WellCare Health Plans will use VirtualHealth's care-management platform for its Medicare, Medicaid and long-term services and supports programs in 20 states, the two companies announced Thursday.
"This partnership will allow us to really innovate delivery of care directly for our members," said Darren Ghanayem, chief information officer of WellCare, which has 4.3 million members. The Tampa, Fla.-based insurer provides government-sponsored managed-care services, mostly through Medicaid, Medicare Advantage and Medicare prescription drug plans.
As part of the partnership, VirtualHealth will aggregate health data from electronic health records, claims and other sources, standardize them in one place, and analyze them for population health purposes.
"With all the data in one place and everyone working in one place, you can run really advanced predictive analytics and risk stratification," said VirtualHealth CEO Adam Sabloff. Such stratification will allow the two organizations to identify and manage WellCare's high-risk members.
"With the way things are going, especially with the Aetna-CVS merger, we're moving towards a proactive view of the healthcare system," Sabloff said. VirtualHealth's platform promotes that view, he added.
"Part of our delivery model is to make sure the providers are giving the best quality outcomes and not just getting reimbursed based on an activity," Ghanayem said. VirtualHealth will support that model by informing what WellCare recommends to improve patients' health. "It could be as simple as recommending someone get treatment for high blood pressure with medication," Ghanayem said.
The partnership comes on the heels of VirtualHealth's announcement, late last year, of $7 million in new funding. The end of the year was less auspicious for WellCare. A former general counsel of the insurer was sentenced to six months in prison for submitting false documents to the Florida Medicaid Program. Earlier in 2017, the CMS announced it would fine WellCare $1.17 million for violating Medicare requirements for prescription drug plan problems.
