Annual Cost of Cardiovascular Disease in the US
Imaging | Interventional | Devices
HealthHelp was the first in the industry to introduce comprehensive cardiology benefits management, including diagnostic testing, interventional procedures, and cardiac devices. The program works to deliver the most appropriate utilization of services for a variety of conditions before and after diagnosis.
HealthHelp was given a 99% satisfaction rating among providers. Since program inception in 2009, our process has resulted in:
- 15-20% reduction in unnecessary Percutaneous Coronary Interventions (angioplasty and stents)
- 15-20% reduction, over 5 years in diagnostic catheterizations without having any prior non-invasive imaging
- 5% reduction, over 3 years in monthly length of use for wearable cardioverter defibrillators
- Enhanced quality care and member safety while reducing utilization
- Reduction in repeat cardiac imaging and inappropriate utilization of cardiology services
- Collaborative peer-to-peer reviews by academically affiliated specialists
Patient Clinical Information*
- Patient diagnosis
- Clinical indication
- Test ordered
- Reason for test
- Patient symptoms and duration
- Laboratory studies
- Prior treatments
- High or low-risk indication
- Supporting clinical information
Automated Decision Support
Providers submit procedure requests. If the request meets evidence-based criteria, it is automatically approved.
If the request falls outside of pre-set clinical guidelines, it is sent to nurse review.
Specialty Nurse Review
HealthHelp nurses evaluate requests, gather additional information and provide approvals for requests that meet clinical guidelines. For requests that fall outside of these criteria, nurses will present an alternative care pathway as guided by the proprietary Clinical Decision Support system.
If not approved at the nurse review level, the request is sent for a peer-to-peer consultation.
A HealthHelp physician reviews the request. After consultation with the requesting provider, the request will either be approved by the expert reviewer, or withdrawn/changed by the requesting provider.
Medically Appropriate Procedures*
- Cardiac Catheterization
- Stress Echo
- Cardiac Ablation
- Electrophysiologic Testing
- Doppler Flow of Extremities
- Percutaneous Coronary Intervention (PCI)
- Implantable Cardiac Defibrillators
- Implantable Cardiac Pacemakers
- Cardiac Re-synchronization Therapy (CRT-D)
- Cardiac Re-synchronization Therapy (CRT-P)
- Cardiac Durable Medical Equipment
- Cardiac Left Ventricular Pacing Electrode Add-on
- Left Ventricular Assist Devices (LVADs)
- Loop Recorder Implants
- Cardiac Wearable Cardioverter-Defibrillator (WCD)
- Cardiac CT
- Cardiac CT Angiogram (CCTA)
- Cardiac MRI
- Cardiac PET