Client Update: Alicare Medical Management to Support HealthHelp’s Alert™ Program Leading Medical Management Organizations Team Up to Promote Best-in-Class Services

Alicare Medical Management (AMM) has begun providing clinical staff support for Houston, TX-based HealthHelp’s Alert™ Program.

“HealthHelp is working with Alicare Medical Management to support our Alert program by providing clinical evaluation of criteria used to order radiological prodedures,” says Mark Hiatt, MD, MBA, MS, HealthHelp’s chief medical officer. “Alert allows health plans to monitor radiology-exam ordering patterns to ensure that evidence-based imaging is taking place, as well as giving providers support and feedback so the best clinical pathways are used.”

AMM President Claire Levitt says her team is “please to be collaborating with HealthHelp to provide clinical support as its Alert Program continues to expand. Combining AMM’s broad care management platform with HealthHelp’s superior specialty programs will provide improved clinical and financial results for HealthHelp’s clients,” she adds.

AMM is recognized as one of the nation’s premier care management organizations, offering a wide range of programs to promote optimal health outcomes and manage healthcare costs through patient advocacy, support, health information and education by medical professionals. AMM’s programs are supported by hundreds of clinicians nationwide and have earned four URAC accreditations for health utilization management, case management, health call center and independent review.

HealthHelp also is recognized as one of the nation’s leading organizations offering specialty medical management services. HealthHelp’s innovative programs enable healthcare payers of all types and sizes to achieve critical goals through effective benefit management for diagnostic imaging, radiation oncology, and diagnostic cardiology. Many of its programs qualify as “activities that improve healthcare quality” under the new federal medical-loss ratio (MLR) requirement, which took effect January 1, 2011, as part of the Patient Protection and Affordable Care Act (PPACA). HealthHelp also is recognized by URAC and NCQA.

“HealthHelp works with payers to establish customized criteria for recognizing physicians whose diagnostic imaging or radiation oncology orders don’t correlate with evidence-based guidelines,” Hiatt says. “When software alerts detect problematic patterns, plan administrators may choose to conduct chart reviews or take a closer look at ordering and outcomes,” he notes.

“We are excited to be assisting HealthHelp in this initiative,” says Julie O’Brien, AMM vice president and COO. “AMM has the clinical expertise and dynamic medical offerings to assist in the support/monitoring of these clinical programs. I was particularly impressed with HealthHelp’s specialty guidelines and its educational approach to working with providers.”

If you would like additional information relating to Alicare Medical Management, please contact Janice Blattenberger, RN, AMM’s director of business development, at (603) 328-6602 or jblattenberger@alicaremed.com. To learn more about HealthHelp, contact Elizabeth Ivey at (281) 447-7000, ext. 1870 or iveye@healthhelp.com.