WellCare of Texas Launches Field-Based Care Management Program

By a News Reporter-Staff News Editor at Insurance Weekly News -- Gregory Gedovin, who is 70, suffered a series of falls and seizures that resulted in multiple hospitalizations. But for Mr. Gedovin, the more serious issue wasn't his health, it was his wife Joyce. She died in February, and after 26 years of partnership, a life of one was a painful adjustment.

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When Michelle Cooper, a registered nurse from WellCare of Texas, his Medicare Advantage health plan, rang his doorbell in May, he didn't immediately answer. "I could hear thumping," she said, "and I was worried he fell."

When he opened the door, he apologized for the delay. This prompted the nurse's first piece of advice: Don't worry about it. You're a week out of the rehabilitation facility. Take it easy until you're feeling stronger. Cooper then sat down with Mr. Gedovin and began an extensive assessment to evaluate his needs and to create a personalized care plan to restore him to health.

Cooper is new to WellCare of Texas, a subsidiary of WellCare Health Plans, Inc., (NYSE: WCG). She was hired as part of WellCare's new field-based care management program, which is designed to deliver personalized, cost-efficient care for medically-complex Medicare Advantage members.

"Field-based care management allows us to engage with members who are dealing with multiple chronic illnesses, behavioral health issues and other challenges, including a lack of access to needed social services, to better address gaps in care," said Michael Radu, WellCare's senior vice president of clinical operations and business development. "Face-to-face interaction is one of the most effective ways for us to assist members with complex health conditions to achieve and maintain optimal health."

By making home visits, WellCare care managers interact with members to address gaps in care, survey home environments for potential hazards, and develop collaborative care plans to help manage their chronic conditions and access the right level of care in the most appropriate setting. Care managers also connect members to community-based agencies to fill social service needs that may be barriers to their ability to prioritize their health. Members who receive care management have had recurrent hospitalizations or emergency room visits, or have several chronic conditions.

Cooper provided the personal touch needed to help Mr. Gedovin restore his health and quality of life. For three years, he served as his wife's primary caregiver, helping her battle Alzheimer's. As is often the case, he neglected his own health as he focused on hers.

Cooper helped him get orthotics to improve his gait and reduce his fall risk, adjusted his medication regime, and checked in to make sure he was attending physical therapy to regain his strength. She also helped him find a new primary care physician closer to his home in Harris County.

Cooper also listened as he shared stories about his life's greatest joy, Joyce. "Losing her is on my mind as much today as it was the day I lost her," he said. "We got it right. I don't know what I ever did to deserve a relationship like ours."

He appreciates the support he's received from WellCare during his difficult transition to widower.

"In the end, what it's really about is listening," said Cooper, a nurse for more than 30 years. "He likes that there's somebody out there who cares. We're all that way."

Keywords for this news article include: Medicare, Health Policy, WellCare Health Plans Inc.

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