How to Automate Care Management & Utilization Management with Configurable Workflows

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 of workflows and rules engines in the platform.

Below we dive into how HELIOS’ unique design lets clients configure streamlined workflows to automate everything from messaging, letters, care plan generation, tasks, and more.

Driving Provider and Payor Efficiency with HELIOS Automations

HELIOS offers a wide array of capabilities, including AI,  to drive provider and payor efficiency and an unparalleled level of automation. Some examples include:

  • Automated messaging
  • Automated case noting
  • Automated correspondence generation
  • Automated case assignment
  • Automated eligibility checks
  • Automated tasking and resolution
  • Automated referrals
  • Automated assessment field population
  • Automated care plan or care plan element population
  • Automated service plan population
  • Automated multi-source data ingestion
  • Automated approval
  • Automated risk scoring
  • And more [Click here to ask about our full PDF of HELIOS capabilities] 

This industry-leading level of automation is a key contributor to the tremendous ROI and efficiencies gained by organizations employing the HELIOS platform, including up to a 92% gain in care team productivity.

How HELIOS Improves & Automates Care Management

HELIOS is designed to intelligently automate and streamline care management processes, member prioritization, and even outreach and communications. HELIOS has the industry’s most configurable rules engines and most flexible platform design (90% configurable out-of-the-box). This allows clients to set up specific criteria and rules that will trigger a workflow to automate a specific activity.

Some of the things HELIOS’ rules engines and highly configurable workflows enable healthcare payors to do:

  1. Quickly and easily identify high-risk members such as those with chronic diseases or who are becoming at risk of similar conditions and need preventive intervention.
  2. Automate care plan elements and generate care plans populated based on things like assessment response and risk scores, as well as other ingested data.
  3. Automate the generation of clinical messages and documentation including letters.
  4. Auto-generate and assign tasks and members to specific users.
  5. Auto-generate notifications, flags, and suggested care plan adjustments.
  6. Automatically suggest or send assessments for members to complete, including the automatic generation of reminders.
  7. Automatically rank members to help individual care managers prioritize outreach and tasks effectively and target high-need members first.

We can keep going on, but these are just a sampling of the automations powered by HELIOS. You can learn more about and see HELIOS in action here if you want.

How HELIOS Improves & Automates Utilization Management

A unified product for utilization management, HELIOSum drives faster authorizations, streamlines and automates UM processes, offers automated prior authorization capabilities, by leveraging AI, and enables faster care delivery, more accurate decisions, letter creation, and cost savings.

HELIOSum’s clinically-integrated workflows are enhanced by AI capabilities to let users do incredible things like automate prior authorizations, which can lead to huge cost savings and faster care delivery.

See more below for some highlighted capabilities to streamline UM in HELIOS:

  • Use pre-built UM pathways, a configurable rules engine, and customizable workflows to streamline reviews, appeals, and grievances, and automate critical processes such as approvals, determinations, triaging high-priority authorizations, turnaround times, and more.
  • A fully configurable auto-approval engine helps identify both pre-authorization and retrospective auto-approvals.
  • HELIOS’ auto-approval rule engine is fully configurable with comprehensive criteria sets that can be tailored to granularly identify requests where no prior authorization (PA) is required for specific request types, LOBs, and other criteria.
  • Integrations enable automated prior authorizations and streamlined electronic prior authorizations from within HELIOSum.
  • Authorization requests can be automatically created through an integration with external provider portals, electronic fax systems, and other sources.
  • Automatically review all submitted authorizations from the HELIOS Provider Portal and auto-approve those that meet the established auto-approval criteria, with immediate updates and notifications available and visible in the Provider Portal.
  • Configurable workflows to track, manage, and resolve grievances.
  • Use various configuration settings to customize your appeals process for a more streamlined experience including settings specifically for appeals, including the ability to configure appeal categories, levels, and other relevant criteria

Again, we could keep going. Instead, set a time with our team here to see HELIOSum in action.


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