We’re in the age of big data, and one of the challenges healthcare payers have is to make sense of all the data they capture. From pulling actionable insights to identify and close care gaps to quickly providing the quality metrics and reports needed by state and federal regulatory bodies. For healthcare organizations, integrating data-driven...
Mental health and behavioral health support is a critical need for health plan members. This is especially true for payers handling commercial, individual, and Medicaid populations with members. As of 2024, the National Institutes of Health has found mental health conditions are common in 33.7% of adults aged 18 to 25 years, 28.1% of adults...
A good UX (user experience) is a key player in how quickly a care management platform is adopted and how successfully it’s utilized. Adoption and usage are key concerns for healthcare organizations when choosing a medical management platform. This is especially true for those with large teams of care managers or case managers who need...
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...
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....
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...
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...
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...
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...
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...
