WellCare Health Plans, Inc. Florida Overview
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1 WellCare Health Plans, Inc. Florida Overview December 3, 2015
2 WellCare Health Plans, Inc. Company Snapshot OUR PRESENCE Founded in 1985 in Tampa, Fla.: Serving 3.8 million members nationwide. 339,000 contracted health care providers. 70,000 contracted pharmacies. Serving 2.4 million Medicaid members, including: Aged, Blind and Disabled (ABD). Children s Health Insurance Program (CHIP). Family Health Plus (FHP). Supplemental Security Income (SSI). Temporary Assistance for Needy Families (TANF). Serving 1.4 million Medicare members, including: 349,000 Medicare Advantage members. 1 million Prescription Drug Plan (PDP) members. Serving the full spectrum of member needs: Dual-eligible populations (Medicare and Medicaid). Managed Long Term Care (MLTC). Spearheading efforts to sustain the social safety net: The WellCare Community Foundation. Advocacy Programs. Creation of Public-Private Partnerships. Significant contributor to the national economy: A FORTUNE 500 and Barron s 500 company. 6,600 associates nationwide. Offices in all states where the company provides managed care. 2
3 WellCare Health Plans, Inc. Vision To 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 3
4 WellCare Health Plans, Inc. Emphasis on lower income populations and value-focused benefit design At WellCare, our members are our reason for being. We work each day to enhance our members health and quality of life. Communication among members and providers to improve outcomes Focus on preventive care including regular doctor visits Community-based solutions to close gaps in the social safety net 4
5 Company History & Growth The states where WellCare currently offers Medicaid and/or Medicare Advantage plans and the year WellCare began operations in the state
6 What We Do Reduce Cost and Improve Quality and Access for Government Health Programs by: Providing managed care services targeted to government-sponsored health care programs, focusing on Medicaid, Medicare and Prescription Drug Plans. Serving a variety of people including families; children; and the aged, blind and disabled; includes a focus on lowincome, dual-eligible populations. Improving quality of care, increasing health care access and improving outcomes for members. Relieving providers of administrative work and hassles. Managed Long Term Care Prescription Drug Plans Medicaid WellCare Dual- Eligible Members Medicare Advantage Providing cost savings for government customers and taxpayers. Medicare Supplement 6
7 WellCare s Integrated Care Model Mental Health Pharmacy Management Disease Management Home and Communitybased Care Case Management Therapy Specialists Transportation Primary Care Members & Caregivers Optical Community-Based Social Services Integrated Care Management and Coordination of Care can: Enhance quality of life for members and family caregivers Provide value to state customers and members Significantly decrease inpatient readmissions Reduce over-utilization across multiple segments Reduce non-emergency ground transportation costs Reduce inpatient bed days 7
8 Serving Florida Staywell and WellCare s economic impact on the state of Florida is $768 million* annually. In Florida, Staywell and WellCare: Serve approximately 921,000 members across the state. Have a local presence with 20 office locations. Employ 4,100 people. Okaloosa Holmes Jackson Walton Washington Gadsden Bay Leon Calhoun Liberty Wakulla Gulf Franklin Hamilton Madison Suwannee Taylor Lafayette Dixie Levy Columbia Gilchrist Alachua Marion Nassau Baker Duval Union Clay Bradford Putnam Saint Johns Flagler Earned the Governor s Top Job Producer Award for Florida-headquartered companies in Citrus Hernando Sumter Lake Volusia Seminole Orange WellCare is one of 15 Florida-based Fortune 500 companies. Pasco Pinellas Hillsborough Polk Osceola Brevard Counties with WellCare offices *Based on a 2011 study commissioned by WellCare and conducted by James V. Koch, Ph.D., Economics, Board of Visitors Professor of Economics and President Emeritus at Old Dominion University. Manatee Hardee Highlands Desoto Charlotte Glades Lee Hendry Indian River Saint Lucie Martin Palm Beach Collier Broward Miami-Dade Monroe Monroe 8
9 Florida Medicaid Presence Staywell serves 773,000 Medicaid members across the state. Santa Rosa Okaloosa Walton Holmes Washington Bay Jackson Gadsden Calhoun Leon Liberty Wakulla Gulf Franklin Madison Taylor Hamilton Suwannee Columbia Union Baker Nassau Duval Clay Florida Medicaid Presence: Dixie Alachua Putnam Flagler Serves 50,500 dual-eligible (Medicare and Medicaid) members. Serves approximately 68,000 Florida Healthy Kids members. Serves approximately 68,000 SSI members. Serves approximately 586,000 TANF members. The largest Medicaid health plan in the state since Levy Pinellas Marion Citrus Lake Sumter Hernando Pasco Hillsborough Polk Manatee Hardee Desoto Charlotte Volusia Orange Osceola Highlands Glades Indian River St. Lucie Martin Lee Hendry Palm Beach Medicaid plans available Collier Broward Monroe Dade 9
10 Florida Healthy Kids Presence Staywell Kids serves approximately 68,000 Florida Healthy Kids members across the state. Florida Healthy Kids Santa Rosa Okaloosa Walton Holmes Washington Bay Jackson Gadsden Calhoun Leon Liberty Wakulla Gulf Franklin Madison Taylor Hamilton Suwannee Columbia Union Baker Nassau Duval Clay The Florida Healthy Kids program is part of Florida KidCare, the State of Florida s high-quality, low-cost health insurance for children. Dixie Levy Alachua Putnam Marion Flagler Volusia The Florida Healthy Kids program is for children ages 5 through 18. Citrus Sumter Hernando Lake Orange Pasco WellCare s Florida Healthy Kids Presence: Plans offered in 65 of Florida s 67 counties through WellCare s Staywell Kids plan. Offers plans in more counties than any other health plan. Pinellas Hillsborough Manatee Polk Hardee Desoto Charlotte Osceola Highlands Glades Indian River St. Lucie Martin Serves more Florida Healthy Kids participants than any other health plan. FHK plans available Lee Hendry Collier Palm Beach Broward Monroe Dade 10
11 Florida Medicare Presence WellCare serves approximately 148,000 Medicare members across the state. Florida Medicare Presence: Serves approximately 107,000 Medicare Advantage members. Santa Rosa Serves approximately 41,000 Medicare PDP members. All Medicare plans offer a Pay-for- Performance program that promotes the timely completion of health care and preventive services, and improves the quality of care for eligible members. Medicare PDPs available statewide. Okaloosa Walton Holmes Washington Bay Jackson Calhoun Gulf Liberty Gadsden Franklin Leon Wakulla Madison Taylor Dixie Medicare Advantage & PDP plans available Hamilton Suwannee Levy Pinellas Columbia Alachua Citrus Union Hernando Pasco Hillsborough Manatee Baker Marion Sumter Clay Hardee Desoto Charlotte Nassau Putnam Lake Duval Polk Flagler Volusia Orange Osceola Highlands Glades Indian River St. Lucie Martin Medicare PDP plans available Lee Hendry Palm Beach Collier Broward Monroe Dade 11
12 Telehealth Telehealth Benefits Increase in Accessibility Evening and Weekend Availability Reduction in Travel Time and Cost Increased Provider Specialty Selection Access in Rural Areas Reduces Stigma Increased Confidentiality More Likely to Seek and Stay Engaged in Outpatient Services More Convenient Reduces Delays and No Shows Promotes Collaboration of Care Increase in HEDIS standards 7 and 30 Day Post Inpatient Discharge Appointments 12
13 Telehealth Telehealth Medicaid March 2014 AHCA Medicaid Community Behavioral Health Services Handbook updated to include Tele Behavioral Health Services Psychiatric Evaluations Behavioral Health Assessments Individual Therapy Family Therapy Psychiatric Medication Management July 2015 AHCA amends the MMA Plans Contracts and lifts previous definition of Hub and Spoke. 13
14 Telehealth Telehealth Challenges Florida Board of Medicine Rule 64-B (4) F.A.C., prohibits physicians to prescribe controlled substances via telehealth. Many therapeutic drugs for ADHD are stimulants in controlled drug classes. WellCare partners with IMPOWER who currently has a waiver which allows their physicians to prescribe controlled substances via telehealth. The need to use Case Managers/Field Staff to provide additional technical support for our members. 14
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