Radiology: Finding the right balance requires the right tools


The marketplace for diagnostic imaging has changed dramatically in recent years with greater consumer access to information about radiological testing. With rising utilization, there is also widespread confusion as patients shop around for the right treatment or the right diagnostic test.


HealthHelp has solutions to help providers simplify the choices in imaging to improve quality and increase savings including:


Collaborative Benefit Management: Pre-authorization of imaging tests using evidence-based guidelines helps reduce over-utilization.


Proactive Claims Review: Ensuring the correct coding for claims payment is essential, but our claims review goes beyond this to help providers evaluate the effectiveness of diagnostic tests.


Procedure Scheduling: Scheduling tests with in-network providers can be key in reducing the opportunity for patients to shop around for inappropriate care.


Clinical Decision Support: Computer-based clinical decision support offers guidance to physicians on which test is best.


Facility Assessment and Data Warehousing: Technical standards that ensure safety and quality help reduce unnecessary retesting.


Referral Pattern Analysis and Modification: Monitoring physician ordering patterns helps detect inappropriate behavior early.


Physician Education: Non-radiology specialists are given extra training through enrollment 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, radiation dose, sensitivity and specificity. 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.