WellCare Launches Fully-Integrated Clinical Platform to Improve Member Outcomes and Drive Efficiencies

WellCare Health Plans, Inc. (NYSE: WCG), a leading provider of managed care services for government-sponsored health care programs, announced today the launch of its new clinical platform designed to more effectively manage the needs of its members in the areas of utilization management, care and disease management, quality management, pharmacy, long-term care and behavioral health. The system is scheduled to be rolled out in phases over a two-year period and is expected to improve member outcomes by enabling holistic, real-time care coordination and increasing the effectiveness of WellCare clinicians and staff.

“This system is designed to be innovative and transform how we care for our members,” said Michael Radu, WellCare’s senior vice president of clinical operations and business development. “When it’s fully operational, we expect to have a best-in-class clinical platform that will allow our care managers to access a more complete history of a member’s care than ever before, whether it involves medical, behavioral health, pharmacy or social service supports. It will also enable us to better coordinate care with providers and help close care gaps, with the goal of improving health outcomes for our members.”

WellCare partnered with Pegasystems, Inc., the software company empowering the world’s leading enterprises with strategic business applications, to create the customized system. Once fully implemented, it is designed to:

  • Provide WellCare clinicians and care managers with a complete and real-time view of a member’s medical, behavioral health and pharmacy needs in a single system that will also be accessible to remote and field-based employees.
  • Integrate medical management programs and processes to improve administrative efficiency and quality.
  • Enhance the exchange of information to WellCare’s provider and pharmacy networks. This approach will enable more effective processes, including hospital discharges, needed follow-up care, and medication adherence.

“This system is designed to improve the flow of information throughout our clinical space,” said Dr. Traci Ferguson, chief medical director, medical management for WellCare. “It will allow us to have a much clearer picture of what a member needs for care. For example, we can do a great job of helping a member transition home from the hospital, but if they are going home to an unheated apartment or suffer from a lack of food, it will be difficult for them to continue to get better. The new clinical platform is designed to also identify these barriers to health.”

Providers also are expected to see improvements, including increased and targeted communication to help them close member care gaps, a streamlined authorization process and improved access to individual care plans for better collaboration.

“The healthcare industry is becoming increasingly complex, and managed care organizations are faced with the challenge of working in disconnected environments with information spread across different aspects of their members’ care plans,” said Susan Taylor, Pegasystems’ vice president and business line leader, healthcare. “By unifying its platform across all dimensions of care, WellCare expects a faster, easier and more cost-effective vehicle to provide care management to help its members live better, healthier lives, especially those most in need.”


About WellCare Health Plans, Inc.
Headquartered in Tampa, Fla., WellCare Health Plans, Inc. (NYSE: WCG) focuses exclusively on providing government-sponsored managed care services, primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug Plans, to families, children, seniors and individuals with complex medical needs. WellCare serves approximately 3.8 million members nationwide as of Dec. 31, 2015. For more information about WellCare, please visit the company’s website at www.wellcare.com or view the company’s videos at https://www.youtube.com/user/WellCareHealthPlan.