Government Health Plans

A System to Optimize Value-Based Care

Operational models for value-based care continue to evolve. Solutions must be flexible to adjust to changing program needs. The VirtualHealth solutions suite is the most advanced on the market and supports population health, care and case management, care coordination, and disease management for millions of members.

HELIOS helps clients maximize their quality care metrics, reduce unnecessary ER visits and avoidable hospitalizations, align with national quality strategy, and comply with government standards.

Medicaid
Support program compliance through a highly configurable system with extensive, specialized, state-specific guidelines. Engage a seamless process to interface with the state system, optimize workflows, and simplify regulatory reporting. Improve quality incentive ratings by proactively addressing care gaps.
Medicare
Utilize the system to improve Medicare Star ratings and HEDIS quality measures. Real-time information, transparency, and comprehensive regulatory reporting ensure compliance with CMS guidelines, improve outcomes, and lower costs.
Dual-Eligibles
Leverage the platform’s proficiency with Medicare and Medicaid to integrate physical health, behavioral health, and social needs for dual-eligible beneficiaries. Precision member management and bi-directional data exchange ensure services are authorized in a timely manner and integrated into the person-centered care plan. Streamlined coordination overcomes fragmentations and increases efficiency.