How Can Payers Achieve Cost-Savings Goals Faster?

CMS’ new care delivery model, Making Care Primary (MCP) focuses on a coordinated, collaborative approach at the primary care level, and the critical role it plays in an organization’s ability to deliver value-based care and improve health outcomes.

As noted in our first blog about the new MCP model, participation is voluntary, and the program will roll out in 2024 with eight states to start. However, the MCP model emphasizes CMS’ efforts to push payers towards value-based care and have payments tied to population health outcomes rather than quantity of services (e.g., an official move away from the Fee-for-Service (FFS) model).

It’s no surprise that part of enabling this shift is using technology that helps untangle data and establish seamless care coordination. Read on to better understand what care management tools can be used by MCP model participants (and non-participants) to help reduce costs and drive improved care efficiency and health outcomes.

Care Coordination Can Help Payers Reduce Costs and Improve Health Outcomes

Whether or not you plan to participate in MCP, a key component to value-based care is a connected care ecosystem where data is shared across care leads and every contact across the continuum has the same real-time view of a member. Here are four medical management platform components that will help drive value-based care forward:

  1. Data interoperability application
  2. Chronic condition workflows, assessments, and risk triggers
  3. Resources and tools for SDOH and behavioral health
  4. Integrated communication tools and user-friendly views

Healthcare Data Silos, Eliminated

When it comes to barriers to value-based care, siloed data is perhaps the biggest (and most expensive) culprit. When data is stored in multiple formats and systems – and not updated reliably – care team members spend too much time finding (or failing to find) the information they need for accurate treatment decisions.

That’s why HELIOShub, the first FHIR® Integration Platform as a Service (FiPaaS) was created. HELIOS integrates data from multiple sources, ensuring that care team members have access to a single view of all the critical data related to a member’s health: new diagnoses, hospitalizations, emergency department visits, medication changes, provider notes, treatment goals, and more. And now with HELIOShub, payers can quickly and easily transform all this data into FHIR®-compatible formats for organization-wide sharing and understanding.

Moreover, because HELIOShub can reduce integration timelines for FHIR® data by 65% or more, not only can payers achieve data interoperability faster, but they’ll also be able to empower care leads across the continuum to make faster decisions and speed up care delivery to members.

Improved Management of Chronic Conditions

Better management of chronic conditions is key to improving outcomes – and to decreasing overutilization that drives up costs (and stress for members). And it starts with greater visibility into members’ health and a proactive, preventive approach.

Several HELIOS capabilities that help improve chronic care management:

  • Out-of-the-box care workflows and assessments for chronic diseases
  • Automated risk triggers and task assignment
  • Configurable rules engine so care teams can uniquely adjust workflows, triggers, and tasks to match specific population disease and condition needs
  • In-platform referrals, generation of assessments, and task assignment and reminders
  • Built-in education resources that can be tailored to conditions, literacy levels, and learning preferences to help members be more proactive about their disease/condition

Ask us about what out-of-the-box assessments and workflows we offer here >

Integrated Tools to Address Behavioral Health

One of the biggest goals of the MCP model is to prioritize whole-person care. This includes better meeting behavioral health and social determinants of health (SDOH) needs.

To help with this, HELIOS’ behavioral health module includes powerful tools for assessing and addressing behavioral health ranging from counseling to addiction treatment to mental health issues. And unlike other care management solutions, VirtualHealth offers behavioral health as a core capability within HELIOS and HELIOSgo.

  • Configurable behavioral health workflows: Capture behavioral health needs and automatically identify behavioral issues, create referrals, assign specialists or enroll in specialized programs, generate tasks and assessment recommendations, and populate care plans
  • A dedicated suite of behavioral health tools: Libraries of behavioral and SUD (substance use disorder) focused assessments and screeners, behavioral-focused care plans, point-of-care assessments and trackers, and behavioral-health partner integrations
  • Predictive analytics and population health insights: Effectively manage both individual cases and population trends within a single ecosystem
  • Real-time referral generation: Based on automated identification of behavioral health risk factors and diagnoses from multiple data feeds
  • High-risk case identification: Automated workflows identify high-risk cases and situations, ensuring timely outreach and interventions, and in-platform assessments and screenings can further help identify members in need of services

Easy Navigation Helps Care Team Members Get Time Back

Finally, one of the biggest results of HELIOS is the time care team members gain back. HELIOS has a unique design that’s easy to navigate, with only one to a few clicks from every view to get to the tools or data users need. It sounds simple, but that flexible and connected design translates to greater care team productivity and efficiency rates.

It also helps care teams spend more time building rapport and trust with patients, educating them on prevention and management, and other initiatives that lead to better health outcomes.


How Quickly Can HELIOS Help You Improve Population Health?

Healthcare technology is an investment. And, as with any technology investment, achieving ROI depends on implementation timing, user buy-in, and scalability for future needs.

HELIOS was designed with all these in mind, offering one of the fastest implementation times in the industry.

  • Configurable to your population. The platform is 90% configurable out of the box, with little or no IT involvement required. This unparalleled flexibility allows organizations to custom-tailer HELIOS to their specific population needs, ensuring the care team has what they need for their population(s).
  • Easy adoption and user experience. The HELIOS user experience is designed for fewer clicks, fewer screens to jump through, and intuitive navigation. We hear from our clients that users typically don’t need the full allotment of training to become fluent in the platform. We also built HELIOS to offer in-platform help and support so that users can get reminders of where things are/how they work.
  • Scalability over time. HELIOS is a web-based solution, so it scales easily to growing populations and user bases without sacrificing performance. Moreover, because HELIOS is updated frequently, HELIOS clients always get access to the latest version of HELIOS tools and features, ensuring no surprise upgrade costs along the way.


Want to get to value-based care faster? Schedule a call with a VirtualHealth team member today and find out how HELIOS can help you crush barriers.

*HL7, FHIR and the FHIR ® are the registered trademarks of Health Level Seven International and their use does not constitute endorsement by HL7.

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