Partnership through the pandemic

Helion's cross continuum collaboration and facilitation resulted in a move toward more nimbleness for a health plan and its home health network as they worked to address the impact of COVID-19.
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THE CHALLENGE

COVID-19 has added strain and uncertainty to an already complex healthcare landscape, especially among providers serving higher-risk patients. Of particular concern is the ability to deliver care to older adults, who are one of the most vulnerable populations and who have been disproportionately impacted by COVID-19.

HOW OUR SOLUTIONS MADE A DIFFERENCE

Community-based care that allows patients to be cared for at home or in the least-intensive clinical setting possible is the preferred setting for members and their families—especially during this unprecedented crisis. Knowing that, Helion believed that additional flexibilities needed to be enacted across the home health network of one of its health plan customers to be best prepared for delivering care during the epidemic. Leveraging the relationships built through our Care Intelligence and Performance Intelligence solutions, Helion was able to work closely with provider and health plan partners to remove roadblocks, rapidly adjust policies, and create care delivery strategies that supported high-quality care delivery while limiting the exposure of highest risk members and their providers.

Helion collaborated with our health plan partner to quickly activate changes, which included:
  • Establishing virtual visits as a service option.
    We added virtual visits and payment for these services to fee schedules because we know that the safety of staff and members can be significantly increased by using video and teleconferencing where clinically appropriate.
  • Enabling telehealth monitoring capabilities.
    We encouraged the use of remote monitoring for services, so the more vulnerable members can remain safely in their home.
  • Revising policy to reduce additional barriers for covid-19+ members.
    We made temporary but sweeping policy changes to ensure that care can be provided as expediently as possible to this populations. The changes include requirements for in-home oxygen and accessories, nebulizers, COVID-19 testing, and CPAP/BiPAP and accessories, among other things.
  • Streamlining authorizations.
    We made temporary policy changes to remove any potential barriers to authorizations so that care in the home can be received as expediently as possible. The changes include requirements for authorization requests, continued stays, and proactively reviewing cases as needed.

Results

Helion's work with provider and health plan partners to remove roadblocks and support optimal care delivery laid the groundwork for a rapid and agile response to the COVID-19 crisis. In less than two weeks, Helion had 17 providers who performed over 41% of total visits shift from face-to-face visits to tele-visits and remote monitoring with intermittent patient contact. And Helion’s network performance managers continue to work with participating providers to enable increased utilization of telemedicine capabilities.

This approach enabled the health plan to create a more capable and nimble network, enact changes to help mitigate risks, continue quality patient care, and build resiliency during this pandemic. It also enabled them to respond more proactively to future challenges and opportunities.