June 14, 2017 – WellCare of Florida, a subsidiary of WellCare Health Plans, Inc. (NYSE: WCG), formed a new, value-base care agreement for the establishment of a behavioral health home with Peace River Center for Personal Development.
Under the agreement, Peace River Center will provide both behavioral and medical services for Staywell Medicaid members identified as having severe medical and behavioral health issues, including those with a formal diagnosis of serious mental illness (SMI). Peace River Center will be responsible for the integration and coordination of care for these members. The agreement also provides incentive payments to Peace River Center for quality-based improvements in certain Healthcare Effectiveness Data and Information Set (HEDIS) measures, a tool used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service.
This is important due to the sobering statistics on premature deaths for people with SMI. According to JAMA Psychiatry, those diagnosed with SMI were more than 3.5 times more likely to die than the general population, and they lose an estimated 28.5 years of life, primarily because of natural causes. Further, 85 percent of premature deaths in SMI populations were due to largely preventable conditions such as high blood pressure, high cholesterol, diabetes, and heart disease. Research also shows that SMI members that are participating in a behavioral health home are more likely to access primary care services and therefore avoid preventable conditions.
“Our members’ health is our first priority, and our job is to help ensure they get the right care at the right time in the most appropriate setting,” said Elizabeth Miller, president, WellCare of Florida. “Too often our members with SMI are using the emergency department for medical care. These members will now have access to a behavioral health home that delivers behavioral, medical and social supports at one location in a coordinated manner.”
“We are pleased to partner with WellCare of Florida to help improve the mental and physical health for members with serious mental illness and to be WellCare’s first behavioral health home in Florida,” said Peace River Center CEO Bill Gardam. “People with common problems like depression or addiction often also suffer from medical complications, and many die far too early.”
“In many cases, this happens because these illnesses make it harder for people to focus on their other medical problems such as diabetes or heart disease. Studies have shown that when people can get all of their health care needs under one roof in a seamless, well-coordinated way—a ‘no wrong door’ approach to care—they get better results with improved satisfaction and compliance with treatment recommendations, which results in improved quality of life and lower medical costs,” said Gardam.
As of March 31, 2017, WellCare serves approximately 776,000 Medicaid members, of which 62,000 members are in the Florida Healthy Kids program, 99,000 Medicare Advantage members, and 30,000 Medicare Prescription Drug Plan members in Florida.