Improving Patient Care

Even the most motivated injured worker’s recovery can be hindered by obstacles and unexpected developments.

Healthesystems’ robust pharmacy and ancillary programs provide the opportunity to comprehensively manage a patient’s care from the time of injury and throughout the lifecycle of the claim. We understand that delivering the right care at the right time can have a profound impact on the clinical and cost outcomes of a claim – and that these care needs change over the course of an injury. Our goal is not to stand in the way of care, but rather to guide a claim along its most successful path, deploying strategic interventions to keep it on course.

Partnering with Payers

Our clients understand that traditional solutions will not produce exceptional results in an evolving healthcare landscape.

Our programs go beyond traditional medical cost management strategies to meet the unique needs of our customers and their patient populations, identifying new trends and opportunities to stay ahead of industry challenges. We offer customizable, scalable solutions that maximize cost savings opportunities and achieve more effective, more efficient, and more affordable outcomes for our customers and the patients we collectively serve.

Supporting Claims Professionals

Claims professionals are on the front line, where quick thinking and decisive action are critical.

When the course is unclear, the right tools can guide claims back on track. Healthesystems is there to provide our users with the information they need to make informed, time-sensitive decisions about patient care.

• With real-time alerts, easy-to-access claims information and embedded clinical guidance, our Verticē claims portal helps claims professionals make important decisions at critical points in care
• Our clinicians are just a phone call or email away for medication-related questions at our Ask a Pharmacist drug information line
• Our 24/7/365 Customer Service Center answers 98% of calls in 30 seconds with a real person

Connecting with Pharmacists

Communication is essential to patient safety, and pharmacists require up-to-date information to feel confident they are dispensing appropriate medications.

Healthesystems exchanges pharmacy information in real-time to manage transactions prospectively at the point of sale, preventing the wrong medications from making it into the hands of patients, and our 24/7/365 Customer Service Center offers proactive assistance whenever pharmacists face difficulty processing a transaction.

Fostering Service Excellence

In the delivery of ancillary products and services, payers require transparency to ensure that patients are receiving appropriate care quickly and effectively, and at an appropriate price.

Healthesystems chooses vendor partners who are aligned with our goal to deliver quality and cost effective ancillary medical products and services. Vendors can only enter the Healthesystems network after displaying in-depth clinical expertise, significant network coverage, and strong data capture abilities, all of which we use to regularly evaluate performance metrics to add value and flexibility in our clients’ choice of ancillary providers.

Engaging with Physicians

Clinical expertise is the bedrock of care, and injured workers are a unique patient population with specialized needs and considerations.

But with workers’ compensation patients representing a small portion of the healthcare population, many physicians are not well-versed in treatment guidelines for conditions common within this unique population.

Our physician outreach programs are developed by our clinical staff, who are experts in occupational medicine and pharmacotherapy as it relates to the treatment of injury. Targeted communications alert prescribers when there is an opportunity to modify prescribing behaviors that contribute to suboptimal claims outcomes and excessive costs.

Our goal is to support physicians with the information they need to make prescribing decisions that align with evidence-based recommendations for the workers’ compensation population.