Exemplary Provider Satisfaction

November 10, 2015

HealthHelp’s Consult program has ordering providers singing its praises in a survey

Handling prior authorizations is a time- and cost-consuming process for physicians, nurses, and other medical staff. It creates a significant financial burden because of the time it takes to work on those prior authorizations for staff members whose time is better spent focused on patients. The lack of transparency that surrounds the approval process and the inability to order their preferred tests often leave providers frustrated, especially if they believe that test is the best option for their patient. But with its Consult program, physician-led HealthHelp cuts through the frustration and burden of dealing with authorization. Its non-denial model is a collaborative program that leaves the final procedure decision in the physician’s hands, but through the model’s strong educational component, it reduces the use of unnecessary tests.The results are statistically apparent: In a two-year study (2011-2013) of a large-state, fee-for-service Medicaid program managing an average of 900,000 lives, there was a 52 percent decrease in MR utilization, a 62 percent decrease in CT utilization, and a 60 percent decrease in PET utilization. The total savings to the state over the 2-year period was nearly $25 million.

Statistics are good, but provider satisfaction is just as important, especially given the changes in the healthcare industry that will depend on physician cooperation for any healthcare program to be successful. Even more, provider satisfaction has been shown to be linked to patient satisfaction.

A recent survey of more than 2,000 ordering providers shows they like the HealthHelp Consult program. In fact, the overall satisfaction rate for HealthHelp’s Consult program was 99 percent, with about half of the respondents rating it as “excellent.”

The HealthHelp Solution

HealthHelp’s Consult program provides clear, accessible, evidence-based criteria for test approval. The focus is on providing a collaborative program that works with providers instead of dictating to them.

The Consult platform provides:

  • Web-based workflow processing of Consult requests
  • Multiple service points to meet client and provider needs: web, fax, phone, IVR, and EDI
  • Less than 30 seconds average response time for incoming phone calls
  • Case processing within each state’s specific turnaround time guidelines
  • Web and IVR allow self-service procedure initiation and status checks

Under the non-denial model, if an ordered procedure doesn’t meet the established evidence-based criteria, rather than being outright denied, the request is elevated for a clinical review, where a nurse and then peer physician discuss with the ordering provider why a procedure was not initially approved and why an alternative procedure is recommended. Educational materials provide reasoning behind procedure selection for various circumstances, and the peer reviewers help physicians better understand which tests to order in a given situation. In so doing, the ordering behavior is changed and tests are approved the first time in the future.

If the ordering provider still disagrees with HealthHelp’s recommendation, HealthHelp will approve the physician’s initial procedure.

Survey results: Online Tools

Because no business model will be successful if its clients aren’t happy, HealthHelp emailed and faxed a survey to 36,952 ordering providers to determine actual provider satisfaction with our system. The survey received a 5.43 percent response rate.

Among the respondents, 73 percent had used HealthHelp’s services for one year or more, and 31.3 percent use HealthHelp every day; 43.7 percent use HealthHelp at least once a week.

The WebConsult program, which allows authorized users to submit and view the status of a procedure request using a secure Internet application, earned a 91 percent “Good” or “Excellent” rating from respondents. Seventy-seven percent of respondents rated WebConsult Online Support Program as “Good” or “Excellent,” while 14 percent have not had a reason to use the support program.

Respondents not only had high marks for HealthHelp, they also had kind words. Many of these busy physicians took the time to provide written feedback on their interactions with the online tools:

  • “This is a wonderful program. More companies need to implement such an easy system. Thank you for having such a good tool for providers to utilize.”
  • “HealthHelp is an extremely convenient service. It allows you to multi-task in a fast-paced healthcare environment.”
  • “HealthHelp makes my job easier because I can obtain the authorizations quicker, therefore making it better for the patient.”
  • “HealthHelp saves me a ton of time, and allows me to obtain authorization after normal business hours.”
  • “The online system support team is awesome! When I send email requests with questions or concerns, someone always gets back to me in a timely manner.”

Survey results: Overall Performance

More than 91 percent of respondents had a case go to the clinical review stage. Of those, 99 percent rated the Clinical Review Team’s service as satisfactory or better, with 39 percent calling it “excellent.”

Of the three-quarters of respondents who had requested a procedure via phone, 98 percent rated that service as satisfactory or better, with 42 percent calling it “excellent.” In their written comments, they also called it better than other call centers and benefits managers:

  • “Your agents are very helpful. Your hold time is minimal. I wish all call centers were like yours!”
  • “I deal with over 20 insurance plans, and HealthHelp is one of my favorites. Great job.”
  • “Obtaining a phone authorization is a smooth process and the call center agents are always awesome.”
  • “The UR nurses are very helpful. As far as I am concerned, they are the easiest to work with out of the insurance companies I have to call.”

Making Physicians More Efficient

The survey results indicate that the HealthHelp Consult program, with its non-denial model, is as good for providers as it is for payers and patients. It’s a system that gives physicians freedom, flexibility, education, and the ability to cut down on costs without sacrificing patient care. Overall, 49 percent of respondents called the program “excellent” and 42 percent called it “good.”

“I love how simple it is,” commented one respondent. “I do many authorizations on a regular basis, and this is so useful and fast that it allows me to get many authorizations done quickly. I am more efficient with the HealthHelp system.”

< Back to Case Studies

Contact Us
Questions? Contact us to find out how our programs can create savings for you.
Please note: If you are communicating as a health plan member, please contact your healthcare provider. HealthHelp does not provide individual healthcare advice.