How to Establish a Connected Care Ecosystem: A Quick Guide for Healthcare Payors

The American Medical Association said it best: “In health care, teams that collaborate effectively can enhance the quality of care for individual patients. By being prudent stewards and delivering care efficiently, teams also have the potential to expand access to care for populations of patients.”

And while the value of a collaborative care approach (aka creating and using a connected care ecosystem) is immense (see the top 10 benefits here), how do you do this correctly?

How Payers Can Establish a Connected Care Ecosystem

Imagine that every patient is a book. Events, storylines, and unexpected plot twists all work together to form a cohesive narrative. Then imagine opening that book only to find pages missing and whole chapters torn out – but being asked to infer the backstory and predict what will happen next anyway.

Unfortunately, this is what often plays out during care episodes in many healthcare payor systems. A provider or specialist picks up the thread in the middle of a member’s story, without crucial context regarding their health history, current interventions, and treatment goals. Providers and specialists then waste time tracking down critical information that should already be there, and members are repeatedly asked to fill in the gaps in their health history. That’s a shaky foundation for sound clinical decision-making and a stressful experience for members.

A connected care ecosystem, where all care team members have reliable access to the complete story of an individual’s health – including new diagnoses, treatments, emergent events, scheduled procedures, ordered tests, and results – and can communicate and collaborate, sets the stage for a successful collaborative care model (and ecosystem).

3 Strategies for Delivering Connected, Collaborative Care

Getting to a connected care ecosystem requires recognizing the challenges health systems are likely to face and planning to address them with a technology-driven strategy. Below are the three critical strategy components to consider.

1. Centralize member data to enable transparent, team-based collaboration

Many individuals, systems, tools, and data sources make up the healthcare ecosystem:

  • Healthcare professionals gather and enter critical patient data in electronic health records (EHRs) or portals. They leverage digital technologies (e.g., remote patient monitoring, imaging systems, telemedicine apps) to track patients’ health and for communication purposes.
  • Care managers and other non-clinical providers (e.g., behavioral health professionals, and social workers) are sources of valuable information on lifestyles, habits, social needs, and environmental factors that influence physical health.
  • Utilization management teams rely on information to meet requirements for approving procedures and prescriptions.
  • Members are using digital tools such as health apps and wearable devices to track and monitor their health more. They’re communicating with healthcare professionals via a range of channels and modalities.

That’s a lot of people, devices, and data. Getting them functioning together cohesively is what a connected care ecosystem is all about. The key? Centralizing the data so stakeholders can work from one source of reliable information.

See how HELIOS operates as a centralized ecosystem for healthcare payers where data can be transformed, integrated, and leveraged all in one place >

2. Break down data silos to eliminate barriers to collaboration and communication.

Getting all that data to flow seamlessly across stakeholders is essential. Making it usable is even more so. However, disparate systems and technologies may not easily interface, or different systems or providers may require unique data formats. This can result in incomplete or delayed sharing of patient information, and it is why data transformation is becoming even more important. Breaking down these data silos means addressing underlying data interoperability issues.

The HL7® FHIR® standard helps promote interoperability by providing a common framework for seamless data exchange between healthcare systems and devices. FHIR® formats are leveraged because they’re often the easiest to use across devices and settings and more commonly known/used than others. And with new regulatory rules in place by CMS, many healthcare organizations are working harder to adopt FHIR® standards.

What to do about different data formats?

Existing data sets may not be in FHIR® compatible formats or aren’t usable within a payer’s system in their current format. Thankfully, VirtualHealth has delivered and supports more than a hundred interfaces, including the X12 and HL7 v.3 C-CDA and HL7 FHIR® standards, and has integrated with hundreds of systems, including specific systems such as SAP and Oracle. To make things even easier when it comes to data interoperability, HELIOShub now makes the formerly complex, time-consuming task of data integrations 65% faster.

  • HELIOShub product enable healthcare payers to connect and transform all their critical data into formats that meet the HL7® FHIR® standard, without either specialization or heavy lifting by IT teams.
  • Configurable data transformations, mapping, and transfer methods translate to faster delivery, rapid time to market, and reduced implementation and maintenance costs
  • Quickly and easily integrate siloed application data
  • Adopt FHIR® painlessly within existing or new data architectures
  • Uses a no-code integration builder, flexible data transfer methods, and robust APIs—all built on FHIR®
  • Seamlessly convert data into FHIR®-compatible formats and exchange it with other enterprise platforms

What is the right way to solve data challenges?

The right data interoperability solution will help health systems navigate these challenges by:

  1. Addressing the full spectrum of FHIR® data needs including data transformation, interoperability, storage, and management.
  2. Streamlining the data transformation process, freeing up IT resources.
  3. Offering scalability to accommodate updates and expansions.

View our quick HELIOShub info sheet to learn more about how organizations can reap the benefits of data interoperability faster, without draining IT resources >

3. Sync Utilization Management and Care Management

Traditionally, utilization management (UM) and care management have been separate functions. In the last year, it’s become apparent – aligning UM and CM offers incredible value in improving care experiences and accuracy, member health, and cost-savings.

Aligning utilization and care management activities is a key aspect of the connected care ecosystem. Sharing UM and CM data (such as medical history, recent health assessment results, authorizations, grievances, appeals, and more) is valuable to care managers, who can then use it to:

  • Design more personalized, effective member care plans,
  • Intervene with timely education regarding upcoming treatments or procedures, and
  • Ensure coordination among a member’s varying specialists

Working from a single source of truth platform also creates greater efficiency and accuracy on the UM side, helping fight the delays in approval that cause administrative headaches for providers and a negative experience for members. Greater transparency simplifies administrative tasks and ensures that all utilization reviews and documentation are based on real-time, accurate data. Moreover, with products like HELIOSum that offer automated prior authorization and concurrent reviews, with configurable UM workflows, it’s easy for healthcare payors to streamline UM processes and eliminate critical errors.

Watch how HELIOSum enables members to get the clinically indicated treatment they need when they need it >

Why Choose to HELIOS Support a Connected Care Ecosystem

The HELIOS platform is the only one purpose-built to support a connected care ecosystem for value-based care. HELIOS keeps teams working together around a single view of each member for stronger clinical decision-making, personalized care planning, and efficient use of resources.

HELIOS helps payers address the challenges discussed above with capabilities including:

  • Automated tasks and workflows that streamline the management of member care
  • 360-degree member views
  • 90% configurable out-of-the-box
  • Configurable workflows, rules engines, tasks, triggers, alerts, and more
  • Intelligent risk stratification and configurable templates with the ability to tie alerts to care gaps and emerging risks
  • Aligned views for utilization management and care management

Learn more about the incredible features HELIOS offers to power a connected care ecosystem that’s specific to the needs of your organization and member health populations.


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