case Management

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what we do

We designed our case management program as a collaborative process with members – one that involves assessments, planning, facilitation, care coordination, evaluation and advocacy for options and services. We engage members in our case management program by demonstrating our role as their trusted advocate. We also work with providers and stakeholders to identify health disparities within various populations to determine measure impacts, as well as proactively address social determinants of health.

how we do it

CASE MANAGEMENT SPECIALTY SOLUTIONS

Behavioral Health Coaching Embedded/Community-based Case Management
Chronic Disease Management – obesity and medically involved members Long-term Acute Care/Rehab
Complex Medical Conditions Neonatal Intensive Care Unit
Complex Wound Care Substance Use Disorder (chronic pain/opioid use)
Difficult Placement/Placement Issues Transplants (adult and pediatric)

Qualitrac’s population health data and risk stratification outputs enable us to support high- acuity clients through clinical health management activities and interventions that address social determinants of health, barriers to care or other triggers that prevent members from complying with/achieving treatment and care plan goals.

We also work with providers and stakeholders to identify health disparities within various populations to determine measure impacts, as well as proactively address social determinants of health.

Why Choose Telligen?

The data that we gather through hands-on, person-centered case management helps inform and guide members’ health goals, connect members with appropriate community resources and encourages them in building self-management skills to improve their health outcomes.

Differentiators

A Large Payor

  • Over $30 million in average annual savings across a 10-year period
  • Reduction of hospital days by 50 percent for high-risk patients

Contact a Health Plan Solutions Expert Today!

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caSe management

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utilization management