For healthcare organizations and providers involved in a Medicare Shared Savings Program (MSSP), 2025 is truly a time of transition and a little uncertainty. When colleagues recently asked for my thoughts on MSSP this year, the old saying “May you live in interesting times” kept coming to mind.
Data-Driven Impact in Healthcare: A Success Story
At HealthEC, we know that healthcare isn’t just about data—it’s about lives. That’s why we approach our work with empathy and humility, understanding that behind every metric are real people. This approach, combined with robust data insights, leads to meaningful change.
FHIR’s Impact on Patient Outcomes & Engagement: HL7 and VirtualHealth Experts Chat
FHIR has gotten a lot of attention in recent months due to the push for FHIR-based APIs under the new CMS-0057-F ruling in January for prior authorization and interoperability. Specifically, this pushed for greater data transparency and sharing for providers, payers, and patients, with the singular goal of making healthcare more efficient, accurate, affordable, and collaborative. Recently, our Director of Solutions Architecture and resident FHIR expert Huthaifa Khan sat down with Daniel Bach, Community Manager at HL7. During their conversation, Khan and Bach looked at the critical impact of FHIR on patient outcomes and engagement. Below these two experts dive...
Future of Care Chat: Episode 12 – Key Measures of Successful Project Management
When it comes to the successful implementation and management of a medical management platform project, there are a lot of elements to consider. We recently sat down with Tracy Styles, Senior Director of Program Management, who walked us through the key considerations, best practices, and pitfalls to avoid. She’ll also share what makes VirtualHealth’s project approach unique. Check out Future of Care Chat – Episode 12: Key Measures of Successful Project Management below. + Watch Video Here Key Considerations of a Medical Management Platform Project Scope: Ensure all planned work is delivered, meeting defined objectives and requirements. Scope management...
Future of Care Chat: Episode 11 – What’s New with Analytics & Insights in HELIOS
As part of VirtualHealth’s continued innovation, our team has been hard at work to bring reporting, analytics, and insights to a whole new level. Get the inside scoop directly from Kelechi Erondu, Director of Analytics, as he walks through some of the new features and functions we have related to analytics and insights in the HELIOS platform, and gives an introduction to our Analytics as a Service program, and HELIOSinsights. Get more information about reporting in HELIOS > Get more information about Analytics as a Service >
Future of Care Chat: Episode 10 – FHIR & Prior Auth APIs
Why Payers Need to Start Solving for Prior Auth and FHIR Now Prior authorization APIs and FHIR® are a big deal right now. The recent CMS ruling in January has got a lot of payers thinking, “How do I get this accomplished?” and “Does my current UM platform support this?” With the new requirements for prior authorization and FHIR standards coming over the next two years, we wanted to get a quick update on the lay of the land from a couple of experts. Watch below for a special Future of Care Chat episode with Huthaifa Khan, Director of Solutions...
What Reporting is Available in HELIOS?
Health Management Reporting: Looking at HELIOS Reporting Options HELIOS offers a variety of reporting and analytics modalities. From dashboards and views to exportable Excel files and graphic charts, healthcare payers can leverage native reporting functionality and work with VirtualHealth to create custom reports, dashboards, and views as well. This helps organizations using HELIOS to get the data and insights they need for quality and regulatory needs, process and operational optimizations, care improvements, and to analyze productivity, efficiency, and performance. Below we look at what reporting options are available natively in HELIOS. Standard Reporting in the HELIOS Platform HELIOS makes...
Using AI and UM Workflows to Automate Prior Authorization, Determinations & More
Prior authorization can cause serious issues for members and providers if processes are not properly architected by a healthcare payor. More than nine in 10 physicians (94%) reported care delays while waiting for health care insurers to authorize necessary care, a physician survey by the American Medical Association found. Eighty percent said prior authorization can lead to treatment abandonment, and 33% reported prior authorization issues have led to serious adverse events including hospitalization, disability, or even death. These pain points are felt by healthcare payors too. Inefficient or inaccurate prior authorization can lead to costly mistakes, tense provider relationships that...
Q&A: The State of Care Management and Value-Based Care
A recent survey from Becker’s Healthcare and VirtualHealth revealed what healthcare payers really think about the current state of value-based care and care management. The results show key obstacles still exist.
Clearinghouse Services for Michigan and Minnesota
For more than 14 years, HealthEC has been providing fast, easy-to-use, and dependable electronic claims submission services for health organizations both large and small.