VH Insights

VirtualHealth HELIOS Care Management Workflows
April 30, 2019
Written by: Rebecca Vos

Unlock the Potential for Smarter Workflows

Workflow is an important foundation for any organization, but it is critical in the healthcare industry. Complexity in healthcare workflows can stem from the structure of healthcare organizations, the populations they serve, and government regulations. Each of these complexities can be further complicated with inadequate technology. For instance, regulations between Medicare, Medicaid, and Commercial plans can vary significantly and require the flexibility that most population management systems are unable to provide. This leads to the utilization of multiple systems and disjointed processes with cumbersome workarounds for the end-users who support membership. Given that health plans typically have more than one membership type, it can be complicated to decide how best to serve every population. HELIOS was designed to overcome the obstacles of workflows and create the most efficient team possible.

The process begins by putting the most critical information at the fingertips of the users. From the moment they view their homepage, they see a snapshot of their workload and the most important tasks. Automated workflows triggered by system actions ensure care managers are providing the right care to the right member at the right time. Further, HELIOS provides seamless communication tools to open channels between interdepartmental care teams, the member, and caregivers. The ability to streamline communication and increase member engagement can be what sets a health plan apart from their competition. If the care team staff feel they are constantly lost in an archaic system, they have a harder time focusing on what matters most: providing superior care to the members. The business rule engines in HELIOS allow health plan clients the ability to tailor even the most difficult and highly regulated workflow to their needs, easing the burden on staff. HELIOS ensures the team remains in compliance through evidence-based, customizable rules stemming from industry best practices.

One of the most complex populations for health plans to manage is members within Long Term Services & Support (LTSS) programs. This population typically has high needs and requires special attention from all parties involved in their care. Care managers can have a profound impact on an LTSS member’s care and outcomes. In an environment where specialized assessments, person-centered care plans, and tight regulatory timeframes are required, a simplified and intuitive process is necessary. The key to increasing member satisfaction and clinical outcomes, as well as preventing any unnecessary fines, is to ensure that a program has met all components of the regulatory requirements at the right time intervals.

Data in a population management system only helps an organization if it is easily accessible and can be harnessed to power the workforce. As a member of a multidisciplinary team, how does a care manager know where his or her role starts or stops? For a member, there is nothing worse than getting multiple calls from different individuals at the same organization who are asking the same questions. When this happens, it can cause severe member antagonism, ultimately impacting the ability to influence the members' care. HELIOS allows for clear delineation of responsibility across all members of the care team and gives them the ability to see the entire breadth of work a member requires. With this knowledge, staff can make the most of their and the member’s time, which maximizes the care team’s productivity.

HELIOS is an innovative solution enabling teams to drive better outcomes using an industry-leading task generation tool. Health plan clients have the power to determine the criteria, from simple to multi-layered, and what system actions should trigger automated tasks to be generated within any step of the workflow. The platform can also automatically mark tasks as “completed” once certain criteria are met, allowing care teams to manage and stay within time-sensitive regulatory requirements.

Future-looking health plans seeking to grow and maximize efficiency are implementing proper workflows to support their care teams. These workflows cannot function properly unless there is a solution in place that’s highly interoperable and enables automated tasking, streamlined communication, proper care team roles and profiles, among other key features. HELIOS is helping to bring healthcare into the future with a system that doesn’t live in the past. Be in control with HELIOS and harness your future.