Medicaid Program

$410Billion

Total cost increase attributed to Medicaid expansion 2014-2019

Non-denial, Educational Pre-notification

HealthHelp offers a unique solution to growing Medicaid costs, healthcare reform with eligibility expansion, state budget deficits, and concern about treatment quality and safety.

Program Results

  • Over 6,000 providers participated in programs covering 800,000 lives and over 115,000 total peer-to-peer consultations
  • Substantial, progressive drop in advanced imaging utilization and cost
  • Decrease in radiation exposure and future cancer incidence saved over 684,000 days of life
  • 99% satisfaction rate among providers and no loss of provider network
  • Inbound calls answered in less than 10 seconds and completed in less than 6 minutes on average
  • 88% of provider consultations completed within 30 minutes, with the majority in less than 7 minutes
  • Zero patient complaints, delays in diagnosis, adverse outcomes, or nonperformance of medically necessary tests
  • HealthHelp’s peer-to-peer consult program collaborates with esteemed academic institutions across the US, including Thomas Jefferson University, The Ohio State University, Cedars-Sinai, and University of Southern California

Patient Clinical Information*

 
  • Patient Diagnosis
  • Clinical Indication
  • Test Ordered
  • Reason for Test
  • Patient Symptoms and Duration
  • Laboratory studies
  • Patient Medications and Duration
  • Prior Treatments
  • Summary of Clinical Findings
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*

  • CT
  • CTA
  • CT Bone Density
  • Cardiac Ablation
  • Electrophysiologic Testing
  • Interventional Radiology
  • MRA
  • MRI
  • MRS
  • fMRI
  • Nuclear Medicine
  • PET Scan
  • SPECT
  • Doppler
  • Ultrasound
  • 3D Mammography
*Lists not comprehensive