Why Telligen

Why Telligen? This is John's story

John's Story

John is a 15-year-old member who is insulin dependent, non-compliant, and argumentative.

Engaging Members to Improve Health Outcomes

A Telligen diabetic educator used health coaching to help John achieve medication compliance and take better control of his health.

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John's Story

Successful Components

  • Identification – Through advanced data analytics, we were able to identify John as a member in need of care management interventions.
  • Assessment – The health coach first received parental consent for participation; they then assessed physical, psycho social, depression and readiness to change.
  • Relationship Building – The health coach developed a trusted relationship with both John and his parents. They also facilitated collaboration with John’s provider.
  • Create Plan – The health coach worked with John to identify barriers and develop a plan so he would become more involved in the management of his diabetes.

Result

  • John is now engaged in the process of managing his diabetes
  • John has begun testing his fasting blood sugar, taking his insulin and eating breakfast before school
  • John’s A1C has improved 2.4 points from 12.9 to 10.5

Donald's Story

Donald is a 56 year-old male with a proposed chemotherapy plan which included an experimental chemotherapy combination.

Engaging Providers to Find Evidence-Based Treatments

A Telligen case manager collaborated with the provider to find a different chemotherapy combination using evidence-based criteria.

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Why Telligen? This is Donald's story

Donald's Story

Successful Components

Donald was able to receive a high-quality evidence-based chemotherapy plan with no unexpected out-of-pocket high costs

Result

  • Donald receives chemotherapy and the benefit plan pays for high quality care per evidence-based standards
  • Donald was able to maximize his benefits
  • Donald’s benefit plan does not pay for experimental treatment and potential unknown complications (estimated to have been upwards of $1 million for eight cycles of medication)
  • Donald has a dedicated Telligen oncology certified case manager
  • The provider has one contact for ongoing treatment to collaborate with Donald

Why Telligen? This is a QIO's story

Iowa's Medicare Beneficiaries' Story

Data analytics revealed one in five hospital Medicare patients were readmitted within one month for potentially preventable conditions.

Improving Health Outcomes Through Community Outreach

Coalitions were formed within communities displaying high hospital readmissions to evaluate medical research and best practice methods that best meet the community’s needs.

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Iowa's Medicare Beneficiaries' Story

Successful Components

  • Comprehensive Discharge Planning — Meet with patients before discharge, make follow-up appointments with primary care physicians and send discharge summaries back to PCPs
  • Medication Reconciliation — Pharmacists communicate with patients following discharge to review medications and communicate problems to PCPs
  • Patient/Caregiver Education — Using the “teach back” method with patients and facilitating open communication between providers

Result

  • 7,826 fewer hospitalizations
  • More than 1,700 fewer readmissions
  • Cost savings of more than $75 million

Oklahoma Medicaid's Story

Providing care to individuals with chronic diseases, many of whom meet the federal disability standard, has placed a significant burden on Oklahoma’s Medicaid budget. In response, the Oklahoma Health Care Authority contracted with Telligen to implement a chronic disease management program.

Achieving Quality Improvement and Cost Containment

Utilize Telligen’s Population Health Management solution to address the needs of Medicaid members suffering from chronic diseases, and employ cost containment strategies at a time of significant fiscal constraints.

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Why Telligen? This is a QIO's story

Oklahoma Medicaid's Story

Successful Components

  • Health coaches working one-on-one with patients and their physicians to develop individualized care plans, build self management skills, improve health literacy, assist with medication management and help patients become more knowledgeable and engaged consumers of healthcare services.
  • Embed practice facilitation experts in physician offices to examine care delivery and business practices and recommend evidence-based changes that will result in better clinical outcomes.

Result

A program evaluation showed the state of Oklahoma saved $182 million over a five-year period in addition to high satisfaction ratings.

  • 91 percent of providers who completed practice facilitation viewed the program favorably and would recommend the program to other providers.
  • 75 percent of providers credited practice facilitation with having a positive impact on enrolled patients.
  • High-risk patients spent 65 percent fewer days in the hospital than they typically would have.
  • Participating physicians were able to reduce claims costs by 11.5 percent.
  • Monthly medical expenditures per member declined in each of the three years following coaching, ranging from 10 percent to 30 percent per year.
  • 90 percent of members were satisfied with their health coach.
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