Caresource

CARESOURCE'S MISSION IS TO MAKE A LASTING DIFFERENCE IN MEMBERS' LIVES BY IMPROVING THEIR HEALTH AND WELL-BEING BY SUPPORTING THE NONPROFIT ENTITIES IN THE CARESOURCE FAMILY OF CO.

CARESOURCE, AS A SUPPORTING ORGANIZATION, PROVIDES STRATEGIC OVERSIGHT TO CARESOURCE OHIO INC., CARESOURCE INDIANA INC., THE CARESOURCE FOUNDATION, CARESOURCE KENTUCKY CO, CARESOURCE GEORGIA CO, CARESOURCE WEST VIRGINIA CO, AND CARESOURCE LIFE SERVICES CO (THE "CARESOURCE FAMILY OF COMPANIES"). CARESOURCE PROVIDES COMMITTEE OVERSIGHT REGARDING QUALITY-OF-CARE MEASURES, HEALTHCARE EFFECTIVENESS DATA AND INFORMATION SET, NATIONAL COMMITTEE FOR QUALITY ASSURANCE, AS WELL AS STATE AND FEDERAL QUALITY MEASURES. CARESOURCE'S GOVERNANCE OVERSIGHT ALSO INCLUDES FINANCIAL REVIEW, COMPLIANCE WITH ALL APPLICABLE HEALTHCARE LAWS, CYBERSECURITY SURVEILLANCE, AND ENTERPRISE RISK MANAGEMENT FUNCTIONS. IN MARCH 2012, CARESOURCE SIGNED AN ALLIANCE AGREEMENT WITH HUMANA, INC., TO JOINTLY PARTICIPATE IN STATE BID OPPORTUNITIES FOR MEDICAID AND PROVIDE COVERAGE FOR PEOPLE WHO QUALIFY FOR MEDICAID IN THE COMMONWEALTH OF KENTUCKY. AS OF DECEMBER 31, 2019, THERE WERE 148,485 MEDICAID MEMBERS IN A HUMANA - CARESOURCE MEDICAID PLAN. CARESOURCE HAS A COMMENDABLE ACCREDITATION FOR THIS MEDICAID PLAN. THE CURRENT TERM OF THE MEDICAID CONTRACT WITH THE COMMONWEALTH OF KENTUCKY ENDED IN JUNE 2019 BUT CONTAINED ONE (1) ADDITIONAL SIX (6) MONTH RENEWAL PERIOD THAT WAS MUTUALLY AGREED UPON. CARESOURCE REINSURANCE LLC ("CSRE"), A SINGLE MEMBER LLC OF CARESOURCE, CONTINUED DOING BUSINESS WITH HUMANA IN THE SAME CAPACITY THROUGH 2019. EFFECTIVE DECEMBER 31, 2019, THE COMPANY ENDED ITS RELATIONSHIP WITH HUMANA AND WILL NOT CONTINUE SERVICING MEMBERS IN THE KENTUCKY MEDICAID PROGRAM. CSRE WILL CONTINUE TO PROCESS CLAIMS RUNOUT FOR EFFECTIVE DATES OF SERVICE DECEMBER 31, 2019, AND PRIOR THROUGH DECEMBER 31, 2022, AS AGREED UPON WITH HUMANA. THE CARESOURCE FAMILY OF COMPANIES' PRIMARY ACTIVITY FOR OVER 30 YEARS HAS BEEN PROVIDING NONPROFIT MEDICAID HEALTH MAINTENANCE ORGANIZATION ("HMO") SERVICES. THE CARESOURCE FAMILY OF COMPANIES STARTED ITS FIRST MEDICAID HMO PROGRAM IN OHIO IN 1989. THIS PLAN IS NOW ONE OF THE LARGEST MEDICAID MANAGED CARE PLANS IN THE COUNTRY. THE CARESOURCE FAMILY OF COMPANIES HAS EXPANDED BEYOND OHIO TO OPERATE MEDICAID PLANS IN VARIOUS OTHER STATES, INCLUDING GEORGIA AND INDIANA. IN TOTAL, THE CARESOURCE FAMILY OF COMPANIES PLANS FACILITATE ACCESS TO HEALTH CARE TO APPROXIMATELY 2,000,000 LOW-INCOME INDIVIDUALS. THE CARESOURCE FAMILY OF COMPANIES REFERS TO THESE INDIVIDUALS AS "MEMBERS." ADDITIONALLY, OVER THE LAST SEVERAL YEARS, THE CARESOURCE FAMILY OF COMPANIES' LEADERSHIP BEGAN TO RECOGNIZE THAT DESPITE HEALTH CARE REFORM, MANY LOW-INCOME INDIVIDUALS REMAINED UNINSURED OR UNDERINSURED. THEY ALSO REALIZED THAT THE CARESOURCE GROUP WAS UNIQUELY POSITIONED TO ADDRESS THIS PROBLEM DUE TO ITS EXTENSIVE EXPERIENCE PROVIDING MANAGED CARE TO LOW-INCOME INDIVIDUALS. THE CARESOURCE FAMILY OF COMPANIES THEREFORE CONCLUDED THAT IT WAS IMPERATIVE THAT IT EXPAND ITS OPERATIONS TO STATES WITH SIGNIFICANT LOW-INCOME POPULATIONS WHICH WOULD BENEFIT FROM THE ORGANIZATION'S CHARITABLE APPROACH TO HEALTH CARE. AS A RESULT, THE CARESOURCE FAMILY OF COMPANIES EXPANDED TO OPERATE QUALIFIED PLANS ON THE HEALTH CARE EXCHANGE IN MULTIPLE STATES, AS WELL AS EXCLUSIVELY THROUGH SEVERAL OF ITS OTHER CARESOURCE-RELATED ENTITIES THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE ("IRC"). AS WITH ITS MEDICAID HMO PLANS, THE CARESOURCE FAMILY OF COMPANIES REFERS TO INDIVIDUALS PARTICIPATING IN ITS HEALTH CARE EXCHANGE PLANS AS "MEMBERS." THROUGH ALL OF ITS ACTIVITIES, THE CARESOURCE FAMILY OF COMPANIES STRIVES TO MAKE A LASTING DIFFERENCE IN ITS MEMBERS' LIVES BY IMPROVING THEIR HEALTH AND OVERALL WELL-BEING. IT FIRMLY ADHERES TO THIS MISSION BY PROVIDING SERVICES TO MEMBERS (BOTH OF ITS MEDICAID HMO PLANS AND HEALTH CARE EXCHANGE PLANS) THAT GO BEYOND THE DELIVERY OF MEDICAL BENEFITS, AND WHICH REMOVE POVERTY AS A BARRIER TO ACHIEVING GOOD HEALTH AND INDEPENDENCE. THE CARESOURCE FAMILY OF COMPANIES ALSO BELIEVES THAT IT CAN IMPROVE THE HEALTH OF ITS MEMBERS THROUGH EDUCATIONAL INITIATIVES. EDUCATION EMPOWERS MEMBERS TO TAKE ON GREATER PERSONAL RESPONSIBILITY FOR THEIR OWN HEALTH AND THE HEALTH OF THEIR FAMILY BY ENCOURAGING HEALTHY DECISIONS AND PREVENTATIVE CARE. FOR EXAMPLE, THE CARESOURCE FAMILY OF COMPANIES PREPARES A PERSONALIZED WELLNESS PLAN FOR EACH OF ITS MEMBERS. MOREOVER, MEMBERS WHO ARE PREGNANT OR HAVE A CHILD UNDER THE AGE OF ONE CAN SIGN-UP FOR TEXT4BABIES. MEMBERS PARTICIPATING IN TEXT4BABIES RECEIVE THREE TEXT MESSAGES PER WEEK THAT PROVIDE ADVICE ON PROPER PREVENTATIVE CARE. OTHER EDUCATIONAL EFFORTS INCLUDE A CHILDHOOD OBESITY MANAGEMENT PROGRAM FOR CHILDREN BETWEEN THE AGES OF FIVE AND 17 YEARS OLD. AT CARESOURCE, WE KNOW THAT SOCIAL DETERMINANTS OF HEALTH ARE KEY DRIVERS OF HEALTHCARE ACCESS, UTILIZATION, AND OUTCOMES. AS SUCH, SOCIAL DETERMINANTS OF HEALTH REQUIRE FULL INTEGRATION INTO THE TREATMENT OF MEMBERS' PHYSICAL HEALTH. WHAT SETS US APART FROM TRADITIONAL MANAGED CARE IS OUR RECORD OF ACCOMPLISHMENTS AND RESULTS IN INTEGRATING THESE NON-CLINICAL ASPECTS INTO EVERY INTERACTION WE HAVE WITH OUR MEMBERS. THE CARESOURCE MISSION IS TO MAKE A LASTING DIFFERENCE IN MEMBERS' LIVES BY IMPROVING THEIR HEALTH AND WELL-BEING. THIS HAS CATALYZED OUR COMMITMENT TO DEVELOP PROGRAMS THAT TARGET OUR MEMBERS' SOCIAL NEEDS - NUTRITION, TRANSPORTATION, HOUSING, JOBS, SOCIAL CONNECTEDNESS, COMMUNICATION, ACCESS, AND MORE. WE SHAPE OUR BENEFITS TO INTEGRATE SOCIAL AND ECONOMIC SOLUTIONS SEAMLESSLY INTO OUR MEMBERS' CARE TO HAVE MAXIMUM IMPACT ON THEIR SOCIAL SUPPORT, STABILITY, HEALTH, AND WELLNESS. CARESOURCE LIFE SERVICES IS THE UMBRELLA FRAMEWORK THROUGH WHICH WE ADDRESS SOCIAL DETERMINANTS OF HEALTH INCLUDING HUNGER, HOUSING, SOCIAL STABILITY, WORKFORCE DEVELOPMENT, AND HEALTH EQUITY. WITHIN CARESOURCE LIFE SERVICES, OUR CARESOURCE JOBCONNECT PROGRAM ADDRESSES THE EDUCATION AND EMPLOYMENT BARRIERS THAT MANY OF OUR MEMBERS FACE AND THAT IMPEDE THEIR PATH TO SELF-SUFFICIENCY. CARESOURCE JOBCONNECT IS WIDELY RECOGNIZED WITHIN THE MANAGED CARE INDUSTRY FOR REDUCING DEPENDENCE ON GOVERNMENTAL SERVICES BY PROVIDING MEMBERS WITH LIFE COACHING, ACCESS TO COMMUNITY-BASED RESOURCES, AND SUPPORT SETTING AND REACHING THEIR PROFESSIONAL AND EDUCATIONAL GOALS. CARESOURCE LIFE SERVICES ALSO PARTICIPATES IN THE JOBS-PLUS PROGRAM ("JOBS-PLUS"). THE JOBS-PLUS PROGRAM WAS CONCEIVED IN THE MID-1990S BY THE DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT ("HUD") IN COOPERATION WITH VARIOUS PRIVATE CHARITABLE ORGANIZATIONS. JOBS-PLUS IS BASED ON THE CONCEPT OF SATURATING LOW-INCOME HOUSING DEVELOPMENTS WITH INFORMATION, SERVICES, AND INCENTIVES TO ENCOURAGE RESIDENTS TO OBTAIN EMPLOYMENT. ADDITIONALLY, IN NOVEMBER 2017 CARESOURCE ENTERED INTO A GRANT AGREEMENT WITH JOBSOHIO IN ORDER TO INVEST IN REDEVELOPMENT ACTIVITIES, FIXED-ASSETS, INFRASTRUCTURE, AND WORKFORCE TRAINING ASSOCIATED WITH GROWTH OF THE ORGANIZATION IN DOWNTOWN DAYTON, OHIO. JOBSOHIO WAS FORMED UNDER THE LAWS OF THE STATE OF OHIO AND WAS ESTABLISHED TO ENCOURAGE BUSINESS DEVELOPMENT IN THE STATE. JOBSOHIO WAS INCORPORATED ON JULY 5, 2011, AS A NONPROFIT CORPORATION, TO PROMOTE ECONOMIC DEVELOPMENT, JOB CREATION, JOB RETENTION, JOB TRAINING, AND THE RECRUITMENT OF BUSINESS TO OHIO. JOBSOHIO IS GOVERNED BY A BOARD OF DIRECTORS APPOINTED BY THE GOVERNOR OF OHIO. THE CARESOURCE FAMILY OF COMPANIES PROVIDES ENHANCED BENEFITS TO MEMBERS THAT ARE ABOVE AND BEYOND REQUIRED BENEFITS DEFINED BY STATE OR FEDERAL AGENCIES. IN ORDER TO ENSURE MEMBERS ARE ABLE TO ACCESS THE MOST APPROPRIATE MEDICAL CARE, THE CARESOURCE FAMILY OF COMPANIES PROVIDES TRANSPORTATION SERVICES FOR OFFICE VISITS TO THEIR MEDICAL PROVIDER'S OFFICE, ENSURING THAT MEMBERS ARE KEEPING PREVENTIVE, SICK, OR FOLLOW-UP APPOINTMENTS. FURTHER SHOWING THE CARESOURCE FAMILY OF COMPANIES' DEDICATION TO ENSURING THAT OUR MOST VULNERABLE MEMBERS RECEIVE NEEDED CARE, THE CARESOURCE FAMILY OF COMPANIES DOES NOT CHARGE MEDICAID MEMBERS A COPAYMENT FOR PHARMACY PRODUCTS, DENTAL VISITS, VISION EXAMINATIONS, VISION HARDWARE OR NON-EMERGENT EMERGENCY DEPARTMENT VISITS, EVEN THOUGH REGULATIONS ALLOW FOR SUCH COPAYS. THE CARESOURCE FAMILY OF COMPANIES IS DEDICATED TO MOTIVATING ITS PREGNANT MEMBERS TO SEEK PRENATAL AND POSTPARTUM CARE BY PARTICIPATING IN THE ORGANIZATION'S BABIES FIRST MEMBER INCENTIVE PROGRAM. MOMS-TO-BE CAN RECEIVE REWARD CARDS FOR ATTENDING REGULAR OB/GYN APPOINTMENTS WHILE PREGNANT AND FOR ALSO ATTENDING APPROPRIATE FOLLOW-UP VISITS AFTER GIVING BIRTH. THE CARESOURCE FAMILY OF COMPANIES ALSO PROVIDES ITS MEMBERS WITH FREE ACCESS TO A HOTLINE STAFFED BY REGISTERED NURSES, 24 HOURS A DAY, SEVEN DAYS A WEEK. OVER THE PHONE, NURSES REVIEW A MEMBER'S SYMPTOMS, OFFER GUIDANCE ON WHEN TO SEEK MEDICAL CARE, EXPLAIN ANY RECENTLY DIAGNOSED CONDITIONS, PROVIDE EDUCATION ON OVER-THE-COUNTER MEDICATIONS, AND HELP MEMBERS PREPARE A LIST OF QUESTIONS PRIOR TO MEETING WITH A PHYSICIAN. ALL OF THESE PROGRAMS ARE PROVIDED TO MEMBERS FR