HealthHelp provides a fully-integrated Pain, Spine, Musculoskeletal, and Orthopedic Implant program for management of chronic pain and bone and joint health.

Annual US Direct and Indirect Costs for Bone and Joint Health

$
BILLION Source


Orthopedic and Pain Program Overview

  • Over 400% ROI.
  • Over 12% of spine surgery requests were withdrawn after consultation.
  • Increased appropriate use of physical therapy with proven improvement in patient outcomes.
  • Significant overall decrease in surgical interventions and implants.
  • Greater consumer engagement via effective member-centric health and wellness and incentive programs.
  • Specific decrease in low-back pain-related spinal interventions.
  • Improvement in quality and safety for members thus qualifying for 85% MLR requirement under ACA law.

 


Pain, Orthopedic, Musculoskeletal, & Spine Consult ProcessThe Right Procedure at the Right Place at the Right Time

Patient Clinical Information*

 

  • Patient history (falls, injuries, or stress)
  • Onset of pain
  • Direction of pain
  • Nature of pain (shooting, stabbing)
  • Severity of pain (at rest, with activity, at night)
  • Relief/aggravation causes
  • Differentiation of pain
  • Other patient symptoms
  • Current or suspected diagnosis
  • Clinical indication
  • Summary of Clinical Findings (range of motion)
  • Radiologic findings (joint space preservation)
  • Functional assessment
  • Reason for test
  • Test ordered
  • Treatment, procedure, or device Requested
  • Patient medications and duration (use of analgesics)
  • Prior medical management history
  • Prior use of injectables and branch blocks
  • Prior invasive procedures or surgeries

 

 

For the evaluation of:

  • Osteoarthritis (OA)
  • Rheumatoid arthritis (RA) and juvenile RA (JRA)
  • Avascular necrosis (AVN) or osteonecrosis (ON)
  • Congenital dislocation of the hip joint (CDH)
  • Hip dysplasia
  • Acetabular dysplasia (shallow hip socket)/protrusion
  • Benign and malignant bone tumors
  • Paget’s disease arthritis
  • Ankylosing spondylitis
  • Frozen, stiff, loose joint
  • Traumatized and malaligned joint
  • Fractures
  • 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.

     

    In all cases, some form of treatment will be approved.

Medically Appropriate Procedures*

 

The program covers the use of diagnostic procedures, invasive interventional procedures, PT/OT therapies, injectables, prostheses, and surgical implantable devices.

Non-Surgical Pain Management

  • Physical Medicine Pain Treatments
  • Epidural Steroid Injections
  • Facet Joint & Medial Branch Blocks
  • Sacroiliac (SI) Joint Injections
  • Intrathecal Morphine Pump
  • Spinal Cord Stimulators (neurostimulators)

Surgical Pain Management

  • Artificial Disc
  • Intrathecal Pain Pump
  • Kyphoplasty/Vertebroplasty
  • Lumbar Discectomy
  • Lumbar Endoscopic Discectomy
  • Lumbar Foraminotomy
  • Lumbar Foraminotomy/Facetectomy
  • Lumbar Fusion
  • Lumbar Laminectomy
  • Minimally Invasive Lumbar Surgery
  • Spinal Cord Stimulator

 

Spine Management

  • Single and Double-Lock Screw Systems
  • Spinal Corpectomy Cages
  • Cervical Plate Systems
  • Steffee Implants
  • Harrington Implants
  • Neurostimulators (Spine)
  • Drug Infusion Systems (chronic pain, spasticity)

 

Hip & Knee

  • Single and Double-Lock Screw Systems
  • Spinal Corpectomy Cages
  • Cervical Plate Systems
  • Steffee Implants
  • Harrington Implants
  • Neurostimulators (Spine)
  • Drug Infusion Systems (chronic pain, spasticity)

 

Upper Extremity, Wrist, Femur, Tibia, Shoulder, Elbow, and Foot

  • Myoelectric prosthesis
  • Body-powered prosthesis
  • Constrained vs. Unconstrained
  • Condylar blade plate
  • Grosse-kempf (GK) nail
  • Buttress plate

*Lists not comprehensive

  • Neer’s prosthesis
  • Souter’s prosthesis
  • Baksi’s prosthesis
  • Single axis
  • SACH Dynamic response

 

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.