An investment in chronic condition management is paying off in big way for Oklahoma’s Medicaid program. An independent evaluation shows the Telligen-administered SoonerCare Health Management Program (HMP) has saved Oklahoma taxpayers $41.2 million over the last two years.
Telligen helps the HMP deliver value by identifying and engaging high-risk members, coordinating care across the continuum and closing gaps in care. The program’s combination of personalized health coaching and one-on-one practice facilitation provides: 1) increased education and support to members with chronic conditions; and 2) strategies that help physician practices identify and prioritize improvement goals and track progress.
“This program is not just saving money; it’s about finding innovative ways to help Medicaid members eliminate barriers to care and improve their health,” said DJ Jones, Telligen’s HMP Director. “By engaging both members and physicians we have a better chance of improving outcomes, delivering value and lowering costs.”
For members with chronic conditions — from heart disease, to asthma to diabetes — Telligen embeds registered nurses within primary care practices and provides one-one-one health coaching, telephone support and home visits. For Fiscal Year 2015, these strategies comprised $12.8 million of total program savings with 87 percent of members reporting a “very satisfied” experience with their health coaches.
In addition, the HMP features on-site practice facilitators who help physicians redesign clinical processes and eliminate gaps in care. Results from FY 2015 show increased compliance with evidence-based guidelines saved an additional $28.4 million.
“Successful condition management requires that the right processes are in place,” says Jones. “Strategies that incorporate physician input, collaboration and support are essential to delivering value to the healthcare system.”
Now in their eighth-year administering the program, Telligen starts by identifying high-risk members, then puts strategies in place that promote prevention through patient education, and help primary care physicians deliver better care.
Results from phase one of the HMP (conducted from 2008 to 2013) achieved a five-year taxpayer savings of more than $180 million; returning $6 for every $1 invested.
“This program represents a major change in the way state Medicaid programs are delivering care,” says Jeff Chungath, Telligen CEO. “Oklahoma is taking an active role in ensuring members are receiving the preventative care and education necessary to manage their conditions. The end result is a reduction in avoidable complications and costly hospital visits.”
Oklahoma’s Medicaid program, known as SoonerCare, is administered by the Oklahoma Health Care Authority (OHCA). SoonerCare works to improve the health outcomes of Oklahomans by ensuring medically necessary benefits and services are available to our members. Qualifying Oklahomans include certain low-income children, seniors, the disabled, those being treated for breast or cervical cancer and those seeking family planning services. Insure Oklahoma assists qualifying adults and small business employees in obtaining health care coverage for themselves and their families. OHCA strives to educate and engage our current 788,116 members regarding personal responsibilities for their health services utilization, behaviors, and outcomes in partnership with a state-wide network of 45,802 providers. For more information, visit www.okhca.org.