Case Study

State Saves Millions in Health Care Costs, Improves Quality

  • The Client: Oklahoma Health Care Authority
  • Total Enrollment: 822,930
  • The Challenge: Reduce costs to the state through decreased utilization and improved health outcomes.
  • The Solution: Increased education and support to high-cost, high-risk members and their primary care providers.

“Telligen has been instrumental in building this strong & comprehensive program . . .
Proving itself as a sound & reliable partner.”
-Della Greg, HMP Program Manager

Background: 

Oklahoma’s Medicaid program was facing increasing costs while ranking 49 out of 50 states for clinical performance measures. The poor performance and high-costs led the state’s Medicaid agency to contract with Telligen to create the SoonerCare Health Management Program (HMP) in 2008.

Strategy:

Telligen identifies members that are high-risk or at-risk for developing chronic conditions; then works with primary care physicians to provide higher-quality, more patient-centered and cost-effective care.

Successful Components:

  • Health Coaching: Nurse health coaches embedded within primary care practices providing members with one-on-one health coaching, telephone support, and home visits. The health coaching component has demonstrated a net savings of $150.9 million.
  • Practice Facilitation: On-site practice facilitators work directly with providers to redesign clinical processes and eliminate gaps in care. Increased compliance with evidence-based guidelines has saved the state an additional $103.6 million.

Results:

  • Cost Savings: The program, now in it’s ninth year, has saved Oklahoma taxpayers a total of $254.5 million.
  • High Satisfaction: Results from the latest independent evaluation show 89 percent of members reporting a “very satisfied” experience.
  • Clinical Improvement: Significant improvement on 17 of the 21 clinical quality measures defined by the state.

 

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