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Based on a recent legal decision, changes to Medicaid under Kentucky HEALTH will not begin on July 1, 2018 as planned. Read more. Important Update about Kentucky HEALTH ×

Quality

WellCare of Kentucky wants to ensure that our members have access to quality, cost-effective health care solutions. Our Quality Improvement (QI) program aims to improve patient safety and care so our members can enhance their quality of life by staying healthy or managing their chronic health problems.

Health and Wellness Programs

Helps members stay healthy by providing access to educational materials and health tips.

2019 HEDIS Toolkit

HEDIS® Guide Adult Quick Tips

2019 HEDIS® AT-A-GLANCE: KEY BEHAVIORAL MEASURES (18 Years and Older)

This form is to assess care needs for older adults.

Every year CMS or NCQA may ask your patient the following questions. How do you rate?

We’re asking our providers to make sure to use accurate CPT Category II codes to improve efficiencies in closing patient care gaps and in data collection for performance measurement.

Preventive Health Counseling and Education for Children and Adolescents Ages 3–17 Years

HEDIS® Guide Pediatric Quick Tips

HEDIS® Pediatric Resource Guide

2018 HEDIS Toolkit

HEDIS® ensures health plans are offering quality preventive care and service to members. It also allows for a true comparison of the performance of health plans by consumers and employers.

2018 HEDIS At-a-Glance Key Adult Measures

This document details the importance of coordination of care.

2018 HEDIS At-a-Glance Key Behavioral Measures (17 Years and Younger)

At WellCare, we value everything you do to deliver quality care for our members – your patients – to make sure they have a positive health care experience. That’s why we’ve created this easy-to-use, informative HEDIS® At-A-Glance Guide. It gives you the tools you need to meet, document and code HEDIS Measures.

Every year CMS or NCQA may ask your patient the following questions. How do you rate?

2018 HEDIS At-a-Glance Key Pediatric Measures

How to Code for a Well Visit with a Sick Visit

Preventive Health Counseling and Education for Children and Adolescents (Ages 3-17 Years)

Program Overview

Case Management

This program coordinates individualized, cost-effective and integrated services to foster positive clinical outcomes for our medically compromised population. Goals include:
  • Decrease fragmentation of health care service delivery
  • Facilitate appropriate use of available resources
  • Optimize member outcomes through education, care coordination and advocacy services

Disease Management

This program provides education and health coaching to empower our members to manage chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), hypertension, depression and human immunodeficiency virus (HIV).

EPSTD Program

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
Improves the rate of members receiving health assessment screenings and testing.

EPSDT Well Child Exam Form This PDF document will open in a new window.

Kentucky Vaccines for Children Program

This program ensures children receive their vaccines and stay healthy. Immunizations should be provided in accordance with ACIP guidelines and the Periodicity Schedule.

Maternity Education and Rewards

Supports pregnant women so they can have healthy babies.

Smoking Cessation

Find out what smoking cessation resources pdf are available to assist members.
  • Case Management

    Case Management

    This program coordinates individualized, cost-effective and integrated services to foster positive clinical outcomes for our medically compromised population. Goals include:
    • Decrease fragmentation of health care service delivery
    • Facilitate appropriate use of available resources
    • Optimize member outcomes through education, care coordination and advocacy services
  • Disease Management

    Disease Management

    This program provides education and health coaching to empower our members to manage chronic conditions, including asthma, diabetes, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), coronary artery disease (CAD), hypertension, depression and human immunodeficiency virus (HIV).

  • EPSTD Program

    EPSTD Program

    Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program
    Improves the rate of members receiving health assessment screenings and testing.

    EPSDT Well Child Exam Form This PDF document will open in a new window.

  • Kentucky Vaccines for Children Program

    Kentucky Vaccines for Children Program

    This program ensures children receive their vaccines and stay healthy. Immunizations should be provided in accordance with ACIP guidelines and the Periodicity Schedule.
  • Maternity Education and Rewards Program

    Maternity Education and Rewards

    Supports pregnant women so they can have healthy babies.

  • Smoking Cessation

    Smoking Cessation

    Find out what smoking cessation resources pdf are available to assist members.
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Last Updated On: 8/6/2018