the Community Health Investment Program, which provides grants to community-based organizations and other social service providers to support investments related to data exchange; (2) the Community Assistance Line, a call center that provides referrals to social service providers; (3) the Community Liaison Program, which employs liaisons to help Community Assistance Line callers navigate community-based and social services; and (4) Community Connections, which contracts with social service providers to exchange data. Wellcare currently operates the Community Assistance Line and Community Health Investment Program in 15 states.

Partner Organizations

Target Population

WellCare members (primarily individuals on Medicare, Medicaid and those who are dually eligible)

Care Team

Community liaisons

Timeframe

2011 - present

Results/ Studies

Members with a social barrier removed were:

• 6.9x likely to have a better Adult Body Mass Index score
• 2.8x more likely to have a better medication assessment score
• 2.3x more likely to have a better Colorectal Cancer screen
• 1.7 x more likely to schedule and go to their annual PCP visit

Removing a social barrier led to an aggregated savings of $450 per-social-service-accessed from reduced:

• Inpatient spending (55%)
• ER use (17%)
• ER spending (26%)

Funding

Wellcare

Resources

Program description (KPMG/The Commonwealth Fund, March 2018)

Program overview and results (Root Cause Coalition, September 2017)