Cardiology: Taking patient safety and provider spending to heart.
The tremendous strides in cardiac care in recent years have given patients and physicians a wide range of choices. However, increasingly cardiology patients are being subjected to unproven procedures with questionable benefits. The overuse of cardiac interventions is a trend that should raise concern as it increases unnecessary healthcare spending and can put patients’ safety at risk.
HealthHelp has a number of ways to help providers navigate the complex decision-making often required in cardiac cases. The goal of the program is to increase coordination, identify appropriate care, and promote efficiencies. Here’s how it works:
Collaborative Benefit Management: Requires pre-authorization of treatment to reduce the chance for overutilization of services.
Proactive Claims Review: Uses accurate billing records to help track patient outcomes.
Procedure Scheduling: Steers patients to in-network providers to better manage treatments.
Facility Assessment and Data Warehousing: Establishes technical standards help ensure quality and safety among contracted providers.
Referral Pattern Analysis and Modification: Monitors physician orders to detect inappropriate behavior.
Nonradiologist ordering: Sets reimbursement policies for a spectrum of imaging specialists.
Physician Education: Enrolls nonradiology specialists in an ACCME-accredited diagnostic imaging education program.
HealthHelp’s Cardiology program includes clinical decision support tools that deliver appropriateness guidelines via an intuitive web- or tablet-based interface. Providers are shown the appropriateness rating of their chosen procedure as well as additional information to support their decision: procedure cost, percent utilization for the stated indications. When an order gets a low rating, physicians are shown how their ordering compares to local and national averages. The provider has the option of choosing a list of more suitable exams or a peer-to-peer consultation. The clinical decision support tools have been designed to increase clinical efficiency, which leads to operational and financial efficiency for providers and payors.