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WellCare Health Plans, Inc.

Agenda

I. Who is WellCare

II. Healthcare Quality and Access

III. Integrated Health Services

IV. Quality

V. Innovation

VI. Questions

11/2/2015

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PICTURE

WellCare Health Plans, Inc.House Study Committee on Children’s Mental Health

By Dauda Griffin, MD, Behavioral Health Medical Director

Remedios Rodriguez, Senior Director, Behavioral Health Operations

October, 20, 2015

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WellCare Health Plans, Inc.

Agenda

I. Who is WellCare

II. Healthcare Quality and Access

III. Integrated Health Services

IV. Quality

V. Innovation

VI. Questions

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WellCare Health Plans, Inc.

VisionTo be a leader in government-sponsored health care programs in partnership with the members, providers, governments and communities we serve.

Mission• Enhance our members' health and quality of life

• Partner with providers and governments to provide quality, cost-effective health care solutions

• Create a rewarding and enriching environment for our associates

Core Values• Partnership

• Integrity

• Accountability

• One Team

Data is per the last reported quarter, ending June 30, 2015All numbers are approximated.Updated: September 18, 2015

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Serving Georgia

WellCare’s direct economic impact* on the state of Georgia is $26 million annually.

In Georgia, WellCare:• Serves 653,000 members across the state†

• Has a local presence with five office locations

• Employs 305 people

Counties with WellCare offices

Echols

Lowndes

Charlton

Seminole

ThomasBrooksGradyDecatur

Camden

Lanier

Clinch

Miller ColquittCook Brantley

AtkinsonMitchell

BakerGlynn

Ware

BerrienEarly Pierce

TiftCalhoun DoughertyMcIntosh

BaconIrwin

Clay

Coffee WayneWorth

Ben HillTurnerLeeRandolph

ApplingTerrell Jeff Davis

Quitman

Long

Crisp

Liberty

Wilcox Telfair

SumterStewart

Webster

ChathamBryan

EvansDooly

Wheeler Tattnall

Toombs

Montgom

ery

Pulaski

Schley

Dodge

TreutlenMacon

Chatta

hooc

hee

CandlerMarion BleckleyEffingham

Muscogee

BullochHoustonPeac

h

Laurens

Taylor

Johnson

Emanuel

CrawfordHarris TalbotTwiggs

Bibb JenkinsUpson

WilkinsonScreven

JonesBaldwin

Monroe

Lam

ar

PikeTroup

Meriw

ether Washington

BurkeJefferson

GlascockSpaldingHeard Butts HancockPutnamCoweta

Jasper RichmondFayette Warren

HenryC

layton

McDuffie

ColumbiaTaliaferroNewton GreeneRock

daleDouglas

Carroll Morgan

Haralson Walton

OconeeDekalb LincolnWilkes

ClarkeOglethorpePaulding

CobbPolk BarrowGwinnett

Fulto

n

MadisonElbertJackson

ForsythCherokeeBartow

Banks HartHall

FranklinPickens

Floyd

Chattooga Dawson

GordonStephensLumpkin

White

Habersham

GilmerWalker

DadeUnion

Catoosa Whitfield

FanninMurray

TownsRabun

Data is per the last reported quarter, ending June 30, 2015All numbers are approximated.Updated: September 18, 2015

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Overview of BH Population

Data is per the last reported quarter, ending June 30, 2015All numbers are approximated.Updated: September 18, 2015

% of Child Members with a Behavioral Health Diagnosis

Estimated % of Child Members with a BH Diagnosis

0.00% - 0.19% Members 0.20% - 0.99% Members 1.00% - 2.99% Members 3%+ Members

Estimated % of Child Members with a BH Diagnosis

American Indian: 40 .09%Asian: 212 .38%Black: 20,2303 36%Black (non-Hispanic): 1223 2%Caucasian: 31,606 57%Other: 1,926 3.5%

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Health Care Quality and Access

Access*Provider Access:• 5,200 primary care providers.

• 21,700 specialists.

• 1,900 behavioral health and substance abuse providers.

Facilities Access:• 150 hospitals

• 26 community mental health centers

• 160 federally qualified health centers

• 115 CORE providers

• 68 Intensive Family Intervention providers

Geographic Access:• One primary care provider within 30 minutes for

urban counties and 45 minutes for rural counties.

• One hospital within 30 minutes for urban counties and 45 minutes for rural counties.

School Based/Telemedicine

• School Based Health Center Partners: Emory University, Clayton County Public Schools and Family Health Centers of Georgia• The school based health center is located at North

Clayton High School. The clinic provides on-site BH support groups and individual counseling. The goal is to evaluate 9th graders over the next four years as they matriculate through high school (academics, social needs, class behaviors). In addition, there is a student committee that works closely with the SHBC team.

• Telemedicine : Crisp County and Appling County (school based)

• Currently, there is limited to no access to therapist and/or psychiatrist in the community. The setup for the telemedicine would be in a convenient location to the school as well as in an area that adults and/or seniors could access it as well.

• CORE and CSB• Tanner Medical Center partnership with Haralson

County School Systems

• APEX Project – school-based counseling by CSB’s

WellCare is committed to continually improving the quality of care and service that we provide to our members.

Data is per the last reported quarter, ending June 30, 2015All numbers are approximated.Updated: September 18, 2015

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Integrated Health Services

Member

Care Coordination

& Provider Engagement

Community & Social

Safety Net Resources

Primary Care, EPSDT & Wellness

Services

Medical & Behavioral

Health Services

Med

ical

Man

agem

ent

Serv

ices

Comm

unity-Based Services

BENEFIT COORDINATION• Comprehensive Needs Assessment • Multidisciplinary Care Plan

Development• Covered Benefits• Enhanced Benefits

BUSINESS & QUALITY MANAGEMENT• Education & training• Continuous Improvement Plans• HEDIS Care gap closures• PIPS - data review and trending• Expanded Benefits & Quality Incentives

CLINICAL CARE MANAGEMENT• Disease Management• Complex Medical Management• Transitions in Levels of Care• Medication Management• Medical Service Authorizations

COMMUNITY CARE MANAGEMENT• Social , Functional & Behavioral

Interventions • Social Determinants of Health• Community Advocacy• Community Resource Mapping

Integrated Case Management

Regional Pod Assignments7 Regional pods Metro Atlanta – North Metro Atlanta – South Non-Metro Atlanta Central Southeast East Southwest

Pod configuration 3 Field Service Coordinators

(RN – Medical, OB & Pediatrics) 1 Social Worker 1 Clinical BH Social Worker 1 OB Social Worker 1 Community Health Worker 1 Care Coordinator 1 Utilization Management nurse

Integrated Health Services

Focus on Quality – Behavioral Health HEDIS® Measures

Follow-up care for children prescribed ADHD medication – One follow-up visit within 30 days of medication initiation. At least two more follow-up visits between 4 and 9 weeks if on medication at least 210 days.

Follow-up after hospital discharge: One follow-up visit with a mental health provider within 7 and 30 days of discharge.

Use of multiple concurrent antipsychotics in children and adolescents

Focus on Care Coordination

Bilateral communication between PCPs and Behavioral Health providers, with member consent, upon care initiation and quarterly thereafter via summary reports that include treatment plan, health status changes and medications.

Psychiatric Hospital communication with PCP and outpatient behavioral health providers upon admission and discharge plan.

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On Site Utilization Management / Discharge Planner

Embedded Care Manger in high volume hospital

Partnership with hospital to provide efficient and high quality care

Assist inpatient team with members who have barriers to discharge

Provide access to outpatient and transition services

Transportation Referral to field-base case

management Call member to ensure they

have everything needed to attend follow-up appointment within 7 days

COBALT

Web-based confidential care When it comes to your patients’ emotional health, we have a program that makes it easy for them to get the support they need. Access self-guided, self-paced, online programs to support them anytime and anywhere.

Programs are:• Clinically proven• Medication free• Easy to use• Long-lasting improvement

This is short-term, goal-oriented, computerized cognitive behavioral therapy (CCBT) that focuses on problem-solving and skill building to help identify thoughts, modify beliefs and change behaviors.

You can refer your patients now to these programs: RESTORE (Insomnia) — for difficulty sleeping, 7 online sessions SHADE — for alcohol or substance use, 10 online sessions FEARFIGHTER—for anxiety, panic and phobia, 9 online sessionsMOODCALMER—for mild to moderate depression, 4 online sessions

Enroll patients now by going to:wellcare.cobaltcbt.com and select "Create Account Now"

Questions?Please call Bridget Cepalia at 860-507-1844

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Questions???