News & Events

  • Most children’s health system experience is limited to the pediatrician’s office, but those with chronic or complex medical needs often deal with care that is fragmented, duplicative and crisis-driven. This leads to stress on families and wasteful utilization.

  • Just 5 percent of the population accounts for 50 percent of national health spending. Behind these numbers are patients and families struggling with multiple chronic conditions, physical and mental impairments, and tremendous stress.

  • Washington, DC – October 10, 2014 – NIHCM Foundation has awarded $215,000 to eight organizations through the first cycle of its new journalism grant program announced earlier this year.

  • The Relative Value Scale Update Committee (RUC)—a small panel of medical professionals whose recommendations have considerable influence over Medicare payment levels for their own services—has drawn quite of bit of political and media scrutiny recently.

  • More than 8 percent of two- to five-year-olds are obese, and another 23 percent are overweight and at substantial risk of becoming obese by the eighth grade. These early years are a critical time to focus on the development of healthy habits.

  • The annual cost of cancer care in the U.S. is large and growing—projected to hit $184 billion by 2020. This fiscal reality has spurred interest in bundled-payment models that reward providers for maintaining or improving clinical outcomes while controlling costs.

WellPoint, Inc.

February 2009 Issue Brief:

Increasing Access to Health Insurance for Children and Families: Innovative Health Plan Outreach and Enrollment Efforts

 

WellPoint Foundation (WLPF) is a private, nonprofit foundation funded by WellPoint, Inc. (WellPoint). The Foundation, established in 2000, is one of the largest corporate foundations in the United States with net assets of about $150 million. WLPF operates primarily in the 14 states covered by WellPoint, providing funding for programs at the state, local and national levels. Efforts to reduce the number of uninsured comprise one of the Foundation’s two Signature Programs. The other Signature Program (“Healthy Generations”) supports programs to improve specific state public health measures.

 

WellPoint’s interest in expanding access to health care is two-fold. First, as a health care organization, the company seeks to provide health insurance to optimize individuals’ health and well-being. Second, it recognizes lack of health insurance as a business problem as well as a social problem: failure to address health problems early results in increased health care costs to consumers and society and drives up the costs of health insurance premiums.

 

WellPoint’s strategic plan provides specific targets for reducing the rate of uninsured in states where the company operates. While WellPoint is focusing on moderate to higher income uninsured people who are not eligible for public coverage, WLPF focuses its funding and programs on the 12 million individuals below the federal poverty level (FPL) who are eligible for public programs.

 

Following this vision, WellPoint announced a company-wide Uninsured Initiative in January 2007 with three major components:

 

1) Affordable benefit plans, 2) Public policy lobbying (state and federal levels), and 3) WLPF funding commitment of $30 million over three years.

 

In addition, an Uninsured Task Force comprised of key associates throughout the company was appointed to lead WellPoint’s uninsured efforts. During 2007, the task force conducted extensive research to identify community-based programs with the greatest potential to reduce the number of uninsured. As a result, WLPF approved $10.6 million (of the $30M commitment) to support organizations providing health-related services, including eligibility and enrollment assistance, to low-income, ethnically diverse and underserved communities with predominantly uninsured populations. These grants accounted for 46 percent of the Foundation’s total 2007 grant budget ($23 million). In February 2008 the task force recommended funding three organizations:

 

1) Foundation for Health Coverage Education (FHCE), 2) The CoverMe Foundation, and 3) Prevention Partners.

 

From 2004 through 2007, WLPF was the primary funder of FHCE with a total contribution of $1.33M. FHCE is a California-based nonprofit organization that provides education and services to assist uninsured individuals in obtaining coverage. FHCE operates a 24/7 call center and produces and disseminates printed Health Coverage Matrices that outline state specific public and private insurance options for individuals. Individuals can call FHCE operators who will guide them through their insurance options, determine whether they are eligible for public programs, and refer them to the appropriate agency to apply for coverage. Individuals can also access state-specific information on the FHCE website at www. coverageforall.org. Over the four years of WLPF funding, FHCE’s outreach efforts have shown value, reflected in increased call volume and hits to the FHCE website. In 2008 WLPF approved two additional grants totaling $112,000 to continue funding the FHCE call center.

 

The other two organizations — The CoverMe Foundation and Prevention Partners — are both working to identify uninsured individuals eligible for government programs and helping them get enrolled.

 

The CoverMe Foundation (CMF) is the nonprofit arm of MedAssist, a national company that specializes in eligibility and enrollment assistance. Through outreach at community events, national public relations, advertising, mailings, a nationwide call center, and referrals from SCHIP, School Lunch Programs, FHCE, Prevention

 

Partners, and WellPoint network physicians, CMF identifies and guides uninsured individuals to enroll in coverage. Once an uninsured individual is identified, CMF conducts comprehensive eligibility screening to determine which coverage type is best suited to an individual’s personal circumstances. For public programs, CMF will provide hands-on counseling and instruction through the application process and ongoing assistance as individuals access public benefits. For individuals not eligible for public coverage, CMF provides education and means to access other free or discounted medical resources. In the first year, WLPF will provide up to $2.5 million to CMF with total funding dependant on their success in enrolling uninsured individuals. WLPF expects CMF to enroll approximately 39,000 individuals each year.

 

Prevention Partners’ outreach model utilizes churches as a safe site to bring health education, awareness and services to the uninsured populations in underserved communities. The program provides direct access to on-site health care services, such as screening tests, education, and access to medical follow-up and treatment. In addition, on-site enrollment specialists from the CoverMe Foundation assist individuals in completing applications for appropriate public programs. The populations impacted are predominantly African American and Hispanic. WLPF provided $1.2 million in funding for one year. The goal is to secure 9,264 enrollees in five of WellPoint’s major markets.

 

WLPF monitors the progress of current grantees as they seek to reach WellPoint’s goal of reducing the number of uninsured. At the start of each funding cycle, WLPF and each grantee jointly establish metrics upon which the program will be evaluated. Evaluation reports submitted at the completion of a grant period assist WLPF in determining the impact of their grants.

 

July 2010 Issue Brief

 
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