Staywell Health Plan's Care Model Delivers Personalized Care for High-Risk Members
TAMPA, Fla., Feb. 10, 2016 /PRNewswire/ -- At Staywell Health Plan, Inc., a WellCare (NYSE:WCG) health plan dedicated to serving Medicaid members in Florida, ensuring that members have personalized, quality care can mean making house calls.
"For our members dealing with multiple chronic illnesses and other challenges, there's no substitute for face-to-face interaction to help us assess how we can assist in restoring and maintaining their health," said Dr. Alan Smith, senior medical director for Staywell. "We provide field-based case management for more than 10,000 Medicaid members each year, which means we're doing things like visiting their homes, engaging with them to help schedule doctors' appointments and ensuring they have the social service supports they need to be able to make managing their chronic conditions a priority."
Because those who are Medicaid eligible often have challenges in life that go beyond health care, Staywell case managers also connect members with local, community-based organizations that can assist them with meeting their basic needs involving food, transportation, shelter and clothing.
Members who receive case management have had recurrent hospitalizations or emergency room visits, or have several chronic conditions they need help managing. By engaging with members, providers and community organizations, Staywell is able to create the personalized, coordinated care plans needed to help improve and maintain the health of members with complex medical needs.
Tampa mother Amelia Lucas was skeptical when Staywell social worker Laura Gannon came to her apartment to assess how Staywell could help Amelia care for her disabled son Jeremy. Two years prior, at age 30, Jeremy suffered a traumatic brain injury and lost his right leg after a motorcycle accident in St. Petersburg. Amelia was emphatic about keeping him at home, rather than sending him to a nursing facility. She was also very frustrated about how difficult it was to coordinate the supplies and services that Jeremy needed to stay alive.
"I went through boxes of medical records to help her make a list of all the medical equipment and care that Jeremy needed every month, from tracheostomy cleaning kits, gauze and tape to physical therapy and nursing support," said Gannon, who has worked for Staywell for three years and "loves the personal touch" she is able to provide members. "Sometimes, when people are in an overwhelming situation, it's hard to organize basic necessities."
Gannon coordinated with others to arrange the needed physical therapy, medical equipment and supplies for Jeremy, but also for respite care for Amelia so she could have breaks and take care of household chores.
"As I sat there, I recognized that Amelia needed more than she realized," Gannon said. "I was concerned about caregiver burnout and it would have been harder to identify if I hadn't been there."
Gannon also helped Amelia complete the paperwork that Amelia needed to become Jeremy's long-term care provider, which allows her to receive payment from the state for some of the care she provides for him. This was an important step as she had to quit her job to care for Jeremy.
Florida was one of the first states where Staywell's parent company, WellCare, started offering field-based case management. There are now more than 125 employees in Florida that support this effort, and WellCare is working to expand it in markets where it doesn't currently exist.
As for Amelia Lucas, she's no longer a skeptic: "Through Staywell and Laura's help, it has all changed; it's better now."
"Through our care model, everyone wins," said Gregg MacDonald, president of WellCare of Florida, which includes Staywell. "By providing our members with this level of care, we're ensuring they have the resources and supports they need to manage their chronic conditions and are taking preventive measures to improve and maintain their health. This helps to improve their lives, and helps us better manage Medicaid costs by reducing things such as avoidable emergency room visits and hospital admissions."
To learn more about how Staywell cares for its members, watch Jeremy's story at https://www.youtube.com/user/WellCareHealthPlan.
As of Dec. 31, 2015, WellCare serves approximately 781,000 Medicaid members, 55,000 Florida Healthy Kids members, 107,000 Medicare Advantage members and 39,000 Medicare Prescription Drug Plan members in Florida.
About WellCare Health Plans, Inc.
Video - http://youtu.be/6qfUzzrxv04
To view the original version on PR Newswire, visit:http://www.prnewswire.com/news-releases/staywell-health-plans-care-model-delivers-personalized-care-for-high-risk-members-300217913.html
SOURCE WellCare Health Plans, Inc.