© 2008 WellCare Health Plans Inc. All rights reserved.

CommUnity AdvocacyConnecting Managed Care

with Public Health 2014

Pamme Lyons-TaylorVice President

Advocacy & Community Based Programs

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Health Factors and Health Outcomes

County Health Rankings show that much of what affects health

occurs outside of the doctor’s office.

The 80/20 Rule

Unmet social needs are directly leading

to worse health.

The problems created by unmet social needs are problems for everyone.

Physicians surveyed say:

Robert Wood Johnson Foundation

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How Social Supports Link with Managed Care

Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages.

Community Based Programs

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How Social Supports Link with Managed Care

Contracted Social Supports

Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages.

Community Based Programs

Contracted community based supports vary based on population and coverage program and are included in benefit packages like Long Term Social Supports (or LTSS). These usually include services like in-home respite.

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How Social Supports Link with Managed Care

Contracted Social Supports

Contracted Acute Care /

Preventive Care Services

Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages.

Acute care services comprise the remaining contracted benefits and some enhancements. These are typically included in HEDIS and quality measures.

Community Based Programs

Contracted community based supports vary based on population and coverage program and are included in benefit packages like Long Term Social Supports (or LTSS). These usually include services like in-home respite.

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Social Supports are not “one-size-fits-all”

Community Based Programs

Temporary Assistance for Needy Families

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Social Supports are not “one-size-fits-all”

Community Based Programs

Temporary Assistance for Needy Families

Low Income Aged, Blind and Disabled

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Social Supports are not “one-size-fits-all”

Community Based Programs

Temporary Assistance for Needy Families

Low Income Aged, Blind and Disabled

Long-Term Care

p 904/20/23 01:10

Social Supports are not “one-size-fits-all”

Community Based Programs

Temporary Assistance for Needy Families

Low Income Aged, Blind and Disabled

Long-Term Care

Aged and Retired

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Social Supports are not “one-size-fits-all”

Community Based Programs

Temporary Assistance for Needy Families

Low Income Aged, Blind and Disabled

Long-Term Care

Aged and Retired

Dually Eligible

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Social Supports are not “one-size-fits-all”

Community Based Programs

Temporary Assistance for Needy Families

Low Income Aged, Blind and Disabled

Long-Term Care

Aged and Retired

Dually Eligible

Special Populations

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Social Supports are not “one-size-fits-all”

Community Based Programs

Temporary Assistance for Needy Families

Aged and Retired

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Risks to Funding, Recovery & Philanthropy

Four years of budgetary surplus (2004-2007) resulted in $936B in

accumulated cash that was virtually wiped out

in two years of recession. Recovery

spans tens years.

Source: Center for Budget and Policy Priorities, April 2012

Recovery

Giving in the US stabilized at $45.7 billion

in 2010, following a record 2.1% decline in giving (2008 – 2009)

and an unprecedented 17% drop in foundation

assets in 2008

Source: The Foundation Center, Foundation Yearbook, April 2011

Philanthropy

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CommUnity Advocacy Model Overview

The overarching goals are to:

1) Integrate Social Safety Net services into managed care for government programs,

2) Create a highly localized, systematic “program enhancement” approach for WellCare for members and their families/caregivers, and

3) Establish a platform on which to quantify the impact of social services on health outcomes while improving the health of our communities.

Community-based Activities / Programs

Community-based Strategic Giving

Social Safety NetRelationship Management

Research /Local & National Advocacy

Goal: To identify or create community-based and health focused programs for target populations

Goal: To unify, track and leverage all community – based strategic philanthropy in order to extend its impact

Goal: To quantify Social Safety Net impact on health outcomes and to find creative ways to sustain the network through greater coordination

Goal: To create a platform on which to advocate for communities, social safety providers, members, caregivers, families and communities-at-large

Primary Functions: Primary Functions: Primary Functions: Primary Functions:

Field•Lead or participate in community-based disease management

programs •Host local HCCs

Corporate•Maintain taxonomy and platform for intranet-based tools•Reporting•Manage multi-state campaigns

Field•Community investments focused on community health initiatives and associated outcomes

Corporate•Conduct community-focused research •Manage executive board placement

Field•Manage relationship with local SSN providers•Responsive network gap-fill activity

Corporate•Research & load initial SSN network (~2,500)•Maintain network database taxonomy and technical platform•Proactive network gap-fill activity

Field•Identify state level trends•Participate in local CHNA & MAPP initiatives

Corporate•Identify national trends•Host The CommUnity Commitment•Launch national affinity relationships and campaigns

Tools: •Campaign Tracker•Activity Trackers•CommUnity Library

Tools:•Activity Trackers•Grant & CHIP Tracker•CommUnity Library

Tools:•Navigator•Referral Tracker•Relationship Management Tracker

Tools:•Referral Tracker•CommUnity Library•Relationship Management Tracker

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CommUnity Advocacy Model Adoption

Establish Baseline Transitional Period Final Implementation

• Focused Metrics• Marketing / Lead Focused Activities• Culture & Linguistics• Potential Duplication• Focused Tracking• Population Analysis• Community Health Analysis

• Use baseline plus one of the following: Level I:

o Service Gaps (secondary research)o Population Characteristics by county

Level II (all of I + one of the following):o Service Gaps (primary interventions)o Population Characteristics by membero Strategic Giving

Level III (all of I & II + the following):o Community Based DM Programs

• All of the following (Levels I, II & III): Service Gaps - both Population Characteristics Strategic Giving Community Based DM Programs

• Plus the following: Referral Tracking Social Service Vendor Referrals Productivity Analysis Workforce Innovation Community Planning Councils Future Potential Revenue

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CommUnity Advocacy Model Overview

CommUnity Command Center

Catalogue of Social Supports

Community Activities

Community Health Planning / Research

Workforce Innovation / Diversity

Strategic Giving

Field-based Community-focused

Resources

Liaisons / Advocates

Community Investment Fund

HealthConnections Councils

Evaluation

Improved Health Outcomes

Automated Analytics

Management Reports

Cost Containment

Intra-agency Collaboration

Growth / Expansion

Quality / HS Analytics

Research / Design Process / Tools Outcomes / Results