Use industry-leading rules engines and intelligent workflows for efficiency gains Did you know that HELIOS already has built-in functionality that helps clients automate and streamline care management, utilization management, and case and disease management? This includes everything from automations for assigning tasks to the right staff member and triaging members to letters, risk flagging, and more. It’s why HELIOS can result in up to 93% increased efficiency for care management teams. Our tools to help automate care management and utilization management are available with HELIOS’ out-of-the-box platform. How is this possible? It’s thanks to the unmatched configurability (90%) and flexibility...
Why a Lack of Interoperability is Problematic in Healthcare
Interoperability is currently a big challenge for healthcare organizations using care management and population health technologies. To put it simply, these technologies lack interoperability (or sufficient interoperability). And it’s hurting member care and engagement. Interoperability is also lacking in utilization management solutions, which contributes to delays in authorizations and getting members the care they need. Moreover, many of today’s data interoperability solutions are just not interoperable enough. They’re not able to support seamless communications between healthcare payors and providers, and they’re not able to quickly exchange bi-directional feeds. Why Does Interoperability Matter for Care and Utilization Management? Interoperability means two...
VirtualHealth & AI: Harnessing AI in HELIOS to Accelerate CM and UM Value
Artificial intelligence (AI) is a trending thing in healthcare, and it’s why HELIOS already has built-in integrations powered by AI that clients can leverage. AI is threaded throughout the HELIOS platform in a variety of ways. Specifically for this blog, we’ll focus on how AI is leveraged to power predictive analytics for population health and help automate decisioning and authorizations. VirtualHealth is actively integrating Artificial Intelligence (AI) technologies into its HELIOS platform intending to accelerate outcomes its customers care most about, which are to enhance efficiencies, improve patient outcomes, and streamline operations. By leveraging machine learning models, secured LLMs (Large...
What to Know About CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F): Quick Facts & Next Steps
For healthcare organizations, CMS-0057-F outlines the modern healthcare system and offers opportunities to improve care and utilization management In the last couple of years, the Centers for Medicare & Medicaid Services (CMS) have been making strides to increase health data exchange, as well as improve and expand access to care. On January 17, CMS finalized its interoperability and prior authorization rule. The rule applies to Medicare Advantage (MA) organizations, Medicaid and the Children’s Health Insurance Program (CHIP) fee-for-service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and issuers of Qualified Health Plans (QHPs) offered on the Federally-Facilitated Exchanges...
How to Achieve Healthcare Data Interoperability Without Overtaxing IT Teams
For healthcare payors and organizations, the HL7® FHIR® (Fast Healthcare Interoperability Resources 1) standard is crucial to data interoperability efforts. This standard is designed to improve data interoperability by providing a standardized way to exchange and integrate health information from multiple sources stored in disparate systems. And as healthcare payors look for ways to enable or improve collaboration across different care teams and settings, interoperable data will be paramount. The key to accurate and expedient value-based care, data interoperability can make or break a payor’s ability to properly serve its population. Burdens on IT Team Make Data Interoperability a Challenge...
Understanding Whole-Person Care: What It Is, How to Deliver It
In the last few years, many payors have worked hard to implement a whole-person care approach or whole-person integrated care model. But what does that even mean? What is the definition of whole-person care? How is whole-person care delivered today? And what are the challenges in whole-person care today? Below we dive into all three for a quick understanding of modern-day whole-person care. What is Whole-Person Care? Whole-person care is a framework for care delivery. It involves an approach where healthcare payors and practitioners consider the well-being of a person collectively. This means a care model that focuses on optimal...
How Rule-Driven Assessments Help Streamline Care Management
Assessments are a critical component of care and case management programs. Assessments help care and case managers quickly identify the health and social needs of members, flag at-risk individuals, and help teams prioritize and effectively handle their caseloads When assessment response data is incorporated into member views and care management workflows, this can help automate the generation of the next best actions (task assignment, outreach, etc.). Below we quickly look at how assessments, that incorporate rules, can help streamline care management, reduce administrative burden, and prevent costly events such as hospital readmissions. Using Rule-Driven Assessment in Care and Case Management...
Future of Care Chat – Episode 8: Talking Configuration Management in HELIOS
HELIOS is the most configurable platform for healthcare payors with 90% configurability right out of the box. You may have heard us say this before, but if not, “HELIOS is the most configurable and flexible solution for healthcare management.” But what does that even mean? HELIOS comes 90% configurable out-of-the-box, and that means clients on HELIOS can tweak it to meet their specific program needs. This makes it easier to drive efficiencies and productivity gains for care management, disease management, population health, utilization management, and more. In HELIOS clients can configure many things including workflows, assessments, task assignment, rules, access...
6 Healthcare Trends to Watch in 2024 and How They’ll Impact Care Management
As a new year approaches, the U.S. healthcare industry faces converging factors that signal some significant upcoming changes. An estimated 60% of adults have at least one chronic disease, and 40% suffer from two or more, straining healthcare resources. In 2023, life expectancy declined to 76.4 years, due in part to social inequities and to a healthcare system that has long prioritized cure over prevention. Many providers are still generally operating under a fee-for-service model where compensation is based on service volume instead of the value and quality of the provided care Evolutions in technology for healthcare services have increased...
Interoperability in Value-Based Care: Leveraging FHIR-compatible Data for Seamless Care Coordination and Improved Population Health
New FHIR® data interoperability application helps payers quickly transform and manage critical data for organization-wide sharing, visibility, and care team us Data interoperability is a hot agenda item for many healthcare organizations. 1. Stakeholders across the board – providers, payers, patients, and regulatory bodies – are recognizing the need for a frictionless data ecosystem that allows quick, accurate exchange of patient information at the point of care. Improving care coordination and outcomes and reducing overutilization depends on it. 2. Data silos are becoming even more problematic. Currently, critical patient data is often stored in multiple systems and formats, each with...