Why is Medicaid changing in OH?

HB 66/Budget Mandate: Transform Medicaid by expanding care management programs and stabilizing costs

Expanding the current full-risk program to all CFC consumers statewide

Applying care management to the ABD population through the most effective approach

ODJFS Average Medicaid Spending Per PersonPer Member Per Monthn

$-

$400

$800

$1,200

$1,600

$2,000

95 96 97 98 99 00 01 02 03

State Fiscal Year (SFY)

Ave

rage

per

mem

ber,

per m

onth

cos

ts

= Aged, Blind and Disabled

= Covered Families and Children

Why Managed Care?

Managed Care is Cost Effective Ensures Access to Providers Enhances Quality of Care Ensures Customer Satisfaction Plans offer Value Added Services

Disease Management/Case Management A 24-hour Personal Health Advisor Expanded Benefits & Incentive Programs

Who’s affected?

Covered Families and Children (CFC)Also known as Healthy Families and Healthy Start Children (up to age 19) Pregnant Women Families (Parents and Children) About 261,000 people in NE region

Aged, Blind and Disabled (ABD) Except for dual-eligibles, children under 20,

waiver, institutionalized and spend-down About 25,000 in NE Region

What’s happening in your county?

Northeast Region –

Managed Medicaid

Members

Government Partners

Premium to WellCare

AdministrationNetwork and Medical

HospitalsAncillary

PhysiciansSpecialists

Case ManagementCustomer Services

Claims PaymentDisease Management

How do we partner with the State?

Who is WellCare Health Plan?

IL IN

NYCT

FL

GA

LA

Core Business Operational Strategy

Largest provider of managed care services exclusively focusing on Medicaid & Medicare

Over 2 Million Members Nationally

National Prescription Drug Plan Opportunity

One of the largest PDP plans in the Country

New Medicaid Opportunity – Ohio

Contract with ODJFS for CFC and ABD

Patient-focused with preventive care emphasis

MO

OHIO

What does WellCare offer?

-

,

Benefit Design

Network Structure

Preventive Care

Primary Care Model

AdditionalServices

Case/ Disease Mgmt

Mandatory Benefits

PCP, Specialists, Ancillary, Facilities

HealthCheck, Prenatal

Coordination of Care, Referrals

Therapies, Home Care, Surgery

RN’s coordinate care for members with chronic, high risk conditions

What are WellCare’s Extra Benefits?

No copays for any service Transportation (30 one-way, 15 round trip)

Medical appointment WIC Redetermination

Vision Annual exam (Kids and Adults) Up to 2 pairs eyeglasses each year Frame upgrade

Extra Benefits (continued)

Personal care items mailed to your home each month (Up to $10)

Pain relievers, vitamins, bandages, toothbrushes, etc.

No cost No prescription necessary You choose what you need

Extra Benefits (continued)

Personal Health Advisor 24-hour health advisor line

Care Management Programs for chronic diseases Nurses work with members to help coordinate

healthcare needs

Prenatal Rewards Program Prenatal Visits/Postpartum Visit Free Stroller

How Do Clients Enroll? Automated Health Systems (AHS)

Enrollment Vendor for ODJFS Choice

Eligible clients must call AHS to enroll FFS until member of WellCare

If No Choice Auto-assigned

Assignment Process History/Relationship with Provider (PCP/Hospital) Proximity to Provider

AHS Contact Information (800) 605-3040 TTY – (800) 292-3572

How Can WellCare Member Services Help?

Educator Educating members on benefits Educating on how to access services

Researcher Finding providers that meet cultural, demographic,

health care needs Assisting with claim issues

Facilitator Supporting transportation arrangements Capturing changes to demographic information Providing language services Capturing OTC orders

Coordinator Identifying transition and/or coordination of care needs Identifying candidates for disease/case management

Dedicated customer service team

Multi-lingual capacity

Superior responsiveness

Our Member Service Associates serve as advocates for our Members’ health care needs.

WellCare Member Benefits

How Do We Work Together? Opportunities for Education Health Fairs Community Events

Contact UsSusan TitteringtonOffice: (216) 378-7651Cell: (216) 255-1806

Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials

How Do We Work Together? Opportunities for Education Health Fairs Community Events

Contact UsLynn CharlesOffice: (216) 378-7820Cell: (216) 357-8901

Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials

How Do We Work Together? Opportunities for Education Health Fairs Community Events

Contact UsChristine ThwingOffice: (216) 378-7845Cell: (216) 357-8902

Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials

How Do We Work Together? Opportunities for Education Health Fairs Community Events

Contact UsTiffanie RiggsOffice: (216) 378-7818Cell: (216) 357-8904

Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials

How Do We Work Together? Opportunities for Education Health Fairs Community Events

Contact UsIvelisse RoigOffice: (216) 378-7522Cell: (216) 357-8905

Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials

How Do We Work Together? Opportunities for Education Health Fairs Community Events

Contact UsJacqueline ShorterOffice: (216) 378-7816Cell: (216) 357-8903

Website address: www.wellcare.com Provider Look-up Rx Formulary Member Materials