Integrated Care Model Case Management: Member centric - One case manager approach to all member care needs integrated care model (incorporates behavioral, medical and social) Utilizes CORE and Predictive Pathways Modeling (PPM) to identify and stratify member Embeds CM in large practice facilities Incorporates onsite NICU CM, face-to-face for highest level of care members as well as telephonic outreach Focus : top utilization and highest risk ED utilization Hospital readmission High risk disease management Neonatal Abstinence (NAS) Hepatitis C

What is CORE

Sr. Director Field Service Coordination, Kentucky Market Care Management Shannon Jones RN,CCM Sr. Director Field Service Coordination, Kentucky Market WellCare Health Plans

Essentials Of WellCare’s Enhanced Care Model WellCare’s enhanced model of care: Identifies members with high, impactable needs who can benefit most from care management. Uses trusted evidence-based guidelines to drive Clinical & Quality of Care interventions. Addresses our members’ complex needs using a high touch community-based approach to promote their optimal health and wellness. We leverage community resources to act as a bridge between the formal health care system and the members we serve.

WellCare’s Care Management Model The Care Model rests on the foundation of an integrated case and disease management philosophy, enabling holistic care of the individual. The Care Model facilitates seamless delivery of care and services, care management, utilization management, and quality care. Medical and behavioral health are aligned under this structure. The Care Model acknowledges that healthcare is delivered locally and solutions must also consider the member’s community resources, personal healthcare, social determinants, and cultural ecosystem.

Care Management: Identify Members REACH ENGAGE ACCESS CARE HELP Predictive Modeling & Early Intervention Chronic Care Management (Most Vulnerable Population) Acute Care Management Value Drivers Operating Principles / Features Clinical Controls HRA, Algorithms, Census, etc. Local Deployment Field interdisciplinary care management teams Efficient Allocation of Clinical Resources Targeted use of face-to-face visits in concert with chronic, acute and condition management interventions Early Intervention Use of care managers embedded at the point of care Impactable Conditions Quality Metrics Financial Stewardship

Engaging our Members IDENTIFY REACH ENGAGE ACCESS CARE HELP Focused geographic staff assignments to synergize market expertise (CM/BH/SW/UM). Discharge planning nurses provide transitional interventions and monitor length of stay at facilities with a high daily census. Innovative outreach and education strategies. Incentive programs for rewarding engagement in health and wellness activities.

Access & Care for our Members IDENTIFY REACH ENGAGE ACCESS CARE HELP Member Care Coordination & Provider Engagement Community & Social Safety Net Resources Primary Care, EPSDT & Wellness Services Medical & Behavioral Health Services Community-Based Services Medical Management CLINICAL CARE MANAGEMENT BUSINESS & QUALITY MANAGEMENT BENEFIT COORDINATION COMMUNITY CARE MANAGEMENT 11 Property of WellCare Health Plans, Inc.

Clinical Programs COPD Transitions of Care Asthma High-Risk Obstetrics IDENTIFY REACH ENGAGE ACCESS CARE HELP COPD Transitions of Care Asthma High-Risk Obstetrics Substance Abuse Obesity Foster Care Emergency Department

Kentucky Field Service Coordination List-Physical Health Terri Flanigan Vice President, Field Health Services Terri.flanigan@wellcare.com Cell 216-255-7710 Shannon Jones Sr. Director, Field Service Coordination Shannon.jones@wellcare.com Cell 502-689-6776 Region 5 and 7 Paula Franklin, Manager Cell 502-689-6405 Paula.franklin@wellcare.com Ashland Office 606-327-6200 Lexington Office 859-264-5100 Region 3 and 6 Donna Chapman, Manager Cell 502-640-1981 Donna.chapman@wellcare.com Louisville Office 502-253-5100 Region 8 Leeann Caudill, Manager Cell 502-689-6801 Leeann.caudill@wellcare.com Hazard Office 606-436-1500 Region 1, 2 and 4 Trudy Smyth, Sr. Manager Bowling Green & Owensboro Cell 502-689-6713 Trudy.smyth@wellcare.com BG Office 270-793-7301 Owensboro Office 270-688-7000

Kentucky Field Service Coordination List-Behavioral Health Vice President, Field Health Services Terri Flanigan  terri.flanigan@wellcare.com   Cell 216-255-7710 Sr. Director of Product Operations Lori Gordon  lori.gordon@wellcare.com   Cell 270-331-2155 Behavioral Health Program Manager Kate Miller kathryn.miller@wellcare.com   Cell 502-548-5113  Sr. Manager, Foster Care, Adoption & Guardianship Leann Magre  leann.magre@wellcare.com   Cell 502-640-1957  

Your Connection to Disease and Case Management Programs Care Coordination Your Connection to Disease and Case Management Programs Robert Beaty, RCP, RRT-ACCS, AE-C, BA Team Lead, Care Coordination Passport Health Plan

What is Care Coordination?

Purpose To improve the health status and quality of life of members, while decreasing unnecessary hospitalizations and emergency room (ER) visits, by improving member self-management skills, and by increasing adherence of both members and providers with clinician adherence with national guidelines.

Onsite Programs ER Navigator Tiny Tots Discharge Education Team Stork Care Embedded Case Management The ER Navigators and ER Coordinators are working to reduce these numbers by educating our members on proper ER utilization and the programs and services available here at Passport to assist them with their health care needs. The ER Navigators are the nurses in the ER making face-to-face contact with the members, giving them information on the programs and services available to them in an effort to reduce the non-emergent ER utilization. Passport kids are not subject to ER lock in The ER Coordinators receive daily (Norton and Sts. Mary and Elizabeth) or weekly (Hardin Memorial) reports on ER utilization of Passport members and use telephonic outreach and mailings to educate members on proper ER utilization and refer them to the appropriate programs/departments to assist them with any barriers to care. Tiny Tots One in nine babies born in the United States are premature Almost two-thirds of all childhood hospital stays are for newborns (babies up to 30 days old) Goal: Ensure a secure and healthy transition of the detained newborn from hospital to home Identify detained newborns and primary caregiver at point of initial hospitalization Provide early education regarding care of medically fragile infant Coordinate a safe transition to home Assist in arranging discharge needs when medically stable Identify gaps in care Ensure adherence to after care instructions Ensure adherence to scheduled physician appointments Ensure appropriate interventions are followed Definitions: Detained Newborn: Infant in the first 28 days of life that remained hospitalized after mother was discharged. Discharge The goal of our program is to reach out to our members in person while they are in the hospital. We provide education in certain disease categories, currently we are concentrating on CHF, COPD, Respiratory, AMI, Diabetes and Chronic Illness and look for barriers they may have to receiving care. We are sometimes asked by hospital staff to visit members with other conditions that might benefit from our help and we are always happy to do so. 502-588-8593

Programs at Passport Disease Management Complex Case Management Behavioral Health Case Management Foster Care/Adoption Guardianship Liaison Mommy Steps Specialty Programs

Process Case Manager Technician Rapid Response Case Manager/Embedded Case Manager* Appropriate Program *Pregnant, Medically Fragile, etc.

Value 2015 when compared to 2014 297% increase in Health Risk Assessments 13,003 24/7 RN hotline calls 37% increase 88% referred to Lower Level of Care 95% in agreement ER, IP, and Readmit representative of members in CM

How to refer to Care Coordination http://passporthealthplan.com/wp- content/uploads/2015/01/2-cc-care-coordination- request-form.pdf Rapid Response 1-877-903-0082 Fax 502-585-7997