Affordable, quality health care. For everyone.

WellCare’s CommUnity Impact Model

Target Population

Adults With Complex Medical Conditions and/or Multiple Chronic Conditions

Country

United States

Year Established

2011

HOW IT WORKS

CommUnity Impact is a social service case management service offered to WellCare health plan members as well as the general public. WellCare screens members for potential social issues before they become critical or clients can request help with accessing social resources through their clinical case manager, a peer-based help line, or local community health workers. An intake process is used to pre-screen individuals for appropriate social support programs. These communications are facilitated through three-way calling. Community liaisons are responsible for inbound calls from the community assistance line for program intake, referral and tracking. Case managers are responsible for the intake and screening process. The tracking system includes data on required services and completed referrals. This information can be connected to health care utilization data.

IMPACT

Since accepting its first client in 2011, WellCare has referred nearly 100,000 people to more than 300,000 social services. The program has been formally evaluated through retrospective reviews resulting in 10 different peer-reviewed studies to reveal the following:

  • Consumers with social needs are more likely to readmit into the hospital in 30 days (62%), 90 days (95%) and 180 days (125%).
  • Consumers with their social needs met visit the emergency room 12% less often, leading to an 8% drop in related costs.
  • Healthcare payers save $450 USD per social service accessed by consumers enrolled in Medicare Advantage and/or Managed Medicaid.
  • Healthcare payers save $2,443 USD per consumer per year enrolled in Medicare Advantage and/or Managed Medicaid when all of their social needs have been met.

WHAT’S INNOVATIVE

For providers

The program operates with a multidisciplinary team–based structure across multiple care settings. Community liaisons are primarily responsible for identifying the services needed and providing referrals. Primary care providers can provide the CommUnity Impact contact information to their patients but they are not responsible for the social service referrals. There is a relatively strong network of virtual services. Program staff are currently adapting “hot-spotting” methodology to support network capacity building and primary care engagement.

For patients/caregivers

Both patients and caregivers can use the referral service. Patient and community liaisons share in decision-making about what services, if any, are needed. There is strong organizational backing for patient empowerment and caregiver support and coaching, with training provided in these areas.

GOVERNANCE

Through the community advocacy team, WellCare is working to strengthen the relationship between the program and social service organizations in order to strengthen how social services are identified and delivered to consumers.  WellCare forms community planning councils to expand innovative community-based programs or to introduce new programs.

SUPPORTIVE POLICIES

The CommUnity Health Investment Program provides microgrants to community-based organizations, non-profits, and other community partners that support social services. Partners receive funding from WellCare specifically for the exchange of data or to support data exchange. The CommUnity Health Investment Program allows WellCare to invest funds in building a data-sharing infrastructure and data exchange capabilities with its social service partners rather than the more traditional method of paying for social services directly. WellCare supports six different levels of investment contract with social service providers. The contract levels are designed to help social service agencies advance their operations in order to compliantly capture, collate, and report consumer-level data in a format that is familiar to healthcare payer.

Publication Details

Publication Date: November 9, 2018