HealthHelp was the first in the industry to introduce comprehensive cardiology benefits management, including diagnostic testing and interventional procedures.

Annual Cost of Cardiovascular Disease in the US

$
BILLION Source


Cardiology Program Results

In summer 2014, we had a 99% satisfaction rating among providers. Since program inception in 2009, our process has resulted in:

  • Over 40% of Cardiac Catheterization requests that escalated to peer review resulted in change or withdrawal.
  • Over 20% of Cardiac Device requests that escalated to peer review resulted in change or withdrawal.
  • Over 31% reduction in Cardiac Nuclear Medicine utilization.
  • Over 95% compliance to guidelines achieved for all Cardiology programs.
  • No appeals and no lawsuits against the program.

Cardiology ConsultThe Right Procedure at the Right Place at the Right Time

Patient Clinical Information*

  • Patient Diagnosis
  • Clinical Indication
  • Test Ordered
  • Reason for Test
  • Patient Symptoms and Duration
  • Laboratory Studies
  • Prior Treatments
  • High or Low-Risk indication
  • Supporting Clinical Information
  • Automated Decision Support

    Providers submit procedure requests. If the treatment meets evidence-based criteria, it is automatically approved.

     

    If the treatment falls outside of pre-set clinical guidelines, it is sent to nurse review.

    Specialty Nurse Consult

    HealthHelp nurses evaluate requests and provide approvals for treatments within clinical guidelines. For procedures that fall outside of these criteria, nurses will discuss an alternative care pathway.

     

    If consensus is not reached, the request is sent for a peer-to-peer consultation.

    Peer-to-Peer Consultation

    A HealthHelp physician reviews the treatment. After consultation with the requesting provider, the procedure will either be changed, not performed, or agreement will not be reached.

Medically Appropriate Procedures*

  • Cardiac Catheterization
  • Echocardiography
  • Stress Echo
  • Cardiac Ablation
  • Electrophysiologic Testing
  • Doppler Flow of Extremities
  • Percutaneous Coronary Intervention (PCI)
  • Implantable Cardiac Defibrillators
  • Implantable Cardiac Pacemakers
  • Cardiac Re-synchronization Therapy (CRT-D)
  • Cardiac Re-synchronization Therapy (CRT-P)
  • Cardiac Durable Medical Equipment
  • Cardiac Left Ventricular Pacing Electrode Add-on
  • Left Ventricular Assist Devices (LVADs)
  • Loop Recorder Implants
  • Cardiac Wearable Cardioverter-Defibrillator (WCD)
  • Cardiac CT
  • Cardiac CT Angiogram (CCTA)
  • Cardiac MRI
  • Cardiac PET

*Lists not comprehensive

Contact Us
Questions? Contact us to find out how our programs can create savings for you.
Please note: If you are communicating as a health plan member, please contact your healthcare provider. HealthHelp does not provide individual healthcare advice.