Total cost increase attributed to Medicaid expansion 2014-2019$
HealthHelp’s collaborative care model has been shown to be successful among state Medicaid programs, increasing quality of care for its members and reducing costs. Because of the consult program’s educative components, Medicaid physicians become more skilled at ordering tests, thus improving quality of care for their patients.
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.
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.
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.
*Lists not comprehensive