Sleep Program

$66 Billion
Annual US Direct and Indirect Costs for Sleep Disorders

Obstructive Sleep Apnea (OSA) | Non-OSA | Sleep Disorders

HealthHelp has identified a unique opportunity in the overall management of sleep disorders, resulting in the most appropriate care delivered to members with a comprehensive approach to cost savings and care management.

Program Overview

  • Collaborative care approach that helps physicians choose the most medically appropriate in-home or in-lab diagnostic sleep study guided by evidence-based criteria
  • 46% increase in In-Home Sleep Study Utilization trend
  • 25% Conversion to In-Home for Suspected OSA population
  • Elimination of unnecessary testing for detection of low-to-severe sleep apnea, improving diagnostic efficiency and treatment
  • Increased safety and quality of care for the patient while achieving sustained savings for the payer
  • Reduced double testing rate for patients who receive in-home testing first, followed by an in-lab
  • Compliance CPAP/BiPAP therapies
  • Ensuring that in-lab sleep tests are received in certified facilities assessed for safety and quality

Member Clinical Information*

 
  • 20 uniquely developed OSA assessment criteria
  • Member Suspected or Current Diagnosis
  • Clinical Indication
  • Test Ordered
  • Treatment Requested
  • Member Medications and Duration
  • Prior Treatments
  • Summary of Clinical Findings
  • Reason for Test
  • Member Symptoms

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.

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 After consultation with the requesting provider, the request will either be approved by the expert reviewer, or withdrawn/changed by the requesting provider.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*

  • In-Home Polysomonography
  • In-Lab Polysomonography
  • Sleep Site – safety & quality certified Sleep labs
  • C-PAP Compliance
 
*Lists not comprehensive