HealthHelp has identified a unique opportunity in the overall management of OSA, resulting in the most appropriate care delivered to patients with a comprehensive approach to cost savings and care management.

Annual US Direct and Indirect Costs for Sleep Disorders

$
BILLION Source


Sleep Care Program Overview

  • Collaborative care approach that helps physicians choose the most medically appropriate obstructive sleep apnea (OSA) in-home or in-lab diagnostic study.
  • Appropriate triage between in-lab or in-home tests by applying evidence-based OSA clinical criteria, achieving up to 40% impact.
  • Elimination of unnecessary testing for detection of low to severe sleep apnea, improving diagnostic efficiency and treatment.
  • Increased safety and quality of care for the patient while achieving sustained savings for the payor.
  • Reduced double testing rate for patients who receive in-home testing first, followed by an in-lab.
  • Compliance CPAP/BiPAP therapies.
  • Ensuring that in-lab sleep tests are received in certified facilities assessed for safety and quality.

Sleep ConsultThe Right Procedure at the Right Place at the Right Time

Patient Clinical Information*

  • 20 uniquely developed OSA assessment criteria
  • Patient Suspected or Current Diagnosis
  • Clinical Indication
  • Test Ordered
  • Treatment Requested
  • Patient Medications and Duration
  • Prior Treatments
  • Summary of Clinical Findings
  • Reason for Test
  • Patient Symptoms
  • 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*

 

  • In-Home Polysomonography
  • In-Lab Polysomonography
  • Sleep Site – safety & quality certified Sleep labs
  • C-PAP Compliance

 

 

*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.