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.
How Can Healthcare Plans Empower Members to be Active Participants in Their Health?
When people have the knowledge, skills, and confidence to engage in their own health, better outcomes are much more achievable. According to the Centers for Disease Control and Prevention (CDC), this conclusion was based on a research review that linked better health outcomes to higher levels of activation (having the knowledge, skills, and confidence to be engaged in their health) and health literacy. Active participation and engagement are also tied to higher satisfaction. Payers can use these insights to further health outcome goals by taking steps to improve member participation in a few key areas: Position care managers to better...
5 Strategies to Re-Engage Members in a Post-Covid World
The worst of COVID-19 may be retreating into the rearview, but the pandemic’s effect on general population health lingers. Whether it was limited access to care, fear of exposure, or tangential factors like lack of childcare, people of all ages and socioeconomic backgrounds put preventive care on pause. That has led to: Delays in care Missed cancer screenings and colonoscopies (the American Cancer Society reported significant drops in cervical, breast, and colorectal cancer screenings in 2020) Missed well visits Missed behavioral health therapy As recently as 2022, a survey by the Prevent Cancer Foundation found that 50 percent of Americans...
How Can You Engage Generation Z in Healthcare?
This is the final post in a five-part series highlighting top insights from our white paper, Personalized Value-Based Care: Effective Multi-Generational Care Management Strategies. It’s true that meeting the health needs of individuals across generations is partly about age-related clinical factors. But there’s much more to consider. Addressing generation-specific attitudes, concerns, and preferences regarding healthcare, as well as individual non-clinical factors that impact health, is integral to member engagement and better outcomes. Here, we explore how organizations can improve the delivery of personalized, value-based care at scale for Generation Z health populations. What Makes Generation Z Unique When It Comes...