1. © 2008 WellCare Health Plans Inc. All rights reserved. CommUnity Advocacy Connecting Managed Care with Public Health 2014 Pamme Lyons-Taylor Vice President Advocacy & Community Based Programs

2. p 1 10/20/2015 6:09 PM Health Factors and Health Outcomes County Health Rankings show that much of what affects health occurs outside of the doctor’s office. The 80/20 Rule Unmet social needs are directly leading to worse health. The problems created by unmet social needs are problems for everyone. Physicians surveyed say: Robert Wood Johnson Foundation

3. p 2 10/20/2015 6:09 PM How Social Supports Link with Managed Care Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages. Community Based Programs

4. p 3 10/20/2015 6:09 PM How Social Supports Link with Managed Care Contracted Social Supports Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages. Community Based Programs Contracted community based supports vary based on population and coverage program and are included in benefit packages like Long Term Social Supports (or LTSS). These usually include services like in-home respite.

5. p 4 10/20/2015 6:09 PM How Social Supports Link with Managed Care Contracted Social Supports Contracted Acute Care / Preventive Care Services Community based services include those programs that address social barriers to accessing healthcare like utility assistance, nutrition and so on. These have not historically been included in benefit packages. Acute care services comprise the remaining contracted benefits and some enhancements. These are typically included in HEDIS and quality measures. Community Based Programs Contracted community based supports vary based on population and coverage program and are included in benefit packages like Long Term Social Supports (or LTSS). These usually include services like in-home respite.

6. p 5 10/20/2015 6:09 PM Social Supports are not “one-size-fits-all” Community Based Programs Temporary Assistance for Needy Families

7. p 6 10/20/2015 6:09 PM Social Supports are not “one-size-fits-all” Community Based Programs Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled

8. p 7 10/20/2015 6:09 PM Social Supports are not “one-size-fits-all” Community Based Programs Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Long-Term Care

9. p 8 10/20/2015 6:09 PM Social Supports are not “one-size-fits-all” Community Based Programs Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Long-Term Care Aged and Retired

10. p 9 10/20/2015 6:09 PM Social Supports are not “one-size-fits-all” Community Based Programs Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Long-Term Care Aged and Retired Dually Eligible

11. p 10 10/20/2015 6:09 PM Social Supports are not “one-size-fits-all” Community Based Programs Temporary Assistance for Needy Families Low Income Aged, Blind and Disabled Long-Term Care Aged and Retired Dually Eligible Special Populations

12. p 11 10/20/2015 6:09 PM Social Supports are not “one-size-fits-all” Community Based Programs Temporary Assistance for Needy Families Aged and Retired

13. p 12 10/20/2015 6:09 PM Risks to Funding, Recovery & Philanthropy Four years of budgetary surplus (2004-2007) resulted in $936B in accumulated cash that was virtually wiped out in two years of recession. Recovery spans tens years. Source: Center for Budget and Policy Priorities, April 2012 Recovery Giving in the US stabilized at $45.7 billion in 2010, following a record 2.1% decline in giving (2008 – 2009) and an unprecedented 17% drop in foundation assets in 2008 Source: The Foundation Center, Foundation Yearbook, April 2011 Philanthropy

14. p 13 10/20/2015 6:09 PM CommUnity Advocacy Model Overview The overarching goals are to: 1) Integrate Social Safety Net services into managed care for government programs, 2) Create a highly localized, systematic “program enhancement” approach for WellCare for members and their families/caregivers, and 3) Establish a platform on which to quantify the impact of social services on health outcomes while improving the health of our communities. Community-based Activities / Programs Community-based Strategic Giving Social Safety Net Relationship Management Research / Local & National Advocacy Goal: To identify or create community-based and health focused programs for target populations Goal: To unify, track and leverage all community – based strategic philanthropy in order to extend its impact Goal: To quantify Social Safety Net impact on health outcomes and to find creative ways to sustain the network through greater coordination Goal: To create a platform on which to advocate for communities, social safety providers, members, caregivers, families and communities-at-large Primary Functions: Field Lead or participate in community- based disease management programs Host local HCCs Corporate Maintain taxonomy and platform for intranet-based tools Reporting Manage multi- state campaigns Field Community investments focused on community health initiatives and associated outcomes Corporate Conduct community- focused research Manage executive board placement Field Manage relationship with local SSN providers Responsive network gap-fill activity Corporate Research & load initial SSN network (~2,500) Maintain network database taxonomy and technical platform Proactive network gap-fill activity Field Identify state level trends Participate in local CHNA & MAPP initiatives Corporate Identify national trends Host The CommUnity Commitment Launch national affinity relationships and campaigns Tools: Campaign Tracker Activity Trackers CommUnity Library Tools: Activity Trackers Grant & CHIP Tracker CommUnity Library Tools: Navigator Referral Tracker Relationship Management Tracker Tools: Referral Tracker CommUnity Library Relationship Management Tracker

15. p 14 10/20/2015 6:09 PM CommUnity Advocacy Model Adoption Establish BaselineTransitional PeriodFinal Implementation Focused Metrics Marketing / Lead Focused Activities Culture & Linguistics Potential Duplication Focused Tracking Population Analysis Community Health Analysis Use baseline plus one of the following: Level I: o Service Gaps (secondary research) o Population Characteristics by county Level II (all of I + one of the following): o Service Gaps (primary interventions) o Population Characteristics by member o Strategic Giving Level III (all of I & II + the following): o Community Based DM Programs All of the following (Levels I, II & III): Service Gaps - both Population Characteristics Strategic Giving Community Based DM Programs Plus the following: Referral Tracking Social Service Vendor Referrals Productivity Analysis Workforce Innovation Community Planning Councils Future Potential Revenue Second Phase Transitional Period Full Adoption Final Implementation Social Services Referrals Community Activities Research Growth Related Activities Focused Tracking CommUnity Advocacy First Phase Establish a baseline

16. p 15 10/20/2015 6:09 PM CommUnity Advocacy Model Overview CommUnity Command Center Catalogue of Social Supports Community Activities Community Health Planning / Research Workforce Innovation / Diversity Strategic Giving Field-based Community-focused Resources Liaisons / Advocates Community Investment Fund HealthConnections Councils Evaluation Improved Health Outcomes Automated Analytics Management Reports Cost Containment Intra-agency Collaboration Growth / Expansion Quality / HS Analytics Research / Design Process / ToolsOutcomes / Results