Measuring the return on investment for social determinants of health initiatives is no easy task for managed care organizations, but Centene's Medicaid plan in Kentucky, WellCare, is using members' data to create customized and local solutions aimed at improving health outcomes across the state.
"I've never seen a program like this," Corey Ewing, CEO at WellCare of Kentucky, told Becker's. "Other [MCOs] are using more of a spread or one-size-fits-all approach. I think the hyper focus that we put on each individual county and member is what differentiates what we're doing."
WellCare has deployed SDOH initiatives across the state since 2011, but it began ramping up its county-level programs over the last few years. The organization operates in all 120 Kentucky counties and serves 450,000 people.
By using an algorithm based on internal and publicly available data, WellCare deploys microgrants down to the county level, depending on which social needs are greatest within the local community. Counties are asked to provide member data back to WellCare so health and financial outcomes stemming from the grants can be tracked. In 2023, WellCare of Kentucky had 15 SDOH contracts with community-based organizations, delivering approximately $200,000 in targeted grants.
"Microgrants can see a much quicker return," Mr. Ewing said. "Instead of throwing millions of dollars into one big project, you're doing 100 programs across the state that can have an immediate impact."
One example of the microgrants is $10,000 that went to a rental assistance program in Northern Kentucky last year. By addressing members' housing needs, WellCare recorded a 56% reduction in medical costs, a 43% reduction in inpatient visits and a 33% reduction in ER visits, collectively saving more than $600,000 for the year. In 2023, the program engaged with 18,000 members and saw 42,000 social service referrals.
"I spent most of my career as a hospital executive," Mr. Ewing said. "If an MCO had ever approached me about something like this, I would have loved it, because I saw so many patients in the emergency room that were dealing with SDOH issues."
Mr. Ewing encouraged providers in Kentucky to take advantage of the services available to Medicaid beneficiaries. Beneficiaries are also able to access services through WellCare's Community Connections Help Line.