HealthHelp, WNS’s clinical solution, is expanding our existing utilization management solution to include additional Business Process Management (BPM) models designed to support health plans where they need resources in their utilization management (UM) as well as their care management (CM), and disease management (DM) programs.
With over two decades of clinical program and BPM expertise, the ideal place for product expansion was additional integration of BPM models within health plans existing clinical workflow processes. . Adding flexible models enables plans to enhance and scale operations without replacing existing tech and people.
“Our expanded BPM solution allows health plans to leverage our expertise in a way that supports what they have already established,” said George Gjermano, Senior VP of Product at WNS/HealthHelp. “We saw the need to provide this additional flexibility for our clients that desire to grow and adapt their clinical programs within their existing culture.”
Our expanded services are uniquely designed to meet health plans where they are in their growth journey. We also continue to offer our fully delegated and shared utilization management programs. In total, WNS/HealthHelp clinical solutions can now be categorized as follows:
- Our Clinical Experts, Our Platform – Our intelligent UM platform and clinical team offer fully delegated UM programs to payers like genetic testing, cardiology, musculoskeletal, oncology, and radiology.
- Shared Payer and HealthHelp / WNS Clinical Experts, Shared Platform – Our intelligent UM platform can be integrated into payer workflows. Our clinical team as well as payer clinical teams share the same process environment and collaborate on UM programs.
- Our Clinical Experts, Your Platform – payers who prefer to keep their current clinical platforms and processes, can access our skilled clinical and non-clinical experts to supplement their existing teams or processes around UM, CM and DM. This includes resources to support intake, clinical review, provider and member services, care management, and disease management.
About WNS
As a Business Transformation and Services partner, WNS works with marquee brands across industries, solving operational challenges and driving strategic growth journeys.
Our collaborative patient care solutions – led by industry, analytics and digital – enable healthcare companies to navigate a changing, regulated and cost-intensive landscape. Our Healthcare BPM services in the payer, provider and life science segments encompass claims, revenue cycle management, healthcare analytics and more. Our evidence-based clinical decision support system lets us evaluate the latest advancements to drive quality care at low costs.
About HealthHelp
HealthHelp, a division of WNS, is a trusted healthcare advisor for clinical solutions. We offer a unified suite of solutions to simplify medical complexity and workforce challenges while enhancing provider relations, member journeys, and digital strategies.
We co-create with payers to optimize savings and health care experiences. For over 20 years, the organization has provided proven results including 98% provider satisfaction rate and an average 30% reduction in unnecessary procedures. The company is accredited by URAC, NCQA, HITRUST, and QIO. HealthHelp’s clinical BPM expanded solutions are designed to meet the evolving needs of health plans, driving operational efficiency and improving outcomes across the board.