Industry recognition for the need to reform prior authorizations programs is growing across the health sector. According to AMA survey results released recently, high wait times associated with prior authorizations have consequences for patients, such as delays in access to care and patients abandoning treatment. HealthHelp takes the pain out of prior authorizations. HealthHelp began with the objective of addressing the growing need for clinically correct, education based utilization management that would create a win-win-win effect. The process drives the most appropriate clinical care to the patient, educates the physician and helps them improve their outcomes, and brings down the cost for insurers by doing the right procedure first.
HealthHelp was founded in 1999 in response to an increasing need for efficient, outcomes-based health care utilization. HealthHelp held the core belief that a precertification and denial-based utilization management UM process will not yield long-term, sustainable results. Instead, evidence-based guidelines developed through the collective input of peer-reviewed literature, renowned academic institutions, and practicing specialty physicians will help determine appropriate utilization and yield the best patient outcomes. HealthHelp’s mission was to have a post-authorization means to educate and correct deviance from guidelines, and, by using physician scorecards, drive network optimization for its payer clients.
Cherrill Farnsworth, the CEO of WNS-HealthHelp is responsible for the performance and compliance of HealthHelp that oversees the management of high-tech, high-cost healthcare specialty spend for health plans. In this capacity, HealthHelp oversees the quality and safety of more than 50 million Americans in oncology, radiology, cardiology, sleep, and musculoskeletal. Under her progressive leadership, HealthHelp has been recognized as one of the fastest growing companies in the US by various leading publications.
HealthHelp introduced its unique non-denial model to the utilization management industry through providing services specific to radiology. Later, it expanded its scope of operation to interventional cardiology and radiation oncology. HealthHelp was the first company to introduce cardiology, radiation oncology, and medical oncology benefits management on a national scale. Today, HealthHelp continues to move health care forward through additional programs that focus on musculoskeletal surgeries, sleep care, medical oncology, oncology surgeries and biopsies, and integrated oncology. Further, HealthHelp has a strategic focus on building future programs in wound care and high cost–pharmacy utilization.
HealthHelp has created a differentiated model that redirects specialty physician–level reviews to academically affiliated specialty physicians within the health delivery system. Using specialists internal to the provider organization gives an opportunity for HealthHelp and the plan to further minimize friction from clinical review processes. HealthHelp’s programs deliver evidence-based education that guides provider decisions and thereby helps to improve member access to quality care, the provider and member experience, and health care safety and quality. HealthHelp supports trend management, employing active trend-bender cycles to help clients achieve incremental savings year over year. HealthHelp’s relationships with academic centers for clinical support and policy development keep us ahead of curve on upcoming trends.
HealthHelp consistently delivers immediate and long term savings by changing physicians ordering behavior for over a decade. HealthHelp has no lawsuits and their largest national client has had no lawsuits filed against them for over 10 years, a testament to the non-denial model. The company remains vigilant, always scanning the data for unexpected trends and areas of increased utilization. HealthHelp routinely communicates the findings to the payor along with suggested procedures to address the trend such as operational changes and updated savings methodology. These ‘trend benders’, when agreed upon, are used to decrease utilization and generate savings for the payor. “One such example is our newest program, Genetics & Molecular Testing. For the road ahead we plan enhance our solution and services alongside identifying nee findings that can cause an increase in existing procedures,” says Cherrill .