A case study in scaling Medicaid care management using Helios® by Elligint Health®.
Organization
Regional Care Coordination Org
Focus Areas
Medicaid Care Management
Coverage
1M+ Medicaid Members
Platform
Helios® CM
For community-based organizations supporting large, vulnerable Medicaid populations, a modernized care management platform is essential for efficient, timely, and accurate care delivery in scaling Medicaid care management using Helios® by Elligint Health.
A Leading Care Management Team Seeks a Modernized Platform
This organization — a pioneering community-based nonprofit that has spent over two decades serving underserved populations across its state — contracts with five commercial insurers and the state to serve a Medicaid population of more than 1 million lives. In 2017, it sought an integrated medical management solution to increase clinician efficiency and manage each member’s health across the full care continuum — combining Health and Wellness, Care Management, BehavioralHealth, and Disease Management into a single 360° view, with automated workflows to identify and assign interventions across the entire membership.
To serve its primary focus of improving outcomes for members with complex health needs, the organization leverages more than 800 care managers and an affiliated, physician-led network of 3,000 primary care providers across more than 900 practices. Together, these resources support roughly one in three Medicaid members statewide. Yet, the organization could not achieve the efficiency it wanted without upgrading its technology.
As its population grew, the organization’s homegrown case management system grew harder to use, with care managers spending significant time on manual processes, like entering one value into multiple forms, and maintenance costs continued to climb. To serve its growing Medicaid population more efficiently, the organization needed to automate routine, time-consuming tasks — freeing care managers to spend more time delivering care and less on administrative work. Knowing its members deserved accurate, responsive service, the organization chose Helios as its care management platform to modernize operations.
85%
Improvement in completed client care plans
The Helios Solution: Care Management With More Care and Less Management
The organization turned to Helios in 2017 after a brief, unsatisfactory experience with a competing platform. Care teams loved the intuitive interface — one supervisor noted it was intuitive enough that little training would be required — and cited its robust functionality and potential to increase care team efficiency.
Unlike its prior homegrown solution, Helios is delivered as a cloud-based SaaS platform maintained and updated through a regular release cycle. Its no-code configurability reduces the time and cost of system upkeep and enhancements, freeing internal resources from server and application maintenance, custom coding, security patching, and other technical demands. Helios automation also enables care teams to reclaim time spent on repetitive administrative tasks and redirect it toward member care.
Client Perspective
“Today, we are so much faster with a typical member interaction than we used to be. The automated assessments, workflows, and task assignments have removed so much of the manual effort we used to document with each interaction.”
– Top Case Manager
Regional Care Coordination Organization
Conclusion
An organization covering as high-needs a member base as this one requires top-tier technology to deliver optimal care. Helios gave it an adaptive, intuitive, and fully configurable platform — and since launch, care managers have seen an average efficiency increase of 85%.
“The platform is highly configurable, allowing us flexibility to adapt to a fluid situation,” said a top-level manager. Today, the vast majority of the state’s Medicaid population receives value-based, proactive care — powered by Helios®.
About Elligint Health
Helios by Elligint Health is the platform that accelerates smarter care for modern health plans. With configurable automation, embedded intelligence, and FHIR-native interoperability, Helios powers care management (CM) and utilization management (UM) for value-based care leaders and risk-bearing entities, helping payer and provider organizations transform operations, speed decision-making, and scale whole-person care without friction. Helios is NCQA Pre-validated for Population Health and HITRUST Certified, giving organizations added confidence in both compliance and care quality.