Case Study: Healthcare
Focused care management and improved patient engagement
lead to nearly 4:1 ROI for a state agency
Sagility placed 24 regionally-based care teams throughout Texas to provide one-on-one counseling, assessment, case management, and personal care planning, while coordinating with providers and community resources to support and educate Medicaid patients.
The program supported eligible patients with regional care teams across the state. This strategy provided patients with regionally-based resources who helped with personalized care plans, follow-up appointments, equipment and medications, and transportation to appointments. Using evidence-based clinical guidelines, these teams coordinated care with the patients’ physicians and treatment teams to work collaboratively on patients’ behalf.
Several inventive pilots were launched in support of the client. An innovative funds pilot program placed a dedicated RN in high volume clinics to assist with coordination of care for eligible patients. A telemonitoring program was conducted for patients with diabetes with training and nutritional counseling. A Six Sigma pilot was conducted to reduce avoidable pneumonia inpatient admissions.
The programs promoted improved health outcomes by supporting the provider-patient relationship and building connections between HHSC, providers, patients, and community resources. A focused provider outreach plan informed providers of services available through the program, provided practice support, and enabled collaboration among providers and regional care teams. A program Advisory Board consisting of physicians and members of numerous state professional associations was set up to exchange information, share program performance results, and gather feedback regarding program initiatives and outcomes.
These initiatives improved quality of care for the patients and increased patient and provider satisfaction.
3.95:1 ROI in most recent year
$209m in total net savings in the first five years
168,000 patients cared for in six-year period
16.77% net savings in most recent year
50% increase in enrollments over the first year
95% patients agreed that the program is helpful in condition management
31% reduction in inpatient pneumonia spend
36% average relative improvement across 10 HEDIS
14% reduction in ED visits and 53% reduction in inpatient admissions
Outstanding Collaborative Care Award from the Care Continuum Alliance