Care Management

Our DNA is Different

HELIOS® was designed to make the transition to value-based care seamless through an end-to-end ecosystem for all workflows and processes related to care management. Its modular design allows it to function as a comprehensive system or to integrate and extend existing capabilities.

The value-based care solution improves health outcomes and empowers its clients to meet complex regulatory requirements. The care management platform enables proactive healthcare by promoting the right care at the right time for the right member. This prevents common, avoidable illness complications and leads to healthier members.

A Powerful Solution

HELIOS® helps to improve quality measures and increase quality scores for higher Star Ratings through precision workflow management. HELIOS® helps your team:

  • Meet quality incentive requirements for Medicaid and Medicare
  • Incorporate social determinants and community services as part of care management
  • Optimize care through extensive clinical content
  • Create better outcomes, healthier members, and lower costs
The Power of the Right Solution

Care Management Done the Right Way

A care manager may coordinate healthcare for up to 600 individual members. How do they ensure they are helping the right member, with the right service, at the right time?

With HELIOS®, analytic insights inform configurable, role-based workflows that give users the right care management tools to drive a team-based, member-centric approach to healthcare. Care managers are provided with the most up-to-date and critical information for timely interventions and to manage the health of their populations.

The HELIOS® Right Triangle

Right Member
Right Service
Right Time
Right Member

Robust case management capabilities create a tailored solution for members using comprehensive and automated data gathering, that considers physical, behavioral, and social determinants of health.

Risk stratification algorithms and powerful analytics identify high-risk and high-cost members. This allows care managers to assist the members who need it most.

Right Service

Real-time data drives workflows and triggers to prioritize resources through prescriptive care management to ensure that an intervention happens when an event has occurred.

Right Time

Automated workflows with custom rules and evidence-based clinical content enable care teams to identify the most optimal and timely next action.

Accurate data and actions at the care team’s fingertips improve efficiency and productivity.

Personalized Care Plans with Intelligent Data Flow

Personalized Care Plans with Intelligent Data Flow

Smart data flow auto-populates information from claims and assessments into the care plan to increase efficiency and reduce administrative efforts and human error.

Rather than spending time gathering relevant information from disparate systems, the care team can focus on specific member needs and tailored interventions.

Mind the Gap

The platform identifies gaps in care to increase adherence to quality measures.

VirtualHealth Care Management Automated Workflows
Automated workflows flag members with chronic conditions and create tasks for assessments and outreach.
VirtualHealth Care Management Configurable Reports
Configurable reports provide visibility to members who are at risk for gaps in care.
VirtualHealth Care Management Tailored Interventions
Tailored interventions focus on members to relieve specific care gaps.
VirtualHealth Care Management Tracking and trending adherence to quality measures
Tracking and trending adherence to quality measures improves metrics from year to year.
VirtualHealth Care Management interoperability across HER systems
Interoperability across EHR systems enables information exchange and supports quality incentive efforts.

Expand Your Focus with Whole Person Care

Non-clinical factors can determine up to 80%* of a member’s health.

Whether your team is heavily leveraging social services, or just starting to widen its focus, HELIOS® lets you easily partner with organizations that are dedicated to improving the health of your populations. Quickly integrate additional care team members through role-based access and provide full interoperability, whether internal or external to your organization.

Leverage third-party community services on HELIOS® to proactively address members’ social determinant concerns.

*Robert Wood Johnson Foundation
VirtualHealth Food
Access to Health Options
VirtualHealth Healthcare
Quality of Care
Cultural Competency
Economic Stability
Income Debt
VirtualHealth Education
Early Childhood Education
Social Support

A System of Action

The key to whole person care is a combination of actionable insights and resource access. Innovative care management platforms must provide all information relevant to a member’s clinical and social determinants of health and then empower care managers to effect change in real time. Using HELIOS®, care managers can identify the members who need help and then connect them to any of the community resources that they require from within the platform.

The Power of the Right Solution

Everyone engaged with a member’s care can work collaboratively using the seamless HELIOS® ecosystem. Vendors can access orders, exchange information with the care team, and provide service updates. Members can fully utilize the services available to them. Role-based configuration means that everyone’s access is limited to essential information.

Care management becomes more powerful when a care management platform delivers actionable information and access to the appropriate resources.

How it Works

Sandra Feels Unwell
Sandra Feels Unwell
Several weeks ago, Sandra suffered from severe abdominal pain.
A New Episode of Care
A New Episode of Care
Sandra called for an ambulance to go to the ER and was admitted for an emergency appendectomy.
360° Member View
360° Member View
Several days after her discharge, Sandra missed her follow-up appointment. HELIOS® automatically alerted Julia, Sandra’s care manager, that Sandra did not make it to her appointment.
Identifying Member Needs
Identifying Member Needs
Julia reached out to Sandra and learned that she missed her appointment because she has no access to transportation.
On-Demand Services
On-Demand Services
Julia scheduled Sandra a ride through HELIOS® and Sandra received an alert in the member portal for her ride to her re-scheduled appointment.
Proactive Care
Proactive Care
Two days later, Sandra went to her follow-up appointment. Her physician noticed a complication and prescribed her medication to treat it. If untreated, it could have landed her back in the ER.

Mobility Matters

Your members can easily coordinate all activities with their care team on one platform through a simple mobile application with offline capabilities. Track communication across every engagement channel for easy retrieval from the platform.

Vendor Access and Integration

The platform provides dedicated portals where vendor partners can access orders, exchange information with the care team, and provide service updates. Vendors are granted limited access to only essential member information.

Improving Outcomes in an Evolving Landscape

Complex, integrated care management requires a solution that is capable of handling the inevitable changes in healthcare. HELIOS® is built using an unparalleled framework, with the flexibility to evolve with the needs of our clients.